|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
OP
|
$1,548.26
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$424.26 |
| Max. Negotiated Rate |
$1,393.43 |
| Rate for Payer: Aetna Commercial |
$1,316.02
|
| Rate for Payer: Aetna Medicare |
$774.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.37
|
| Rate for Payer: BCBS Complete |
$619.30
|
| Rate for Payer: BCBS Trust/PPO |
$670.74
|
| Rate for Payer: BCN Commercial |
$670.74
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cofinity Commercial |
$1,331.50
|
| Rate for Payer: Cofinity Commercial |
$1,083.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,083.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.61
|
| Rate for Payer: Healthscope Commercial |
$1,393.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.02
|
| Rate for Payer: PHP Commercial |
$1,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.37
|
| Rate for Payer: Priority Health SBD |
$975.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.26
|
| Rate for Payer: UHC Exchange |
$1,145.71
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
IP
|
$1,548.26
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$975.40 |
| Max. Negotiated Rate |
$1,393.43 |
| Rate for Payer: Aetna Commercial |
$1,316.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.37
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cofinity Commercial |
$1,083.78
|
| Rate for Payer: Cofinity Commercial |
$1,331.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,083.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.61
|
| Rate for Payer: Healthscope Commercial |
$1,393.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.02
|
| Rate for Payer: PHP Commercial |
$1,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.37
|
| Rate for Payer: Priority Health SBD |
$975.40
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
IP
|
$2,365.89
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,490.51 |
| Max. Negotiated Rate |
$2,129.30 |
| Rate for Payer: Aetna Commercial |
$2,011.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.83
|
| Rate for Payer: Cash Price |
$1,892.71
|
| Rate for Payer: Cofinity Commercial |
$1,656.12
|
| Rate for Payer: Cofinity Commercial |
$2,034.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.71
|
| Rate for Payer: Healthscope Commercial |
$2,129.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.01
|
| Rate for Payer: PHP Commercial |
$2,011.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.83
|
| Rate for Payer: Priority Health SBD |
$1,490.51
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
OP
|
$2,365.89
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$424.26 |
| Max. Negotiated Rate |
$2,129.30 |
| Rate for Payer: Aetna Commercial |
$2,011.01
|
| Rate for Payer: Aetna Medicare |
$1,182.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.83
|
| Rate for Payer: BCBS Complete |
$946.36
|
| Rate for Payer: BCBS Trust/PPO |
$670.74
|
| Rate for Payer: BCN Commercial |
$670.74
|
| Rate for Payer: Cash Price |
$1,892.71
|
| Rate for Payer: Cash Price |
$1,892.71
|
| Rate for Payer: Cofinity Commercial |
$1,656.12
|
| Rate for Payer: Cofinity Commercial |
$2,034.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.71
|
| Rate for Payer: Healthscope Commercial |
$2,129.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.01
|
| Rate for Payer: PHP Commercial |
$2,011.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.83
|
| Rate for Payer: Priority Health SBD |
$1,490.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.26
|
| Rate for Payer: UHC Exchange |
$1,750.76
|
|
|
HC MR BRAIN W CON
|
Facility
|
IP
|
$2,487.28
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,566.99 |
| Max. Negotiated Rate |
$2,238.55 |
| Rate for Payer: Aetna Commercial |
$2,114.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.73
|
| Rate for Payer: Cash Price |
$1,989.82
|
| Rate for Payer: Cofinity Commercial |
$1,741.10
|
| Rate for Payer: Cofinity Commercial |
$2,139.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,741.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,989.82
|
| Rate for Payer: Healthscope Commercial |
$2,238.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.19
|
| Rate for Payer: PHP Commercial |
$2,114.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,616.73
|
| Rate for Payer: Priority Health SBD |
$1,566.99
|
|
|
HC MR BRAIN W CON
|
Facility
|
OP
|
$2,487.28
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,238.55 |
| Rate for Payer: Aetna Commercial |
$2,114.19
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$367.12
|
| Rate for Payer: BCN Commercial |
$367.12
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,989.82
|
| Rate for Payer: Cash Price |
$1,989.82
|
| Rate for Payer: Cofinity Commercial |
$2,139.06
|
| Rate for Payer: Cofinity Commercial |
$1,741.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,741.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,989.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,238.55
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.19
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,114.19
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,616.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,566.99
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,840.59
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BRAIN WO CON
|
Facility
|
IP
|
$2,072.90
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,305.93 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.38
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,451.03
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,451.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.96
|
| Rate for Payer: PHP Commercial |
$1,761.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.38
|
| Rate for Payer: Priority Health SBD |
$1,305.93
|
|
|
HC MR BRAIN WO CON
|
Facility
|
OP
|
$2,072.90
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.38
|
| 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 |
$249.56
|
| Rate for Payer: BCN Commercial |
$249.56
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Cofinity Commercial |
$1,451.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,451.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| 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 |
$1,761.96
|
| 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 |
$1,761.96
|
| 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 |
$1,347.38
|
| 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 |
$1,305.93
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,533.95
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
OP
|
$3,165.73
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,849.16 |
| Rate for Payer: Aetna Commercial |
$2,690.87
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,057.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$415.52
|
| Rate for Payer: BCN Commercial |
$415.52
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cofinity Commercial |
$2,722.53
|
| Rate for Payer: Cofinity Commercial |
$2,216.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,216.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,849.16
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.87
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,690.87
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,994.41
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$2,342.64
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
IP
|
$3,165.73
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,994.41 |
| Max. Negotiated Rate |
$2,849.16 |
| Rate for Payer: Aetna Commercial |
