|
HC MSMART BM CMPT3
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna Commercial |
$147.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.45
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$29.37
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$121.10
|
| Rate for Payer: Cofinity Commercial |
$148.78
|
| Rate for Payer: Healthscope Commercial |
$155.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.05
|
| Rate for Payer: PHP Commercial |
$147.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health SBD |
$108.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Exchange |
$23.25
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
OP
|
$63.99
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Aetna Medicare |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: BCBS Complete |
$23.94
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$32.64
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$55.03
|
| Rate for Payer: Cofinity Commercial |
$44.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Mclaren Medicaid |
$22.80
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Medicaid |
$23.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.39
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$54.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.79
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health SBD |
$40.31
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.02
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.68
|
| Rate for Payer: UHC Exchange |
$41.68
|
| Rate for Payer: UHC Medicare Advantage |
$42.93
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
IP
|
$63.99
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.59
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$55.03
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.39
|
| Rate for Payer: PHP Commercial |
$54.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.79
|
| Rate for Payer: Priority Health SBD |
$40.31
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR CMPT
|
Facility
|
OP
|
$53.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$46.01
|
| Rate for Payer: Cofinity Commercial |
$37.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$48.15
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.45
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$33.70
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR CMPT
|
Facility
|
IP
|
$53.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$48.15 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$37.45
|
| Rate for Payer: Cofinity Commercial |
$46.01
|
| Rate for Payer: Healthscope Commercial |
$48.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.45
|
| Rate for Payer: Priority Health SBD |
$33.70
|
|
|
HC MTHFR 2 MUTATIONS
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$447.30 |
| Rate for Payer: Aetna Commercial |
$422.45
|
| Rate for Payer: Aetna Medicare |
$67.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.68
|
| Rate for Payer: BCBS Complete |
$37.53
|
| Rate for Payer: BCBS MAPPO |
$65.34
|
| Rate for Payer: BCN Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$427.42
|
| Rate for Payer: Cofinity Commercial |
$347.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$447.30
|
| Rate for Payer: Mclaren Medicaid |
$35.74
|
| Rate for Payer: Mclaren Medicare |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$37.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.45
|
| Rate for Payer: PACE Medicare |
$62.07
|
| Rate for Payer: PACE SWMI |
$65.34
|
| Rate for Payer: PHP Commercial |
$422.45
|
| Rate for Payer: PHP Medicare Advantage |
$65.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health Medicare |
$65.34
|
| Rate for Payer: Priority Health SBD |
$313.11
|
| Rate for Payer: Railroad Medicare Medicare |
$65.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.41
|
| Rate for Payer: UHC Core |
$71.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.34
|
| Rate for Payer: UHC Exchange |
$65.34
|
| Rate for Payer: UHC Medicare Advantage |
$67.30
|
| Rate for Payer: VA VA |
$65.34
|
|
|
HC MTHFR 2 MUTATIONS
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$447.30 |
| Rate for Payer: Aetna Commercial |
$422.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.05
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$347.90
|
| Rate for Payer: Cofinity Commercial |
$427.42
|
| Rate for Payer: Healthscope Commercial |
$447.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.45
|
| Rate for Payer: PHP Commercial |
$422.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health SBD |
$313.11
|
|
|
HC MTHFR MUTATION
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000102
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
|
|
HC MTHFR MUTATION
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000102
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Medicare |
$67.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.68
|
| Rate for Payer: BCBS Complete |
$37.53
|
| Rate for Payer: BCBS MAPPO |
$65.34
|
| Rate for Payer: BCN Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$35.74
|
| Rate for Payer: Mclaren Medicare |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$37.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PACE Medicare |
$62.07
|
| Rate for Payer: PACE SWMI |
$65.34
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Medicare Advantage |
$65.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health Medicare |
$65.34
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: Railroad Medicare Medicare |
$65.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.41
|
| Rate for Payer: UHC Core |
$71.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.34
|
| Rate for Payer: UHC Exchange |
$65.34
|
| Rate for Payer: UHC Medicare Advantage |
$67.30
|
| Rate for Payer: VA VA |
$65.34
|
|
|
HC M TUBERCULOSIS COMPLEX, PCR
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Aetna Commercial |
$164.90
|
| Rate for Payer: Aetna Medicare |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: BCBS Complete |
$23.94
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$32.64
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$166.84
|
| Rate for Payer: Cofinity Commercial |
$135.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$174.60
|
| Rate for Payer: Mclaren Medicaid |
$22.80
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Medicaid |
$23.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.90
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$164.90
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health SBD |
$122.22
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.02
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.68
|
| Rate for Payer: UHC Exchange |
$41.68
|
| Rate for Payer: UHC Medicare Advantage |
$42.93
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC M TUBERCULOSIS COMPLEX, PCR
