|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$714.47
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$450.12 |
| Max. Negotiated Rate |
$643.02 |
| Rate for Payer: Aetna Commercial |
$607.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.41
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$500.13
|
| Rate for Payer: Cofinity Commercial |
$614.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.58
|
| Rate for Payer: Healthscope Commercial |
$643.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.30
|
| Rate for Payer: PHP Commercial |
$607.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.41
|
| Rate for Payer: Priority Health SBD |
$450.12
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
OP
|
$714.47
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$607.30
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCCCP Commercial |
$50.35
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$614.44
|
| Rate for Payer: Cofinity Commercial |
$500.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$643.02
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.30
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$607.30
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$450.12
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$528.71
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
IP
|
$84.15
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Aetna Commercial |
$71.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.70
|
| Rate for Payer: Cash Price |
$67.32
|
| Rate for Payer: Cofinity Commercial |
$58.90
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.32
|
| Rate for Payer: Healthscope Commercial |
$75.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.53
|
| Rate for Payer: PHP Commercial |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.70
|
| Rate for Payer: Priority Health SBD |
$53.01
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
OP
|
$84.15
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Aetna Commercial |
$71.53
|
| Rate for Payer: Aetna Medicare |
$42.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.70
|
| Rate for Payer: BCBS Complete |
$33.66
|
| Rate for Payer: Cash Price |
$67.32
|
| Rate for Payer: Cofinity Commercial |
$58.90
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.32
|
| Rate for Payer: Healthscope Commercial |
$75.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.53
|
| Rate for Payer: PHP Commercial |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.70
|
| Rate for Payer: Priority Health SBD |
$53.01
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,856.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health SBD |
$2,570.40
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.46 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$621.68
|
| Rate for Payer: BCN Commercial |
$621.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Cofinity Commercial |
$2,856.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,856.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$2,570.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.46
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$882.81
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$345.93
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.22
|
| Rate for Payer: Priority Health SBD |
$311.34
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$47.14
|
| Rate for Payer: BCN Commercial |
$47.14
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Cofinity Commercial |
$345.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$311.34
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.62
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$132.32
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
OP
|
$1,492.97
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Commercial |
$1,269.02
|
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$265.42
|
| Rate for Payer: BCN Commercial |
$265.42
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cofinity Commercial |
$1,045.08
|
| Rate for Payer: Cofinity Commercial |
$1,283.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,194.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$1,343.67
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.02
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$1,269.02
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Priority Health SBD |
$940.57
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.38
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
IP
|
$1,492.97
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$940.57 |
| Max. Negotiated Rate |
$1,343.67 |
| Rate for Payer: Aetna Commercial |
$1,269.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.43
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cofinity Commercial |
$1,045.08
|
| Rate for Payer: Cofinity Commercial |
$1,283.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,194.38
|
| Rate for Payer: Healthscope Commercial |
$1,343.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.02
|
| Rate for Payer: PHP Commercial |
$1,269.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.43
|
| Rate for Payer: Priority Health SBD |
$940.57
|
|
|
HC MANTIS CLIP
|
Facility
|
IP
|
$1,156.68
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$1,041.01 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.84
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cofinity Commercial |
$809.68
|
| Rate for Payer: Cofinity Commercial |
$994.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$809.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.34
|
| Rate for Payer: Healthscope Commercial |
$1,041.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.18
|
| Rate for Payer: PHP Commercial |
$983.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.84
|
| Rate for Payer: Priority Health SBD |
$728.71
|
|
|
HC MANTIS CLIP
|
Facility
|
OP
|
$1,156.68
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,041.01 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna Medicare |
$578.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.84
|
| Rate for Payer: BCBS Complete |
$462.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cofinity Commercial |
$809.68
|
| Rate for Payer: Cofinity Commercial |
$994.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$809.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.34
|
| Rate for Payer: Healthscope Commercial |
$1,041.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.18
|
| Rate for Payer: PHP Commercial |
$983.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.84
|
| Rate for Payer: Priority Health SBD |
$728.71
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Mclaren Medicaid |
$2.04
|
| Rate for Payer: Mclaren Medicare |
$3.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: Meridian Medicaid |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$5.70
|
| Rate for Payer: PACE Medicare |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.80
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Narrow Network |
$3.04
|
| Rate for Payer: Priority Health SBD |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$2.14
|
| Rate for Payer: VA VA |
$3.80
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$29.18
|
|
|
HC MAPLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
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 MAPLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
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 MAPPING W/INTRACARDIAC 3D
|
Facility
|
OP
|
$6,169.57
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$307.14 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: Aetna Medicare |
$3,084.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,010.22
|
| Rate for Payer: BCBS Complete |
$2,467.83
|
| Rate for Payer: BCBS Trust/PPO |
$307.14
|
| Rate for Payer: BCN Commercial |
$307.14
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$4,318.70
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,318.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,010.22
|
| Rate for Payer: Priority Health SBD |
$3,886.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.75
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
IP
|
$6,169.57
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,886.83 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,010.22
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$4,318.70
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,318.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,010.22
|
| Rate for Payer: Priority Health SBD |
$3,886.83
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
OP
|
$4,398.08
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$453.33 |
| Max. Negotiated Rate |
$3,958.27 |
| Rate for Payer: Aetna Commercial |
$3,738.37
|
| Rate for Payer: Aetna Medicare |
$2,199.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,858.75
|
| Rate for Payer: BCBS Complete |
$1,759.23
|
| Rate for Payer: BCBS Trust/PPO |
$453.33
|
| Rate for Payer: BCN Commercial |
$453.33
|
| Rate for Payer: Cash Price |
$3,518.46
|
| Rate for Payer: Cash Price |
$3,518.46
|
| Rate for Payer: Cash Price |
$3,518.46
|
| Rate for Payer: Cofinity Commercial |
$3,078.66
|
| Rate for Payer: Cofinity Commercial |
$3,782.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,078.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.46
|
| Rate for Payer: Healthscope Commercial |
$3,958.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.37
|
| Rate for Payer: PHP Commercial |
$3,738.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,858.75
|
| Rate for Payer: Priority Health SBD |
$2,770.79
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
IP
|
$4,398.08
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,770.79 |
| Max. Negotiated Rate |
$3,958.27 |
| Rate for Payer: Aetna Commercial |
$3,738.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,858.75
|
| Rate for Payer: Cash Price |
$3,518.46
|
| Rate for Payer: Cofinity Commercial |
$3,078.66
|
| Rate for Payer: Cofinity Commercial |
$3,782.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,078.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.46
|
| Rate for Payer: Healthscope Commercial |
$3,958.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.37
|
| Rate for Payer: PHP Commercial |
$3,738.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,858.75
|
| Rate for Payer: Priority Health SBD |
$2,770.79
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,005.68 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.59
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$5,561.87
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,561.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health SBD |
$5,005.68
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.94 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,429.38
|
| Rate for Payer: BCN Commercial |
$1,429.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Cofinity Commercial |
$5,561.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,561.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$5,005.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.94
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,076.54 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.95 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$840.61
|
| Rate for Payer: BCN Commercial |
$840.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.95
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,788.93
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
HC MASSAGE THERAPY
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
