|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| 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 |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$48.77
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC LAMBS QUARTERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200091
|
|
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 LAMBS QUARTERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200091
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
30100278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
30100278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.15
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS MAPPO |
$19.32
|
| Rate for Payer: BCN Medicare Advantage |
$19.32
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$10.36
|
| Rate for Payer: Mclaren Medicare |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.29
|
| Rate for Payer: Meridian Medicaid |
$10.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PACE Medicare |
$18.35
|
| Rate for Payer: PACE SWMI |
$19.32
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$19.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.32
|
| Rate for Payer: UHC Medicare Advantage |
$19.32
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$19.32
|
|
|
HC LAMICTAL LEVEL
|
Facility
|
IP
|
$54.10
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
30100054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.16
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Healthscope Commercial |
$48.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: PHP Commercial |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health SBD |
$34.08
|
|
|
HC LAMICTAL LEVEL
|
Facility
|
OP
|
$54.10
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
30100054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$48.69
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$45.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$34.08
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Facility
|
OP
|
$10,480.00
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Commercial |
$8,908.00
|
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,812.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Cash Price |
$8,384.00
|
| Rate for Payer: Cash Price |
$8,384.00
|
| Rate for Payer: Cofinity Commercial |
$9,012.80
|
| Rate for Payer: Cofinity Commercial |
$7,336.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,336.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,384.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Healthscope Commercial |
$9,432.00
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,908.00
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Commercial |
$8,908.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,812.00
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Priority Health SBD |
$6,602.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$2,024.44
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
HC LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Facility
|
IP
|
$10,480.00
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,602.40 |
| Max. Negotiated Rate |
$9,432.00 |
| Rate for Payer: Aetna Commercial |
$8,908.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,812.00
|
| Rate for Payer: Cash Price |
$8,384.00
|
| Rate for Payer: Cofinity Commercial |
$7,336.00
|
| Rate for Payer: Cofinity Commercial |
$9,012.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,336.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,384.00
|
| Rate for Payer: Healthscope Commercial |
$9,432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,908.00
|
| Rate for Payer: PHP Commercial |
$8,908.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,812.00
|
| Rate for Payer: Priority Health SBD |
$6,602.40
|
|
|
HC LA RO SSB SJOGRENS AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC LA RO SSB SJOGRENS AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC LARYNGOSCOPY
|
Facility
|
IP
|
$2,564.80
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,615.82 |
| Max. Negotiated Rate |
$2,308.32 |
| Rate for Payer: Aetna Commercial |
$2,180.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,667.12
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$1,795.36
|
| Rate for Payer: Cofinity Commercial |
$2,205.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,795.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: PHP Commercial |
$2,180.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health SBD |
$1,615.82
|
|
|
HC LARYNGOSCOPY
|
Facility
|
OP
|
$2,564.80
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,025.92 |
| Max. Negotiated Rate |
$2,308.32 |
| Rate for Payer: Aetna Commercial |
$2,180.08
|
| Rate for Payer: Aetna Medicare |
$1,282.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,667.12
|
| Rate for Payer: BCBS Complete |
$1,025.92
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$1,795.36
|
| Rate for Payer: Cofinity Commercial |
$2,205.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,795.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: PHP Commercial |
$2,180.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health SBD |
$1,615.82
|
|
|
HC LARYNGOSCOPY DIRECT OPERATIVE W BIOPSY
|
Facility
|
IP
|
$4,795.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,020.85 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Aetna Commercial |
$4,075.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,116.75
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cofinity Commercial |
$3,356.50
|
| Rate for Payer: Cofinity Commercial |
$4,123.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,836.00
|
| Rate for Payer: Healthscope Commercial |
$4,315.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,075.75
|
| Rate for Payer: PHP Commercial |
$4,075.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,116.75
|
| Rate for Payer: Priority Health SBD |
$3,020.85
|
|
|
HC LARYNGOSCOPY DIRECT OPERATIVE W BIOPSY
|
Facility
|
OP
|
$4,795.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Commercial |
$4,075.75
|
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,116.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cofinity Commercial |
$4,123.70
|
| Rate for Payer: Cofinity Commercial |
$3,356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,836.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Healthscope Commercial |
$4,315.50
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,075.75
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Commercial |
$4,075.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,116.75
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Priority Health SBD |
$3,020.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$946.88
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
OP
|
$372.28
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna Commercial |
$316.44
|
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$297.82
|
| Rate for Payer: Cash Price |
$297.82
|
| Rate for Payer: Cofinity Commercial |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$260.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$335.05
