|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$402.53
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$563.85 |
| Rate for Payer: Aetna Commercial |
$342.15
|
| Rate for Payer: Aetna Medicare |
$208.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.39
|
| Rate for Payer: BCBS Complete |
$112.73
|
| Rate for Payer: BCBS MAPPO |
$200.31
|
| Rate for Payer: BCN Medicare Advantage |
$200.31
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cofinity Commercial |
$346.18
|
| Rate for Payer: Cofinity Commercial |
$281.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.31
|
| Rate for Payer: Healthscope Commercial |
$362.28
|
| Rate for Payer: Mclaren Medicaid |
$107.37
|
| Rate for Payer: Mclaren Medicare |
$200.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.33
|
| Rate for Payer: Meridian Medicaid |
$112.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.15
|
| Rate for Payer: PACE Medicare |
$190.29
|
| Rate for Payer: PACE SWMI |
$200.31
|
| Rate for Payer: PHP Commercial |
$342.15
|
| Rate for Payer: PHP Medicare Advantage |
$200.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.64
|
| Rate for Payer: Priority Health Medicare |
$200.31
|
| Rate for Payer: Priority Health SBD |
$253.59
|
| Rate for Payer: Railroad Medicare Medicare |
$200.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.85
|
| Rate for Payer: UHC Core |
$297.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.31
|
| Rate for Payer: UHC Exchange |
$297.87
|
| Rate for Payer: UHC Medicare Advantage |
$200.31
|
| Rate for Payer: UHCCP Medicaid |
$112.77
|
| Rate for Payer: VA VA |
$200.31
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.29 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Aetna Commercial |
$82.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.23
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Healthscope Commercial |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: PHP Commercial |
$82.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: Priority Health SBD |
$61.29
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Aetna Commercial |
$82.69
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$87.55
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$82.69
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$61.29
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$14.02
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.19
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health SBD |
$58.34
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Cofinity Commercial |
$64.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$58.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$14.02
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,223.73 |
| Max. Negotiated Rate |
$1,748.19 |
| Rate for Payer: Aetna Commercial |
$1,651.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.58
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,359.70
|
| Rate for Payer: Cofinity Commercial |
$1,670.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,359.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Healthscope Commercial |
$1,748.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: PHP Commercial |
$1,651.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: Priority Health SBD |
$1,223.73
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.26 |
| Max. Negotiated Rate |
$3,756.32 |
| Rate for Payer: Aetna Commercial |
$1,651.07
|
| Rate for Payer: Aetna Medicare |
$1,387.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,668.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,668.05
|
| Rate for Payer: BCBS Complete |
$751.02
|
| Rate for Payer: BCBS MAPPO |
$1,334.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,334.44
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,670.49
|
| Rate for Payer: Cofinity Commercial |
$1,359.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,359.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,334.44
|
| Rate for Payer: Healthscope Commercial |
$1,748.19
|
| Rate for Payer: Mclaren Medicaid |
$715.26
|
| Rate for Payer: Mclaren Medicare |
$1,334.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,401.16
|
| Rate for Payer: Meridian Medicaid |
$751.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: PACE Medicare |
$1,267.72
|
| Rate for Payer: PACE SWMI |
$1,334.44
|
| Rate for Payer: PHP Commercial |
$1,651.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,334.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: Priority Health Medicare |
$1,334.44
|
| Rate for Payer: Priority Health SBD |
$1,223.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,334.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,756.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,334.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,334.44
|
| Rate for Payer: UHCCP Medicaid |
$751.29
|
| Rate for Payer: VA VA |
$1,334.44
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,388.71 |
| Max. Negotiated Rate |
$1,983.87 |
| Rate for Payer: Aetna Commercial |
$1,873.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$1,543.01
|
| Rate for Payer: Cofinity Commercial |
$1,895.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Healthscope Commercial |
$1,983.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.65
|
| Rate for Payer: PHP Commercial |
$1,873.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health SBD |
$1,388.71
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$254.63 |
| Max. Negotiated Rate |
$1,983.87 |
| Rate for Payer: Aetna Commercial |
$1,873.65
|
| Rate for Payer: Aetna Medicare |
$494.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.83
|
| Rate for Payer: BCBS Complete |
$267.36
|
| Rate for Payer: BCBS MAPPO |
$475.06
|
| Rate for Payer: BCN Medicare Advantage |
$475.06
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$1,895.70
|
| Rate for Payer: Cofinity Commercial |
$1,543.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.06
|
| Rate for Payer: Healthscope Commercial |
$1,983.87
|
| Rate for Payer: Mclaren Medicaid |
$254.63
|
| Rate for Payer: Mclaren Medicare |
$475.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.81
|
| Rate for Payer: Meridian Medicaid |
$267.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.65
|
| Rate for Payer: PACE Medicare |
$451.31
|
| Rate for Payer: PACE SWMI |
$475.06
|
| Rate for Payer: PHP Commercial |
$1,873.65
|
| Rate for Payer: PHP Medicare Advantage |
$475.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health Medicare |
$475.06
|
| Rate for Payer: Priority Health SBD |
$1,388.71
|
| Rate for Payer: Railroad Medicare Medicare |
$475.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,337.25
|
| Rate for Payer: UHC Core |
$1,631.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.06
|
| Rate for Payer: UHC Exchange |
$1,631.18
|
| Rate for Payer: UHC Medicare Advantage |
$475.06
|
| Rate for Payer: UHCCP Medicaid |
$267.46
|
| Rate for Payer: VA VA |
$475.06
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$2,598.00 |
| Rate for Payer: Aetna Commercial |
$2,453.67
|
| Rate for Payer: Aetna Medicare |
