|
HC IR PERCUTANEOUS TUBE CHANGE
|
Facility
|
IP
|
$587.78
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
32000228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$370.30 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$499.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.06
|
| Rate for Payer: Cash Price |
$470.22
|
| Rate for Payer: Cofinity Advantage |
$411.45
|
| Rate for Payer: Cofinity Commercial |
$505.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.22
|
| Rate for Payer: Healthscope Commercial |
$529.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.83
|
| Rate for Payer: PHP Commercial |
$499.61
|
| Rate for Payer: Priority Health SBD |
$370.30
|
|
|
HC IR PERCUTANEOUS TUBE CHANGE
|
Facility
|
OP
|
$587.78
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
32000228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.47 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$499.61
|
| Rate for Payer: Aetna Medicare |
$293.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.06
|
| Rate for Payer: BCBS Complete |
$235.11
|
| Rate for Payer: BCBS Trust/PPO |
$129.47
|
| Rate for Payer: BCN Commercial |
$129.47
|
| Rate for Payer: Cash Price |
$470.22
|
| Rate for Payer: Cash Price |
$470.22
|
| Rate for Payer: Cofinity Advantage |
$411.45
|
| Rate for Payer: Cofinity Commercial |
$505.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.22
|
| Rate for Payer: Healthscope Commercial |
$529.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$470.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.83
|
| Rate for Payer: PHP Commercial |
$499.61
|
| Rate for Payer: Priority Health SBD |
$370.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.06
|
| Rate for Payer: UHC Core |
$306.23
|
| Rate for Payer: UHC Exchange |
$231.00
|
|
|
HC IR PLACEMENT CAROTID STENT
|
Facility
|
IP
|
$11,870.12
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
36100163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,478.18 |
| Max. Negotiated Rate |
$10,683.11 |
| Rate for Payer: Aetna Commercial |
$10,089.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,715.58
|
| Rate for Payer: Cash Price |
$9,496.10
|
| Rate for Payer: Cofinity Advantage |
$8,309.08
|
| Rate for Payer: Cofinity Commercial |
$10,208.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,496.10
|
| Rate for Payer: Healthscope Commercial |
$10,683.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,089.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,902.59
|
| Rate for Payer: PHP Commercial |
$10,089.60
|
| Rate for Payer: Priority Health SBD |
$7,478.18
|
|
|
HC IR PLACEMENT CAROTID STENT
|
Facility
|
OP
|
$11,870.12
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
36100163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,701.87 |
| Max. Negotiated Rate |
$10,683.11 |
| Rate for Payer: Aetna Commercial |
$10,089.60
|
| Rate for Payer: Aetna Medicare |
$5,935.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,715.58
|
| Rate for Payer: BCBS Complete |
$4,748.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,701.87
|
| Rate for Payer: BCN Commercial |
$2,701.87
|
| Rate for Payer: Cash Price |
$9,496.10
|
| Rate for Payer: Cash Price |
$9,496.10
|
| Rate for Payer: Cofinity Advantage |
$8,309.08
|
| Rate for Payer: Cofinity Commercial |
$10,208.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,496.10
|
| Rate for Payer: Healthscope Commercial |
$10,683.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,496.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,089.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,902.59
|
| Rate for Payer: PHP Commercial |
$10,089.60
|
| Rate for Payer: Priority Health SBD |
$7,478.18
|
|
|
HC IR PLACEMENT STENT INTRACRANIAL W ANGIOPLASTY
|
Facility
|
OP
|
$3,526.75
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
36100274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,410.70 |
| Max. Negotiated Rate |
$3,881.44 |
| Rate for Payer: Aetna Commercial |
$2,997.74
|
| Rate for Payer: Aetna Medicare |
$1,763.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.39
|
| Rate for Payer: BCBS Complete |
$1,410.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,881.44
|
| Rate for Payer: BCN Commercial |
$3,881.44
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cofinity Advantage |
$2,468.72
|
| Rate for Payer: Cofinity Commercial |
$3,033.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.40
|
| Rate for Payer: Healthscope Commercial |
$3,174.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,821.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.06
|
| Rate for Payer: PHP Commercial |
$2,997.74
|
| Rate for Payer: Priority Health SBD |
$2,221.85
|
|
|
HC IR PLACEMENT STENT INTRACRANIAL W ANGIOPLASTY
|
Facility
|
IP
|
$3,526.75
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
36100274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,221.85 |
| Max. Negotiated Rate |
$3,174.07 |
| Rate for Payer: Aetna Commercial |
$2,997.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.39
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cofinity Advantage |
$2,468.72
|
| Rate for Payer: Cofinity Commercial |
$3,033.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.40
|
| Rate for Payer: Healthscope Commercial |
$3,174.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.06
|
| Rate for Payer: PHP Commercial |
$2,997.74
|
