|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 36582
|
| Min. Negotiated Rate |
$225.60 |
| Max. Negotiated Rate |
$503.90 |
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Medicare |
$283.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.99
|
| Rate for Payer: BCBS Complete |
$225.60
|
| Rate for Payer: BCBS MAPPO |
$272.38
|
| Rate for Payer: BCN Medicare Advantage |
$272.38
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cofinity Commercial |
$392.23
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.38
|
| Rate for Payer: Healthscope Commercial |
$435.81
|
| Rate for Payer: Healthscope Commercial |
$503.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.60
|
| Rate for Payer: Nomi Health Commercial |
$326.86
|
| Rate for Payer: PACE SWMI |
$272.38
|
| Rate for Payer: PHP Medicare Advantage |
$272.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.60
|
| Rate for Payer: Priority Health Medicare |
$272.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.38
|
| Rate for Payer: UHC Medicare Advantage |
$272.38
|
|
|
PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 36581
|
| Min. Negotiated Rate |
$172.66 |
| Max. Negotiated Rate |
$1,020.50 |
| Rate for Payer: Aetna Commercial |
$231.36
|
| Rate for Payer: Aetna Medicare |
$179.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.36
|
| Rate for Payer: BCBS Complete |
$628.00
|
| Rate for Payer: BCBS MAPPO |
$172.66
|
| Rate for Payer: BCN Medicare Advantage |
$172.66
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cofinity Commercial |
$248.63
|
| Rate for Payer: Cofinity Commercial |
$231.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.66
|
| Rate for Payer: Healthscope Commercial |
$319.42
|
| Rate for Payer: Healthscope Commercial |
$276.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.50
|
| Rate for Payer: Nomi Health Commercial |
$207.19
|
| Rate for Payer: PACE SWMI |
$172.66
|
| Rate for Payer: PHP Medicare Advantage |
$172.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.50
|
| Rate for Payer: Priority Health Medicare |
$172.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.66
|
| Rate for Payer: UHC Medicare Advantage |
$172.66
|
|
|
PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 62194
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$1,218.10 |
| Rate for Payer: Aetna Commercial |
$654.25
|
| Rate for Payer: Aetna Medicare |
$507.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.25
|
| Rate for Payer: BCBS Complete |
$749.60
|
| Rate for Payer: BCBS MAPPO |
$488.25
|
| Rate for Payer: BCN Medicare Advantage |
$488.25
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$703.08
|
| Rate for Payer: Cofinity Commercial |
$654.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.25
|
| Rate for Payer: Healthscope Commercial |
$781.20
|
| Rate for Payer: Healthscope Commercial |
$903.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,218.10
|
| Rate for Payer: Nomi Health Commercial |
$585.90
|
| Rate for Payer: PACE SWMI |
$488.25
|
| Rate for Payer: PHP Medicare Advantage |
$488.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health Medicare |
$488.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.25
|
| Rate for Payer: UHC Medicare Advantage |
$488.25
|
|
|
PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 63744
|
| Min. Negotiated Rate |
$705.13 |
| Max. Negotiated Rate |
$1,472.90 |
| Rate for Payer: Aetna Commercial |
$944.87
|
| Rate for Payer: Aetna Medicare |
$733.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.39
|
| Rate for Payer: BCBS Complete |
$906.40
|
| Rate for Payer: BCBS MAPPO |
$705.13
|
| Rate for Payer: BCN Medicare Advantage |
$705.13
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$944.87
|
| Rate for Payer: Cofinity Commercial |
$1,015.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.13
|
| Rate for Payer: Healthscope Commercial |
$1,304.49
|
| Rate for Payer: Healthscope Commercial |
$1,128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,472.90
|
| Rate for Payer: Nomi Health Commercial |
$846.16
|
| Rate for Payer: PACE SWMI |
$705.13
|
| Rate for Payer: PHP Medicare Advantage |
$705.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.90
|
| Rate for Payer: Priority Health Medicare |
$705.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$705.13
|
| Rate for Payer: UHC Medicare Advantage |
$705.13
|
|
|
PR RPLCMT/IRRIGATION VENTRICULAR CATHETER
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 62225
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$710.23
|
| Rate for Payer: Aetna Medicare |
$551.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.23
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$530.02
|
| Rate for Payer: BCN Medicare Advantage |
$530.02
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$763.23
|
| Rate for Payer: Cofinity Commercial |
$710.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.02
|
| Rate for Payer: Healthscope Commercial |
$848.03
|
| Rate for Payer: Healthscope Commercial |
$980.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,771.25
|
| Rate for Payer: Nomi Health Commercial |
$636.02
|
| Rate for Payer: PACE SWMI |
$530.02
|
| Rate for Payer: PHP Medicare Advantage |
$530.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$530.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.02
|
| Rate for Payer: UHC Medicare Advantage |
$530.02
|
|
|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$530.52 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Aetna Commercial |
$710.90
|
| Rate for Payer: Aetna Medicare |
$551.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.90
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$530.52
|
| Rate for Payer: BCN Medicare Advantage |
$530.52
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$763.95
|
| Rate for Payer: Cofinity Commercial |
$710.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.52
|
| Rate for Payer: Healthscope Commercial |
$981.46
|
| Rate for Payer: Healthscope Commercial |
$848.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,469.65
|
| Rate for Payer: Nomi Health Commercial |
$636.62
|
| Rate for Payer: PACE SWMI |
$530.52
|
| Rate for Payer: PHP Medicare Advantage |
$530.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$530.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.52
|
| Rate for Payer: UHC Medicare Advantage |
$530.52
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$1,901.20 |
| Max. Negotiated Rate |
$4,024.82 |
| Rate for Payer: Aetna Commercial |
$2,915.28
|
| Rate for Payer: Aetna Medicare |
$2,262.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,915.28
|
| Rate for Payer: BCBS Complete |
$1,901.20
|
| Rate for Payer: BCBS MAPPO |
$2,175.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,175.58
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cofinity Commercial |
$3,132.84
|
| Rate for Payer: Cofinity Commercial |
$2,915.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,175.58
|
| Rate for Payer: Healthscope Commercial |
$3,480.93
|
| Rate for Payer: Healthscope Commercial |
$4,024.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,284.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.45
|
| Rate for Payer: Nomi Health Commercial |
$2,610.70
|
| Rate for Payer: PACE SWMI |
$2,175.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,175.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,089.45
|
| Rate for Payer: Priority Health Medicare |
$2,175.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,175.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,175.58
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$3,555.00
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$830.75 |
| Max. Negotiated Rate |
$2,310.75 |
| Rate for Payer: Aetna Commercial |
$1,113.20
|
| Rate for Payer: Aetna Medicare |