$2,690.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,057.72
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cofinity Commercial |
$2,216.01
|
| Rate for Payer: Cofinity Commercial |
$2,722.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,216.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.58
|
| Rate for Payer: Healthscope Commercial |
$2,849.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.87
|
| Rate for Payer: PHP Commercial |
$2,690.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.72
|
| Rate for Payer: Priority Health SBD |
$1,994.41
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
OP
|
$289.45
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$115.78 |
| Max. Negotiated Rate |
$461.41 |
| Rate for Payer: Aetna Commercial |
$246.03
|
| Rate for Payer: Aetna Medicare |
$144.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.14
|
| Rate for Payer: BCBS Complete |
$115.78
|
| Rate for Payer: BCBS Trust/PPO |
$461.41
|
| Rate for Payer: BCCCP Commercial |
$324.98
|
| Rate for Payer: BCN Commercial |
$461.41
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$248.93
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.56
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.03
|
| Rate for Payer: PHP Commercial |
$246.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.34
|
| Rate for Payer: Priority Health Narrow Network |
$215.47
|
| Rate for Payer: Priority Health SBD |
$182.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.62
|
| Rate for Payer: UHC Exchange |
$214.19
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
IP
|
$289.45
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$182.35 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.14
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Cofinity Commercial |
$248.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.56
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.03
|
| Rate for Payer: PHP Commercial |
$246.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health SBD |
$182.35
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$777.75
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$913.55
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health SBD |
$777.75
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
IP
|
$1,259.22
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$793.31 |
| Max. Negotiated Rate |
$1,133.30 |
| Rate for Payer: Aetna Commercial |
$1,070.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.49
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cofinity Commercial |
$1,082.93
|
| Rate for Payer: Cofinity Commercial |
$881.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.38
|
| Rate for Payer: Healthscope Commercial |
$1,133.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.34
|
| Rate for Payer: PHP Commercial |
$1,070.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.49
|
| Rate for Payer: Priority Health SBD |
$793.31
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
OP
|
$1,259.22
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,133.30 |
| Rate for Payer: Aetna Commercial |
$1,070.34
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cofinity Commercial |
$881.45
|
| Rate for Payer: Cofinity Commercial |
$1,082.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,133.30
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.34
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,070.34
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$793.31
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$931.82
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,343.74 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,493.04
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,493.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health SBD |
$1,343.74
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Cofinity Commercial |
$1,493.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,493.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,343.74
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,578.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
OP
|
$2,175.58
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$215.47 |
| Max. Negotiated Rate |
$1,958.02 |
| Rate for Payer: Aetna Commercial |
$1,849.24
|
| Rate for Payer: Aetna Medicare |
$1,087.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.13
|
| Rate for Payer: BCBS Complete |
$870.23
|
| Rate for Payer: BCBS Trust/PPO |
$461.41
|
| Rate for Payer: BCCCP Commercial |
$324.98
|
| Rate for Payer: BCN Commercial |
$461.41
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Commercial |
$1,871.00
|
| Rate for Payer: Cofinity Commercial |
$1,522.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,522.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Healthscope Commercial |
$1,958.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: PHP Commercial |
$1,849.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.34
|
| Rate for Payer: Priority Health Narrow Network |
$215.47
|
| Rate for Payer: Priority Health SBD |
$1,370.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.62
|
| Rate for Payer: UHC Exchange |
$1,609.93
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
IP
|
$2,175.58
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,370.62 |
| Max. Negotiated Rate |
$1,958.02 |
| Rate for Payer: Aetna Commercial |
$1,849.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.13
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Commercial |
$1,522.91
|
| Rate for Payer: Cofinity Commercial |
$1,871.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,522.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Healthscope Commercial |
$1,958.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: PHP Commercial |
$1,849.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.13
|
| Rate for Payer: Priority Health SBD |
$1,370.62
|
|
|
HC MR BREAST CAD
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC MR BREAST CAD
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UHC Exchange |
$30.80
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
IP
|
$908.41
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$572.30 |
| Max. Negotiated Rate |
$817.57 |
| Rate for Payer: Aetna Commercial |
$772.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.47
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cofinity Commercial |
$635.89
|
| Rate for Payer: Cofinity Commercial |
$781.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$635.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.73
|
| Rate for Payer: Healthscope Commercial |
$817.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.15
|
| Rate for Payer: PHP Commercial |
$772.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.47
|
| Rate for Payer: Priority Health SBD |
$572.30
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
OP
|
$908.41
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$817.57 |
| Rate for Payer: Aetna Commercial |
$772.15
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cofinity Commercial |
$781.23
|
| Rate for Payer: Cofinity Commercial |
$635.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$635.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$817.57
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.15
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$772.15
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$572.30
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$672.22
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$777.75
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$913.55
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
