|
HC HEAVY METAL PANEL CADMIUM LEVEL
|
Facility
|
IP
|
$38.67
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: Aetna Commercial |
$32.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.14
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cofinity Commercial |
$27.07
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.94
|
| Rate for Payer: Healthscope Commercial |
$34.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.87
|
| Rate for Payer: PHP Commercial |
$32.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.14
|
| Rate for Payer: Priority Health SBD |
$24.36
|
|
|
HC HEAVY METAL PANEL LEAD
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.87
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health SBD |
$12.47
|
|
|
HC HEAVY METAL PANEL LEAD
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCN Commercial |
$10.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$13.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Mclaren Medicaid |
$6.49
|
| Rate for Payer: Mclaren Medicare |
$12.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.72
|
| Rate for Payer: Meridian Medicaid |
$6.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Nomi Health Commercial |
$18.16
|
| Rate for Payer: PACE Medicare |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.11
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.46
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health Narrow Network |
$9.97
|
| Rate for Payer: Priority Health SBD |
$12.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.11
|
| Rate for Payer: UHC Medicare Advantage |
$12.11
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: VA VA |
$12.11
|
|
|
HC HEAVY METAL SCREEN URINE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC HEAVY METAL SCREEN URINE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$1,096.80 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.71
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCN Commercial |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$10.17
|
| Rate for Payer: Mclaren Medicare |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: Meridian Medicaid |
$10.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$28.46
|
| Rate for Payer: PACE Medicare |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.52
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$15.62
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.76
|
| Rate for Payer: UHC Core |
$1,096.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Exchange |
$1,096.80
|
| Rate for Payer: UHC Medicare Advantage |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$10.68
|
| Rate for Payer: VA VA |
$18.97
|
|
|
HC HEINZ BODIES
|
Facility
|
OP
|
$27.95
|
|
|
Service Code
|
CPT 85441
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Aetna Commercial |
$23.76
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.25
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$4.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.72
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.20
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cofinity Commercial |
$24.04
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$25.16
|
| Rate for Payer: Mclaren Medicaid |
$2.25
|
| Rate for Payer: Mclaren Medicare |
$4.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.41
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.76
|
| Rate for Payer: Nomi Health Commercial |
$6.30
|
| Rate for Payer: PACE Medicare |
$3.99
|
| Rate for Payer: PACE SWMI |
$4.20
|
| Rate for Payer: PHP Commercial |
$23.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.32
|
| Rate for Payer: Priority Health Medicare |
$4.20
|
| Rate for Payer: Priority Health Narrow Network |
$3.46
|
| Rate for Payer: Priority Health SBD |
$17.61
|
| Rate for Payer: Railroad Medicare Medicare |
$4.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.20
|
| Rate for Payer: UHC Medicare Advantage |
$4.20
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: VA VA |
$4.20
|
|
|
HC HEINZ BODIES
|
Facility
|
IP
|
$27.95
|
|
|
Service Code
|
CPT 85441
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Aetna Commercial |
$23.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.17
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$24.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.36
|
| Rate for Payer: Healthscope Commercial |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.76
|
| Rate for Payer: PHP Commercial |
$23.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.17
|
| Rate for Payer: Priority Health SBD |
$17.61
|
|
|
HC HELICOBACTER PYLORI DRUG ADMINISTRATION
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
30600224
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC HELICOBACTER PYLORI DRUG ADMINISTRATION
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
30600224
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$8.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.82
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.96
|
| Rate for Payer: BCN Commercial |
$6.96
|
| Rate for Payer: BCN Medicare Advantage |
$7.86
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.86
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Mclaren Medicare |
$7.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.25
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$11.79
|
| Rate for Payer: PACE Medicare |
$7.47
|
| Rate for Payer: PACE SWMI |
$7.86
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$7.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.09
