|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$387.02 |
| Rate for Payer: Aetna Commercial |
$280.33
|
| Rate for Payer: Aetna Medicare |
$217.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.33
|
| Rate for Payer: BCBS Complete |
$163.60
|
| Rate for Payer: BCBS MAPPO |
$209.20
|
| Rate for Payer: BCN Medicare Advantage |
$209.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cofinity Commercial |
$301.25
|
| Rate for Payer: Cofinity Commercial |
$280.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.20
|
| Rate for Payer: Healthscope Commercial |
$387.02
|
| Rate for Payer: Healthscope Commercial |
$334.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.85
|
| Rate for Payer: Nomi Health Commercial |
$251.04
|
| Rate for Payer: PACE SWMI |
$209.20
|
| Rate for Payer: PHP Medicare Advantage |
$209.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.85
|
| Rate for Payer: Priority Health Medicare |
$209.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.20
|
| Rate for Payer: UHC Medicare Advantage |
$209.20
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$287.77 |
| Max. Negotiated Rate |
$661.05 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$299.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.61
|
| Rate for Payer: BCBS Complete |
$406.80
|
| Rate for Payer: BCBS MAPPO |
$287.77
|
| Rate for Payer: BCN Medicare Advantage |
$287.77
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$414.39
|
| Rate for Payer: Cofinity Commercial |
$385.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.77
|
| Rate for Payer: Healthscope Commercial |
$460.43
|
| Rate for Payer: Healthscope Commercial |
$532.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$345.32
|
| Rate for Payer: PACE SWMI |
$287.77
|
| Rate for Payer: PHP Medicare Advantage |
$287.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.05
|
| Rate for Payer: Priority Health Medicare |
$287.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.77
|
| Rate for Payer: UHC Medicare Advantage |
$287.77
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.66
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Healthscope Commercial |
$255.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.25
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.61
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Healthscope Commercial |
$255.12
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.25
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$280.35 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.25
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$311.50
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health SBD |
$280.35
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$311.50
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$280.35
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$188.62 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.61
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Healthscope Commercial |
$301.79
|
| Rate for Payer: Healthscope Commercial |
$348.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.00
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$188.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$352.80
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$188.62 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.75
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Healthscope Commercial |
$301.79
|
| Rate for Payer: Healthscope Commercial |
$348.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.00
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$188.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$538.90
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$443.80
|
| Rate for Payer: Cofinity Commercial |
$545.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$443.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$570.60
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$538.90
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$399.42
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.42 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Aetna Commercial |
$538.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.10
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$443.80
|
| Rate for Payer: Cofinity Commercial |
$545.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$443.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Healthscope Commercial |
$570.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: PHP Commercial |
$538.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health SBD |
$399.42
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.93
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$376.81
|
| Rate for Payer: Healthscope Commercial |
$325.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.10
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$203.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.30
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$325.89
|
| Rate for Payer: Healthscope Commercial |
$376.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.10
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$203.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$209.77 |
| Max. Negotiated Rate |
$517.40 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.09
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| Rate for Payer: BCN Medicare Advantage |
$209.77
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$302.07
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.77
|
| Rate for Payer: Healthscope Commercial |
$335.63
|
| Rate for Payer: Healthscope Commercial |
$388.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.40
|
| Rate for Payer: Nomi Health Commercial |
$251.72
|
| Rate for Payer: PACE SWMI |
$209.77
|
| Rate for Payer: PHP Medicare Advantage |
$209.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health Medicare |
$209.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.77
|
| Rate for Payer: UHC Medicare Advantage |
$209.77
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$209.77 |
| Max. Negotiated Rate |
$517.40 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.07
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| Rate for Payer: BCN Medicare Advantage |
$209.77
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$302.07
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.77
|
| Rate for Payer: Healthscope Commercial |
$335.63
|
| Rate for Payer: Healthscope Commercial |
$388.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.40
|
| Rate for Payer: Nomi Health Commercial |
$251.72
|
| Rate for Payer: PACE SWMI |
$209.77
|
| Rate for Payer: PHP Medicare Advantage |
$209.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health Medicare |
$209.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.77
|
| Rate for Payer: UHC Medicare Advantage |
$209.77
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$676.60
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$557.20
|
| Rate for Payer: Cofinity Commercial |
$684.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$716.40
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$676.60
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$501.48
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$501.48 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna Commercial |
$676.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.40
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$557.20
|
| Rate for Payer: Cofinity Commercial |
$684.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Healthscope Commercial |
$716.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: PHP Commercial |
$676.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health SBD |
$501.48
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$251.20 |
| Max. Negotiated Rate |
$478.98 |
| Rate for Payer: Aetna Commercial |
$346.94
|
| Rate for Payer: Aetna Medicare |
$269.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.94
|
| Rate for Payer: BCBS Complete |
$251.20
|
| Rate for Payer: BCBS MAPPO |
$258.91
|
| Rate for Payer: BCN Medicare Advantage |
$258.91
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cofinity Commercial |
$372.83
|
| Rate for Payer: Cofinity Commercial |
$346.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.91
|
| Rate for Payer: Healthscope Commercial |
$478.98
|
| Rate for Payer: Healthscope Commercial |
$414.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.20
|
| Rate for Payer: Nomi Health Commercial |
$310.69
|
| Rate for Payer: PACE SWMI |
$258.91
|
| Rate for Payer: PHP Medicare Advantage |
$258.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.20
|
| Rate for Payer: Priority Health Medicare |
$258.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.91
|
| Rate for Payer: UHC Medicare Advantage |
$258.91
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$355.30
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$359.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$376.20
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.30
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$355.30
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$263.34
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna Commercial |
$355.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.70
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$359.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.40
|
| Rate for Payer: Healthscope Commercial |
$376.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.30
|
| Rate for Payer: PHP Commercial |
$355.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health SBD |
$263.34
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.71
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| Rate for Payer: BCN Medicare Advantage |
$137.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$198.71
|
| Rate for Payer: Cofinity Commercial |
$184.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.99
|
| Rate for Payer: Healthscope Commercial |
$220.78
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.70
|
| Rate for Payer: Nomi Health Commercial |
$165.59
|
| Rate for Payer: PACE SWMI |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$137.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.99
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.91
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| Rate for Payer: BCN Medicare Advantage |
$137.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$198.71
|
| Rate for Payer: Cofinity Commercial |
$184.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.99
|
| Rate for Payer: Healthscope Commercial |
$220.78
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.70
|
| Rate for Payer: Nomi Health Commercial |
$165.59
|
| Rate for Payer: PACE SWMI |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$137.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.99
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$342.21 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.87
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| Rate for Payer: BCN Medicare Advantage |
$184.98
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$266.37
|
| Rate for Payer: Cofinity Commercial |
$247.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.98
|
| Rate for Payer: Healthscope Commercial |
$342.21
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.90
|
| Rate for Payer: Nomi Health Commercial |
$221.98
|
| Rate for Payer: PACE SWMI |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$184.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health Medicare |
$184.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.98
|
| Rate for Payer: UHC Medicare Advantage |
$184.98
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Aetna Commercial |
$447.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.90
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$368.20
|
| Rate for Payer: Cofinity Commercial |
$452.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.80
|
| Rate for Payer: Healthscope Commercial |
$473.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.10
|
| Rate for Payer: PHP Commercial |
$447.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health SBD |
$331.38
|
|