| Rate for Payer: Priority Health SBD |
$2,221.85
|
|
|
HC IR PLACEMENT TIPS WITH FLUORO
|
Facility
|
OP
|
$5,510.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
36100147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,237.46 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$4,683.50
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,581.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,237.46
|
| Rate for Payer: BCN Commercial |
$2,237.46
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$4,408.00
|
| Rate for Payer: Cash Price |
$4,408.00
|
| Rate for Payer: Cash Price |
$4,408.00
|
| Rate for Payer: Cofinity Advantage |
$3,857.00
|
| Rate for Payer: Cofinity Commercial |
$4,738.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$4,959.00
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,683.50
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,132.50
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$4,683.50
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$3,471.30
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC IR PLACEMENT TIPS WITH FLUORO
|
Facility
|
IP
|
$5,510.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
36100147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,471.30 |
| Max. Negotiated Rate |
$4,959.00 |
| Rate for Payer: Aetna Commercial |
$4,683.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,581.50
|
| Rate for Payer: Cash Price |
$4,408.00
|
| Rate for Payer: Cofinity Advantage |
$3,857.00
|
| Rate for Payer: Cofinity Commercial |
$4,738.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,408.00
|
| Rate for Payer: Healthscope Commercial |
$4,959.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,683.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,132.50
|
| Rate for Payer: PHP Commercial |
$4,683.50
|
| Rate for Payer: Priority Health SBD |
$3,471.30
|
|
|
HC IR PLACE STENT VERTEBRAL ART EA AD
|
Facility
|
IP
|
$10,487.46
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
36100368
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,607.10 |
| Max. Negotiated Rate |
$9,438.71 |
| Rate for Payer: Aetna Commercial |
$8,914.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,816.85
|
| Rate for Payer: Cash Price |
$8,389.97
|
| Rate for Payer: Cofinity Advantage |
$7,341.22
|
| Rate for Payer: Cofinity Commercial |
$9,019.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,389.97
|
| Rate for Payer: Healthscope Commercial |
$9,438.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,914.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,865.60
|
| Rate for Payer: PHP Commercial |
$8,914.34
|
| Rate for Payer: Priority Health SBD |
$6,607.10
|
|
|
HC IR PLACE STENT VERTEBRAL ART EA AD
|
Facility
|
OP
|
$10,487.46
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
36100368
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,194.98 |
| Max. Negotiated Rate |
$9,438.71 |
| Rate for Payer: Aetna Commercial |
$8,914.34
|
| Rate for Payer: Aetna Medicare |
$5,243.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,816.85
|
| Rate for Payer: BCBS Complete |
$4,194.98
|
| Rate for Payer: Cash Price |
$8,389.97
|
| Rate for Payer: Cofinity Advantage |
$7,341.22
|
| Rate for Payer: Cofinity Commercial |
$9,019.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,389.97
|
| Rate for Payer: Healthscope Commercial |
$9,438.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,389.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,914.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,865.60
|
| Rate for Payer: PHP Commercial |
$8,914.34
|
| Rate for Payer: Priority Health SBD |
$6,607.10
|
|
|
HC IR PLACE STENT VERTEBRAL ART INIT
|
Facility
|
OP
|
$10,487.46
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
36100367
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,194.98 |
| Max. Negotiated Rate |
$9,438.71 |
| Rate for Payer: Aetna Commercial |
$8,914.34
|
| Rate for Payer: Aetna Medicare |
$5,243.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,816.85
|
| Rate for Payer: BCBS Complete |
$4,194.98
|
| Rate for Payer: Cash Price |
$8,389.97
|
| Rate for Payer: Cofinity Advantage |
$7,341.22
|
| Rate for Payer: Cofinity Commercial |
$9,019.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,389.97
|
| Rate for Payer: Healthscope Commercial |
$9,438.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,389.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,914.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,865.60
|
| Rate for Payer: PHP Commercial |
$8,914.34
|
| Rate for Payer: Priority Health SBD |
$6,607.10
|
|
|
HC IR PLACE STENT VERTEBRAL ART INIT
|
Facility
|
IP
|
$10,487.46
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
36100367
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,607.10 |
| Max. Negotiated Rate |
$9,438.71 |
| Rate for Payer: Aetna Commercial |
$8,914.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,816.85
|
| Rate for Payer: Cash Price |
$8,389.97
|
| Rate for Payer: Cofinity Advantage |
$7,341.22
|
| Rate for Payer: Cofinity Commercial |
$9,019.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,389.97
|
| Rate for Payer: Healthscope Commercial |
$9,438.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,914.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,865.60
|
| Rate for Payer: PHP Commercial |
$8,914.34
|
| Rate for Payer: Priority Health SBD |