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Aetna Commercial |
$164.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.10
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$135.80
|
| Rate for Payer: Cofinity Commercial |
$166.84
|
| Rate for Payer: Healthscope Commercial |
$174.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.90
|
| Rate for Payer: PHP Commercial |
$164.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health SBD |
$122.22
|
|
|
HC MUCORE RACEMOSUS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200093
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC MUCORE RACEMOSUS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200093
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MUGWORT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC MUGWORT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MULBERRY IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC MULBERRY IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$6.55
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Aetna Commercial |
$5.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.26
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cofinity Commercial |
$4.58
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Healthscope Commercial |
$5.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.57
|
| Rate for Payer: PHP Commercial |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health SBD |
$4.13
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$6.55
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Aetna Commercial |
$5.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.26
|
| Rate for Payer: BCBS Complete |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cofinity Commercial |
$4.58
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Healthscope Commercial |
$5.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.57
|
| Rate for Payer: PHP Commercial |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health SBD |
$4.13
|
|
|
HC MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna Commercial |
$534.65
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$85.34
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cofinity Commercial |
$440.30
|
| Rate for Payer: Cofinity Commercial |
$540.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$566.10
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$534.65
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$534.65
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.30
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$396.27
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.27 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna Commercial |
$534.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.85
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cofinity Commercial |
$440.30
|
| Rate for Payer: Cofinity Commercial |
$540.94
|
| Rate for Payer: Healthscope Commercial |
$566.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$534.65
|
| Rate for Payer: PHP Commercial |
$534.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.30
|
| Rate for Payer: Priority Health SBD |
$396.27
|
|
|
HC MULTILEAF COLLIMATOR
|
Facility
|
OP
|
$836.40
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$752.76 |
| Rate for Payer: Aetna Commercial |
$710.94
|
| Rate for Payer: Aetna Commercial |
$1,048.90
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$460.95
|
| Rate for Payer: BCBS Trust/PPO |
$460.95
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$669.12
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$669.12
|
| Rate for Payer: Cofinity Commercial |
$1,061.24
|
| Rate for Payer: Cofinity Commercial |
$719.30
|
| Rate for Payer: Cofinity Commercial |
$585.48
|
| Rate for Payer: Cofinity Commercial |
$863.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$752.76
|
| Rate for Payer: Healthscope Commercial |
$1,110.60
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,048.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$710.94
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$710.94
|
| Rate for Payer: PHP Commercial |
$1,048.90
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.48
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$777.42
|
| Rate for Payer: Priority Health SBD |
$526.93
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$460.38
|
| Rate for Payer: UHC Exchange |
$460.38
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC MULTILEAF COLLIMATOR
|
Facility
|
IP
|
$836.40
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$526.93 |
| Max. Negotiated Rate |
$752.76 |
| Rate for Payer: Aetna Commercial |
$710.94
|
| Rate for Payer: Aetna Commercial |
$1,048.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.66
|
| Rate for Payer: Cash Price |
$669.12
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cofinity Commercial |
$863.80
|
| Rate for Payer: Cofinity Commercial |
$719.30
|
| Rate for Payer: Cofinity Commercial |
$585.48
|
| Rate for Payer: Cofinity Commercial |
$1,061.24
|
| Rate for Payer: Healthscope Commercial |
$752.76
|
| Rate for Payer: Healthscope Commercial |
$1,110.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,048.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$710.94
|
| Rate for Payer: PHP Commercial |
$1,048.90
|
| Rate for Payer: PHP Commercial |
$710.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.80
|
| Rate for Payer: Priority Health SBD |
$777.42
|
| Rate for Payer: Priority Health SBD |
$526.93
|
|
|
HC MULTIPLE SCLEROSIS PROFILE
|
Facility
|
OP
|
$120.08
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$108.07 |
| Rate for Payer: Aetna Commercial |
$102.07
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$96.06
|
| Rate for Payer: Cash Price |
$96.06
|
| Rate for Payer: Cofinity Commercial |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$103.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$108.07
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.07
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$102.07
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.06
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$75.65
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC MULTIPLE SCLEROSIS PROFILE
|
Facility
|
IP
|
$120.08
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$108.07 |
| Rate for Payer: Aetna Commercial |
$102.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.05
|
| Rate for Payer: Cash Price |
$96.06
|
| Rate for Payer: Cofinity Commercial |
$103.27
|
| Rate for Payer: Cofinity Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$108.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.07
|
| Rate for Payer: PHP Commercial |
$102.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.06
|
| Rate for Payer: Priority Health SBD |
$75.65
|
|