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.44
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$316.44
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.98
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health SBD |
$234.54
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$106.60
|
| Rate for Payer: VA VA |
$189.34
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
IP
|
$372.28
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.54 |
| Max. Negotiated Rate |
$335.05 |
| Rate for Payer: Aetna Commercial |
$316.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.98
|
| Rate for Payer: Cash Price |
$297.82
|
| Rate for Payer: Cofinity Commercial |
$260.60
|
| Rate for Payer: Cofinity Commercial |
$320.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.82
|
| Rate for Payer: Healthscope Commercial |
$335.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.44
|
| Rate for Payer: PHP Commercial |
$316.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.98
|
| Rate for Payer: Priority Health SBD |
$234.54
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$1,066.03 |
| Rate for Payer: Aetna Commercial |
$953.70
|
| Rate for Payer: Aetna Medicare |
$393.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$473.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$473.39
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS MAPPO |
$378.71
|
| Rate for Payer: BCN Medicare Advantage |
$378.71
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$964.92
|
| Rate for Payer: Cofinity Commercial |
$785.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.71
|
| Rate for Payer: Healthscope Commercial |
$1,009.80
|
| Rate for Payer: Mclaren Medicaid |
$202.99
|
| Rate for Payer: Mclaren Medicare |
$378.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.65
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.70
|
| Rate for Payer: PACE Medicare |
$359.77
|
| Rate for Payer: PACE SWMI |
$378.71
|
| Rate for Payer: PHP Commercial |
$953.70
|
| Rate for Payer: PHP Medicare Advantage |
$378.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.30
|
| Rate for Payer: Priority Health Medicare |
$378.71
|
| Rate for Payer: Priority Health SBD |
$706.86
|
| Rate for Payer: Railroad Medicare Medicare |
$378.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.71
|
| Rate for Payer: UHC Medicare Advantage |
$378.71
|
| Rate for Payer: UHCCP Medicaid |
$213.21
|
| Rate for Payer: VA VA |
$378.71
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.86 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Aetna Commercial |
$953.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.30
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$785.40
|
| Rate for Payer: Cofinity Commercial |
$964.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.60
|
| Rate for Payer: Healthscope Commercial |
$1,009.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.70
|
| Rate for Payer: PHP Commercial |
$953.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.30
|
| Rate for Payer: Priority Health SBD |
$706.86
|
|
|
HC LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Facility
|
OP
|
$566.10
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna Commercial |
$481.19
|
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$452.88
|
| Rate for Payer: Cash Price |
$452.88
|
| Rate for Payer: Cofinity Commercial |
$486.85
|
| Rate for Payer: Cofinity Commercial |
$396.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$396.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$509.49
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.19
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$481.19
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.96
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health SBD |
$356.64
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$106.60
|
| Rate for Payer: VA VA |
$189.34
|
|
|
HC LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Facility
|
IP
|
$566.10
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.64 |
| Max. Negotiated Rate |
$509.49 |
| Rate for Payer: Aetna Commercial |
$481.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.96
|
| Rate for Payer: Cash Price |
$452.88
|
| Rate for Payer: Cofinity Commercial |
$396.27
|
| Rate for Payer: Cofinity Commercial |
$486.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$396.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.88
|
| Rate for Payer: Healthscope Commercial |
$509.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.19
|
| Rate for Payer: PHP Commercial |
$481.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.96
|
| Rate for Payer: Priority Health SBD |
$356.64
|
|
|
HC LASER CATHETER
|
Facility
|
IP
|
$4,939.32
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,111.77 |
| Max. Negotiated Rate |
$4,445.39 |
| Rate for Payer: Aetna Commercial |
$4,198.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,210.56
|
| Rate for Payer: Cash Price |
$3,951.46
|
| Rate for Payer: Cofinity Commercial |
$3,457.52
|
| Rate for Payer: Cofinity Commercial |
$4,247.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,951.46
|
| Rate for Payer: Healthscope Commercial |
$4,445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,198.42
|
| Rate for Payer: PHP Commercial |
$4,198.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,210.56
|
| Rate for Payer: Priority Health SBD |
$3,111.77
|
|
|
HC LASER CATHETER
|
Facility
|
OP
|
$4,939.32
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,975.73 |
| Max. Negotiated Rate |
$4,445.39 |
| Rate for Payer: Aetna Commercial |
$4,198.42
|
| Rate for Payer: Aetna Medicare |
$2,469.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,210.56
|
| Rate for Payer: BCBS Complete |
$1,975.73
|
| Rate for Payer: Cash Price |
$3,951.46
|
| Rate for Payer: Cofinity Commercial |
$3,457.52
|
| Rate for Payer: Cofinity Commercial |
$4,247.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,951.46
|
| Rate for Payer: Healthscope Commercial |
$4,445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,198.42
|
| Rate for Payer: PHP Commercial |
$4,198.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,210.56
|
| Rate for Payer: Priority Health SBD |
$3,111.77
|
|
|
HC LATEX IGE
|
Facility
|
OP
|
$35.79
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: Aetna Commercial |
$30.42
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$32.21
|
| 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 |
$30.42
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$30.42
|
| 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 |
$23.26
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$22.55
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 LATEX IGE
|
Facility
|
IP
|
$35.79
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: Aetna Commercial |
$30.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.26
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.63
|
| Rate for Payer: Healthscope Commercial |
$32.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.42
|
| Rate for Payer: PHP Commercial |
$30.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.26
|
| Rate for Payer: Priority Health SBD |
$22.55
|
|