$6,607.10
|
|
|
HC IR PULMONARY
|
Facility
|
IP
|
$2,050.65
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
32000195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,291.91 |
| Max. Negotiated Rate |
$1,845.59 |
| Rate for Payer: Aetna Commercial |
$1,743.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.92
|
| Rate for Payer: Cash Price |
$1,640.52
|
| Rate for Payer: Cofinity Advantage |
$1,435.45
|
| Rate for Payer: Cofinity Commercial |
$1,763.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.52
|
| Rate for Payer: Healthscope Commercial |
$1,845.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,537.99
|
| Rate for Payer: PHP Commercial |
$1,743.05
|
| Rate for Payer: Priority Health SBD |
$1,291.91
|
|
|
HC IR PULMONARY
|
Facility
|
OP
|
$2,050.65
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
32000195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.01 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$1,743.05
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$159.01
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$1,640.52
|
| Rate for Payer: Cash Price |
$1,640.52
|
| Rate for Payer: Cofinity Advantage |
$1,435.45
|
| Rate for Payer: Cofinity Commercial |
$1,763.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$1,845.59
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,743.05
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,537.99
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$1,743.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$1,291.91
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,332.92
|
| Rate for Payer: UHC Core |
$1,068.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$805.91
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IR PULMONARY BILATERAL
|
Facility
|
IP
|
$3,569.52
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
32000196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,248.80 |
| Max. Negotiated Rate |
$3,212.57 |
| Rate for Payer: Aetna Commercial |
$3,034.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,320.19
|
| Rate for Payer: Cash Price |
$2,855.62
|
| Rate for Payer: Cofinity Advantage |
$2,498.66
|
| Rate for Payer: Cofinity Commercial |
$3,069.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,855.62
|
| Rate for Payer: Healthscope Commercial |
$3,212.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,677.14
|
| Rate for Payer: PHP Commercial |
$3,034.09
|
| Rate for Payer: Priority Health SBD |
$2,248.80
|
|
|
HC IR PULMONARY BILATERAL
|
Facility
|
OP
|
$3,569.52
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
32000196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.03 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,034.09
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,320.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$162.03
|
| Rate for Payer: BCN Commercial |
$162.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,855.62
|
| Rate for Payer: Cash Price |
$2,855.62
|
| Rate for Payer: Cofinity Advantage |
$2,498.66
|
| Rate for Payer: Cofinity Commercial |
$3,069.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,855.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,212.57
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.09
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,677.14
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,034.09
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,248.80
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,320.19
|
| Rate for Payer: UHC Core |
$1,859.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$1,402.82
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC IRRADIATION BLOOD PROD-EA UNIT
|
Facility
|
IP
|
$126.20
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
39000026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Advantage |
$88.34
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.65
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health SBD |
$79.51
|
|
|
HC IRRADIATION BLOOD PROD-EA UNIT
|
Facility
|
OP
|
$126.20
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
39000026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$9.89
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Advantage |
$88.34
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.27
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.65
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.88
|
| Rate for Payer: UHC Core |
$58.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$58.88
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC IR RENIN
|
Facility
|
IP
|
$3,555.17
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
32000209
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,239.76 |
| Max. Negotiated Rate |
$3,199.65 |
| Rate for Payer: Aetna Commercial |
$3,021.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,310.86
|
| Rate for Payer: Cash Price |
$2,844.14
|
| Rate for Payer: Cofinity Advantage |
$2,488.62
|
| Rate for Payer: Cofinity Commercial |
$3,057.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.14
|
| Rate for Payer: Healthscope Commercial |
$3,199.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,021.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,666.38
|
| Rate for Payer: PHP Commercial |
$3,021.89
|
| Rate for Payer: Priority Health SBD |
$2,239.76
|
|
|
HC IR RENIN
|
Facility
|
OP
|
$3,555.17
