|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$95.16
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Cofinity Commercial |
$145.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$131.05
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$35.69
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$131.05 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.21
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$145.61
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health SBD |
$131.05
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$262.79
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$223.37
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$96.70
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cofinity Commercial |
$183.95
|
| Rate for Payer: Cofinity Commercial |
$226.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$236.51
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.37
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$223.37
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$165.56
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$24.89
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$262.79
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.56 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$223.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.81
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cofinity Commercial |
$226.00
|
| Rate for Payer: Cofinity Commercial |
$183.95
|
| Rate for Payer: Healthscope Commercial |
$236.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.37
|
| Rate for Payer: PHP Commercial |
$223.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health SBD |
$165.56
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$12.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.51
|
| Rate for Payer: BCBS Complete |
$6.67
|
| Rate for Payer: BCBS MAPPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.09
|
| Rate for Payer: BCN Medicare Advantage |
$11.61
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.61
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$6.35
|
| Rate for Payer: Mclaren Medicare |
$11.61
|
| Rate for Payer: Meridian Medicaid |
$6.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$11.03
|
| Rate for Payer: PACE SWMI |
$11.61
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$11.61
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.93
|
| Rate for Payer: UHC Core |
$19.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.61
|
| Rate for Payer: UHC Exchange |
$11.61
|
| Rate for Payer: UHC Medicare Advantage |
$11.96
|
| Rate for Payer: VA VA |
$11.61
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$11.81
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$8.25
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Medicaid |
$8.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.10
|
| Rate for Payer: UHC Core |
$25.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$15.08
|
| Rate for Payer: UHC Medicare Advantage |
$15.53
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
IP
|
$184.75
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$166.28 |
| Rate for Payer: Aetna Commercial |
$157.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.09
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$129.32
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Healthscope Commercial |
$166.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.04
|
| Rate for Payer: PHP Commercial |
$157.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.32
|
| Rate for Payer: Priority Health SBD |
$116.39
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
OP
|
$184.75
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$166.28 |
| Rate for Payer: Aetna Commercial |
$157.04
|
| Rate for Payer: Aetna Medicare |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.32
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Cofinity Commercial |
$129.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$166.28
|
| Rate for Payer: Mclaren Medicaid |
$9.33
|
| Rate for Payer: Mclaren Medicare |
$17.06
|
| Rate for Payer: Meridian Medicaid |
$9.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.04
|
| Rate for Payer: PACE Medicare |
$16.21
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$157.04
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.32
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health SBD |
$116.39
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.47
|
| Rate for Payer: UHC Core |
$19.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.06
|
| Rate for Payer: UHC Exchange |
$17.06
|
| Rate for Payer: UHC Medicare Advantage |
$17.57
|
| Rate for Payer: VA VA |
$17.06
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.46
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health SBD |
$35.34
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$29.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.12
|
| Rate for Payer: BCBS Complete |
$16.14
|
| Rate for Payer: BCBS MAPPO |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$22.01
|
| Rate for Payer: BCN Medicare Advantage |
$28.10
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.10
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$15.37
|
| Rate for Payer: Mclaren Medicare |
$28.10
|
| Rate for Payer: Meridian Medicaid |
$16.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PACE Medicare |
$26.70
|
| Rate for Payer: PACE SWMI |
$28.10
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: PHP Medicare Advantage |
$28.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health Medicare |
$28.10
|
| Rate for Payer: Priority Health SBD |
$35.34
|
| Rate for Payer: Railroad Medicare Medicare |
$28.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.72
|
| Rate for Payer: UHC Core |
$47.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.10
|
| Rate for Payer: UHC Exchange |
$28.10
|
| Rate for Payer: UHC Medicare Advantage |
$28.94
|
| Rate for Payer: VA VA |
$28.10
|
|
|
HC VITAMIN C LEVEL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
30100112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC VITAMIN C LEVEL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
30100112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.36
|
| Rate for Payer: BCBS Complete |
$5.68
|
| Rate for Payer: BCBS MAPPO |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCN Medicare Advantage |
$9.89
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.89
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$5.41
|
| Rate for Payer: Mclaren Medicare |
$9.89
|
| Rate for Payer: Meridian Medicaid |
$5.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$9.40
|
| Rate for Payer: PACE SWMI |
$9.89
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$9.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$9.89