|
| Rate for Payer: Priority Health Medicare |
$7.86
|
| Rate for Payer: Priority Health Narrow Network |
$6.47
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.86
|
| Rate for Payer: UHC Medicare Advantage |
$7.86
|
| Rate for Payer: UHCCP Medicaid |
$4.43
|
| Rate for Payer: VA VA |
$7.86
|
|
|
HC HELICOBACTER PYLORI IGG
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
30200271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$14.92
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$25.28
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.85
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$13.48
|
| Rate for Payer: Priority Health SBD |
$69.14
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC HELICOBACTER PYLORI IGG
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
30200271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.14 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health SBD |
$69.14
|
|
|
HC HELICO PYL BREATH TST NON RADIOACTIVE ISOTOPE
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
30600223
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC HELICO PYL BREATH TST NON RADIOACTIVE ISOTOPE
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
30600223
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$70.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.20
|
| Rate for Payer: BCBS Complete |
$37.91
|
| Rate for Payer: BCBS MAPPO |
$67.36
|
| Rate for Payer: BCBS Trust/PPO |
$59.63
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: BCN Medicare Advantage |
$67.36
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.36
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$36.10
|
| Rate for Payer: Mclaren Medicare |
$67.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.73
|
| Rate for Payer: Meridian Medicaid |
$37.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$101.04
|
| Rate for Payer: PACE Medicare |
$63.99
|
| Rate for Payer: PACE SWMI |
$67.36
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$67.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.30
|
| Rate for Payer: Priority Health Medicare |
$67.36
|
| Rate for Payer: Priority Health Narrow Network |
$55.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: Railroad Medicare Medicare |
$67.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.36
|
| Rate for Payer: UHC Medicare Advantage |
$67.36
|
| Rate for Payer: UHCCP Medicaid |
$37.92
|
| Rate for Payer: VA VA |
$67.36
|
|
|
HC HELMINTHO SETOMELANO IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC HELMINTHO SETOMELANO IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC HEMATOCRIT
|
Facility
|
OP
|
$23.87
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Mclaren Medicaid |
$1.27
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: Meridian Medicaid |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$3.56
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.44
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$1.95
|
| Rate for Payer: Priority Health SBD |
$15.04
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Medicare Advantage |
$2.37
|
| Rate for Payer: UHCCP Medicaid |
$1.33
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMATOCRIT
|
Facility
|
IP
|
$23.87
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health SBD |
$15.04
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$339.46 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$67.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.70
|
| Rate for Payer: BCBS Complete |
$36.78
|
| Rate for Payer: BCBS MAPPO |
$65.36
|
| Rate for Payer: BCBS Trust/PPO |
$57.86
|
| Rate for Payer: BCN Commercial |
$57.86
|
| Rate for Payer: BCN Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.36
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$35.03
|
| Rate for Payer: Mclaren Medicare |
$65.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.63
|
| Rate for Payer: Meridian Medicaid |
$36.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$196.08
|
| Rate for Payer: PACE Medicare |
$62.09
|
| Rate for Payer: PACE SWMI |
$65.36
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$65.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.25
|
| Rate for Payer: Priority Health Medicare |
$65.36
|
| Rate for Payer: Priority Health Narrow Network |
$53.80
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: Railroad Medicare Medicare |
$65.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.43
|
| Rate for Payer: UHC Core |
$339.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.36
|
| Rate for Payer: UHC Exchange |
$339.46
|
| Rate for Payer: UHC Medicare Advantage |
$65.36
|
| Rate for Payer: UHCCP Medicaid |
$36.80
|
| Rate for Payer: VA VA |
$65.36
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health SBD |
$167.14
|
|
|
HC HEMO CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$208.46
|
| Rate for Payer: BCN Commercial |
$208.46
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.82
|
|
|
HC HEMO CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$119.52
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$119.52
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.42
|
|
|
HC HEMO CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$151.82 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$208.46
|
| Rate for Payer: BCN Commercial |
$208.46
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.82
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