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
32000209
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.48 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$3,021.89
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,310.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$182.48
|
| Rate for Payer: BCN Commercial |
$182.48
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$2,844.14
|
| Rate for Payer: Cash Price |
$2,844.14
|
| Rate for Payer: Cofinity Advantage |
$2,488.62
|
| Rate for Payer: Cofinity Commercial |
$3,057.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$3,199.65
|
| Rate for Payer: Mclaren Medicaid |
$2,899.76
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,021.89
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,666.38
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$3,021.89
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$2,239.76
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,310.86
|
| Rate for Payer: UHC Core |
$1,852.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$1,397.18
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC IR REVASC IVT W ANGIO UNILAT COMPLEX INITIAL VESSEL
|
Facility
|
IP
|
$14,177.75
|
|
|
Service Code
|
CPT 37256
|
| Hospital Charge Code |
36100637
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,931.98 |
| Max. Negotiated Rate |
$12,759.98 |
| Rate for Payer: Aetna Commercial |
$12,051.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.54
|
| Rate for Payer: Cash Price |
$11,342.20
|
| Rate for Payer: Cofinity Advantage |
$9,924.42
|
| Rate for Payer: Cofinity Commercial |
$12,192.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,342.20
|
| Rate for Payer: Healthscope Commercial |
$12,759.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,633.31
|
| Rate for Payer: PHP Commercial |
$12,051.09
|
| Rate for Payer: Priority Health SBD |
$8,931.98
|
|
|
HC IR REVASC IVT W ANGIO UNILAT COMPLEX INITIAL VESSEL
|
Facility
|
OP
|
$14,177.75
|
|
|
Service Code
|
CPT 37256
|
| Hospital Charge Code |
36100637
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Commercial |
$12,051.09
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$11,342.20
|
| Rate for Payer: Cash Price |
$11,342.20
|
| Rate for Payer: Cofinity Advantage |
$9,924.42
|
| Rate for Payer: Cofinity Commercial |
$12,192.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,342.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$12,759.98
|
| Rate for Payer: Mclaren Medicaid |
$2,965.99
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.09
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,633.31
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$12,051.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$8,931.98
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC IR REVASC IVT W ANGIO UNILAT SF INITIAL VESSEL
|
Facility
|
OP
|
$14,177.75
|
|
|
Service Code
|
CPT 37254
|
| Hospital Charge Code |
36100636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Commercial |
$12,051.09
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$11,342.20
|
| Rate for Payer: Cash Price |
$11,342.20
|
| Rate for Payer: Cofinity Advantage |
$9,924.42
|
| Rate for Payer: Cofinity Commercial |
$12,192.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,342.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$12,759.98
|
| Rate for Payer: Mclaren Medicaid |
$2,965.99
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.09
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,633.31
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$12,051.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$8,931.98
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC IR REVASC IVT W ANGIO UNILAT SF INITIAL VESSEL
|
Facility
|
IP
|
$14,177.75
|
|
|
Service Code
|
CPT 37254
|
| Hospital Charge Code |
36100636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,931.98 |
| Max. Negotiated Rate |
$12,759.98 |
| Rate for Payer: Aetna Commercial |
$12,051.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,215.54
|
| Rate for Payer: Cash Price |
$11,342.20
|
| Rate for Payer: Cofinity Advantage |
$9,924.42
|
| Rate for Payer: Cofinity Commercial |
$12,192.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,342.20
|
| Rate for Payer: Healthscope Commercial |
$12,759.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,051.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,633.31
|
| Rate for Payer: PHP Commercial |
$12,051.09
|
| Rate for Payer: Priority Health SBD |
$8,931.98
|
|
|
HC IR REVASC IVT W STENT UNILAT COMPLEX INIT VESSEL
|
Facility
|
OP
|
$28,756.70
|
|
|
Service Code
|
CPT 37260
|
| Hospital Charge Code |
36100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$24,443.19
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,691.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$23,005.36
|
| Rate for Payer: Cash Price |
$23,005.36
|
| Rate for Payer: Cofinity Advantage |
$20,129.69
|
| Rate for Payer: Cofinity Commercial |
$24,730.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,005.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$25,881.03
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,443.19
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,567.53
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$24,443.19
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$18,116.72
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