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$9.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.87
|
| Rate for Payer: UHC Core |
$16.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.89
|
| Rate for Payer: UHC Exchange |
$9.89
|
| Rate for Payer: UHC Medicare Advantage |
$10.19
|
| Rate for Payer: VA VA |
$9.89
|
|
|
HC VITAMIN D
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
30100481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC VITAMIN D
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
30100481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$30.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.00
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$29.60
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$16.19
|
| Rate for Payer: Mclaren Medicare |
$29.60
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$28.12
|
| Rate for Payer: PACE SWMI |
$29.60
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$29.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$29.60
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$29.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.52
|
| Rate for Payer: UHC Core |
$50.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.60
|
| Rate for Payer: UHC Exchange |
$29.60
|
| Rate for Payer: UHC Medicare Advantage |
$30.49
|
| Rate for Payer: VA VA |
$29.60
|
|
|
HC VITAMIN D 1-25 DIHYDROXY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
30100190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$40.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.12
|
| Rate for Payer: BCBS Complete |
$22.11
|
| Rate for Payer: BCBS MAPPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Medicare Advantage |
$38.50
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.50
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Mclaren Medicaid |
$21.06
|
| Rate for Payer: Mclaren Medicare |
$38.50
|
| Rate for Payer: Meridian Medicaid |
$22.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PACE Medicare |
$36.58
|
| Rate for Payer: PACE SWMI |
$38.50
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$38.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health Medicare |
$38.50
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Railroad Medicare Medicare |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.20
|
| Rate for Payer: UHC Core |
$65.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.50
|
| Rate for Payer: UHC Exchange |
$38.50
|
| Rate for Payer: UHC Medicare Advantage |
$39.66
|
| Rate for Payer: VA VA |
$38.50
|
|
|
HC VITAMIN D 1-25 DIHYDROXY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
30100190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC VITAMIN D LEVEL
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
30100126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$30.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.00
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$29.60
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$16.19
|
| Rate for Payer: Mclaren Medicare |
$29.60
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$28.12
|
| Rate for Payer: PACE SWMI |
$29.60
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$29.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$29.60
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$29.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.52
|
| Rate for Payer: UHC Core |
$50.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.60
|
| Rate for Payer: UHC Exchange |
$29.60
|
| Rate for Payer: UHC Medicare Advantage |
$30.49
|
| Rate for Payer: VA VA |
$29.60
|
|
|
HC VITAMIN D LEVEL
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
30100126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC VITAMIN E LEVEL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
30100440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$14.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.72
|
| Rate for Payer: BCBS Complete |
$8.14
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$11.11
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.76
|
| Rate for Payer: Mclaren Medicare |
$14.18
|
| Rate for Payer: Meridian Medicaid |
$8.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$13.47
|
| Rate for Payer: PACE SWMI |
$14.18
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$14.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$14.18
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.02
|
| Rate for Payer: UHC Core |
$24.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.18
|
| Rate for Payer: UHC Exchange |
$14.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.61
|
| Rate for Payer: VA VA |
$14.18
|
|
|
HC VITAMIN E LEVEL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
30100440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC VITAMIN K LEVEL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
30100459
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna Medicare |
$14.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.15
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS MAPPO |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$13.72
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.72
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Mclaren Medicaid |
$7.50
|
| Rate for Payer: Mclaren Medicare |
$13.72
|
| Rate for Payer: Meridian Medicaid |
$7.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.00
|
| Rate for Payer: PACE Medicare |
$13.03
|
| Rate for Payer: PACE SWMI |
$13.72
|
| Rate for Payer: PHP Commercial |
$102.00
|
| Rate for Payer: PHP Medicare Advantage |
$13.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health Medicare |
$13.72
|
| Rate for Payer: Priority Health SBD |
$75.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.72
|
| Rate for Payer: UHC Exchange |
$13.72
|
| Rate for Payer: UHC Medicare Advantage |
$14.13
|
| Rate for Payer: VA VA |
$13.72
|
|
|
HC VITAMIN K LEVEL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
30100459
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.00
|
| Rate for Payer: PHP Commercial |
$102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health SBD |
$75.60
|
|
|
HC VMA AND HVA 4 HOUR RANDOM URINE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$74.80
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$75.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$79.20
|
| Rate for Payer: Mclaren Medicaid |
$8.48
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Medicaid |
$8.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.80
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$74.80
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health SBD |
$55.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.60
|
| Rate for Payer: UHC Core |
$26.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Exchange |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.50
|
|