$863.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,196.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.20
|
| Rate for Payer: BCBS Complete |
$1,422.00
|
| Rate for Payer: BCBS MAPPO |
$830.75
|
| Rate for Payer: BCN Medicare Advantage |
$830.75
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,196.28
|
| Rate for Payer: Cofinity Commercial |
$1,113.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.75
|
| Rate for Payer: Healthscope Commercial |
$1,536.89
|
| Rate for Payer: Healthscope Commercial |
$1,329.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,310.75
|
| Rate for Payer: Nomi Health Commercial |
$996.90
|
| Rate for Payer: PACE SWMI |
$830.75
|
| Rate for Payer: PHP Medicare Advantage |
$830.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| Rate for Payer: Priority Health Medicare |
$830.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.75
|
| Rate for Payer: UHC Medicare Advantage |
$830.75
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$3,924.00
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$1,569.60 |
| Max. Negotiated Rate |
$3,150.22 |
| Rate for Payer: Aetna Commercial |
$2,281.78
|
| Rate for Payer: Aetna Medicare |
$1,770.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,452.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,281.78
|
| Rate for Payer: BCBS Complete |
$1,569.60
|
| Rate for Payer: BCBS MAPPO |
$1,702.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,702.82
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cofinity Commercial |
$2,452.06
|
| Rate for Payer: Cofinity Commercial |
$2,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,702.82
|
| Rate for Payer: Healthscope Commercial |
$2,724.51
|
| Rate for Payer: Healthscope Commercial |
$3,150.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,787.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,550.60
|
| Rate for Payer: Nomi Health Commercial |
$2,043.38
|
| Rate for Payer: PACE SWMI |
$1,702.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,702.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.60
|
| Rate for Payer: Priority Health Medicare |
$1,702.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,702.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,702.82
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$711.27 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.85
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$790.30
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health SBD |
$711.27
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$711.27 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$790.30
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$711.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$1,140.12 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.82
|
| Rate for Payer: BCBS Complete |
$451.60
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Healthscope Commercial |
$986.05
|
| Rate for Payer: Healthscope Commercial |
$1,140.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.85
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$1,140.12 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.44
|
| Rate for Payer: BCBS Complete |
$451.60
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Healthscope Commercial |
$1,140.12
|
| Rate for Payer: Healthscope Commercial |
$986.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.85
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
49550
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$1,043.71 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.40
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$902.67
|
| Rate for Payer: Healthscope Commercial |
$1,043.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.60
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.32 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$544.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.32 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health SBD |
$544.32
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$1,043.71 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.99
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$1,043.71
|
| Rate for Payer: Healthscope Commercial |
$902.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.60
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
|
|
PR RPR 1ST INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 49561
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Medicare |
$1,121.50
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$572.41 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.27
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Healthscope Commercial |
$915.86
|
| Rate for Payer: Healthscope Commercial |
$1,058.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.25
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$572.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,048.95 |
| Max. Negotiated Rate |
$1,498.50 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,165.50
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,165.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health SBD |
$1,048.95
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$572.41 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.27
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Healthscope Commercial |
$1,058.96
|
| Rate for Payer: Healthscope Commercial |
$915.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.25
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$572.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,048.95 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,165.50
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,165.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$1,048.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,063.44 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$1,434.80
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,451.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,181.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$1,519.20
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.80
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$1,434.80
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$1,063.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$509.49 |
| Max. Negotiated Rate |
$1,097.20 |
| Rate for Payer: Aetna Commercial |
$682.72
|
| Rate for Payer: Aetna Medicare |
$529.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.67
|
| Rate for Payer: BCBS Complete |
$675.20
|
| Rate for Payer: BCBS MAPPO |
$509.49
|
| Rate for Payer: BCN Medicare Advantage |
$509.49
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$733.67
|
| Rate for Payer: Cofinity Commercial |
$682.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.49
|
| Rate for Payer: Healthscope Commercial |
$815.18
|
| Rate for Payer: Healthscope Commercial |
$942.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.20
|
| Rate for Payer: Nomi Health Commercial |
$611.39
|
| Rate for Payer: PACE SWMI |
$509.49
|
| Rate for Payer: PHP Medicare Advantage |
$509.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health Medicare |
$509.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.49
|
| Rate for Payer: UHC Medicare Advantage |
$509.49
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,063.44 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,434.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.20
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,451.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,181.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,350.40
|
| Rate for Payer: Healthscope Commercial |
$1,519.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.80
|
| Rate for Payer: PHP Commercial |
$1,434.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health SBD |
$1,063.44
|
|