$685.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,876.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.70
|
| Rate for Payer: BCBS Complete |
$370.86
|
| Rate for Payer: BCBS MAPPO |
$658.96
|
| Rate for Payer: BCN Medicare Advantage |
$658.96
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,482.54
|
| Rate for Payer: Cofinity Commercial |
$2,020.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,020.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.96
|
| Rate for Payer: Healthscope Commercial |
$2,598.00
|
| Rate for Payer: Mclaren Medicaid |
$353.20
|
| Rate for Payer: Mclaren Medicare |
$658.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.91
|
| Rate for Payer: Meridian Medicaid |
$370.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: PACE Medicare |
$626.01
|
| Rate for Payer: PACE SWMI |
$658.96
|
| Rate for Payer: PHP Commercial |
$2,453.67
|
| Rate for Payer: PHP Medicare Advantage |
$658.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health Medicare |
$658.96
|
| Rate for Payer: Priority Health SBD |
$1,818.60
|
| Rate for Payer: Railroad Medicare Medicare |
$658.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.91
|
| Rate for Payer: UHC Core |
$2,136.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.96
|
| Rate for Payer: UHC Exchange |
$2,136.14
|
| Rate for Payer: UHC Medicare Advantage |
$658.96
|
| Rate for Payer: UHCCP Medicaid |
$370.99
|
| Rate for Payer: VA VA |
$658.96
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,818.60 |
| Max. Negotiated Rate |
$2,598.00 |
| Rate for Payer: Aetna Commercial |
$2,453.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,876.34
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,020.67
|
| Rate for Payer: Cofinity Commercial |
$2,482.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,020.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Healthscope Commercial |
$2,598.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: PHP Commercial |
$2,453.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health SBD |
$1,818.60
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$847.50 |
| Max. Negotiated Rate |
$1,210.72 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.41
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,156.91
|
| Rate for Payer: Cofinity Commercial |
$941.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$941.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Healthscope Commercial |
$1,210.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: PHP Commercial |
$1,143.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health SBD |
$847.50
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$1,854.91 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Aetna Medicare |
$685.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.70
|
| Rate for Payer: BCBS Complete |
$370.86
|
| Rate for Payer: BCBS MAPPO |
$658.96
|
| Rate for Payer: BCN Medicare Advantage |
$658.96
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$941.67
|
| Rate for Payer: Cofinity Commercial |
$1,156.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$941.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.96
|
| Rate for Payer: Healthscope Commercial |
$1,210.72
|
| Rate for Payer: Mclaren Medicaid |
$353.20
|
| Rate for Payer: Mclaren Medicare |
$658.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.91
|
| Rate for Payer: Meridian Medicaid |
$370.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: PACE Medicare |
$626.01
|
| Rate for Payer: PACE SWMI |
$658.96
|
| Rate for Payer: PHP Commercial |
$1,143.45
|
| Rate for Payer: PHP Medicare Advantage |
$658.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health Medicare |
$658.96
|
| Rate for Payer: Priority Health SBD |
$847.50
|
| Rate for Payer: Railroad Medicare Medicare |
$658.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.91
|
| Rate for Payer: UHC Core |
$995.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.96
|
| Rate for Payer: UHC Exchange |
$995.48
|
| Rate for Payer: UHC Medicare Advantage |
$658.96
|
| Rate for Payer: UHCCP Medicaid |
$370.99
|
| Rate for Payer: VA VA |
$658.96
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$251.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.06
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$206.83
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Healthscope Commercial |
$265.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: PHP Commercial |
$251.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health SBD |
$186.15
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.19 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$251.15
|
| Rate for Payer: Aetna Medicare |
$147.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.06
|
| Rate for Payer: BCBS Complete |
$118.19
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$206.83
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Healthscope Commercial |
$265.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: PHP Commercial |
$251.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health SBD |
$186.15
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health SBD |
$15.44
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Mclaren Medicaid |
$8.03
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$8.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Mclaren Medicaid |
$8.03
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$15.44
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$8.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health SBD |
$15.44
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$36.26 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health SBD |
$5.24
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$126.67 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$25.34
|
| Rate for Payer: VA VA |
$45.00
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| 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
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$148.78
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.73 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.71
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cofinity Commercial |
$104.15
|
| Rate for Payer: Cofinity Commercial |
$127.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.02
|
| Rate for Payer: Healthscope Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.46
|
| Rate for Payer: PHP Commercial |
$126.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.71
|
| Rate for Payer: Priority Health SBD |
$93.73
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$148.78
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.71
|
| Rate for Payer: BCBS Complete |
$59.51
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cofinity Commercial |
$104.15
|
| Rate for Payer: Cofinity Commercial |
$127.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.02
|
| Rate for Payer: Healthscope Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.46
|
| Rate for Payer: PHP Commercial |
$126.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.71
|
| Rate for Payer: Priority Health SBD |
$93.73
|
|
