|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
30100016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.85
|
| Rate for Payer: BCBS Complete |
$4.89
|
| Rate for Payer: BCBS MAPPO |
$8.68
|
| Rate for Payer: BCN Medicare Advantage |
$8.68
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.68
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Mclaren Medicaid |
$4.65
|
| Rate for Payer: Mclaren Medicare |
$8.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.11
|
| Rate for Payer: Meridian Medicaid |
$4.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: PACE Medicare |
$8.25
|
| Rate for Payer: PACE SWMI |
$8.68
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Medicare Advantage |
$8.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health Medicare |
$8.68
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Railroad Medicare Medicare |
$8.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.68
|
| Rate for Payer: UHC Medicare Advantage |
$8.68
|
| Rate for Payer: UHCCP Medicaid |
$4.89
|
| Rate for Payer: VA VA |
$8.68
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
30100016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health SBD |
$22.28
|
|
|
HC RENIN
|
Facility
|
IP
|
$41.51
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
30100419
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$37.36 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.98
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cofinity Commercial |
$29.06
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.21
|
| Rate for Payer: Healthscope Commercial |
$37.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.28
|
| Rate for Payer: PHP Commercial |
$35.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: Priority Health SBD |
$26.15
|
|
|
HC RENIN
|
Facility
|
OP
|
$41.51
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
30100419
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$61.90 |
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.49
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS MAPPO |
$21.99
|
| Rate for Payer: BCN Medicare Advantage |
$21.99
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$29.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.99
|
| Rate for Payer: Healthscope Commercial |
$37.36
|
| Rate for Payer: Mclaren Medicaid |
$11.79
|
| Rate for Payer: Mclaren Medicare |
$21.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.09
|
| Rate for Payer: Meridian Medicaid |
$12.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.28
|
| Rate for Payer: PACE Medicare |
$20.89
|
| Rate for Payer: PACE SWMI |
$21.99
|
| Rate for Payer: PHP Commercial |
$35.28
|
| Rate for Payer: PHP Medicare Advantage |
$21.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: Priority Health Medicare |
$21.99
|
| Rate for Payer: Priority Health SBD |
$26.15
|
| Rate for Payer: Railroad Medicare Medicare |
$21.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.99
|
| Rate for Payer: UHC Medicare Advantage |
$21.99
|
| Rate for Payer: UHCCP Medicaid |
$12.38
|
| Rate for Payer: VA VA |
$21.99
|
|
|
HC RENO 60 PER ML
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
HCPCS Q9961
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna Commercial |
$0.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.26
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Cofinity Commercial |
$0.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.34
|
| Rate for Payer: PHP Commercial |
$0.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.26
|
| Rate for Payer: Priority Health SBD |
$0.25
|
|
|
HC RENO 60 PER ML
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
HCPCS Q9961
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna Commercial |
$0.34
|
| Rate for Payer: Aetna Medicare |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.26
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Cofinity Commercial |
$0.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.34
|
| Rate for Payer: PHP Commercial |
$0.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.26
|
| Rate for Payer: Priority Health SBD |
$0.25
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
OP
|
$1,581.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$1,343.85
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,359.66
|
| Rate for Payer: Cofinity Commercial |
$1,106.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,106.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,264.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$1,422.90
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,343.85
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$1,343.85
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$996.03
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
IP
|
$1,581.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.03 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,343.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.65
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,106.70
|
| Rate for Payer: Cofinity Commercial |
$1,359.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,106.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,264.80
|
| Rate for Payer: Healthscope Commercial |
$1,422.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,343.85
|
| Rate for Payer: PHP Commercial |
$1,343.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health SBD |
$996.03
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
IP
|
$1,581.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.03 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,343.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.65
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,106.70
|
| Rate for Payer: Cofinity Commercial |
$1,359.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,106.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,264.80
|
| Rate for Payer: Healthscope Commercial |
$1,422.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,343.85
|
| Rate for Payer: PHP Commercial |
$1,343.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health SBD |
$996.03
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
OP
|
$1,581.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$1,343.85
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,359.66
|
| Rate for Payer: Cofinity Commercial |
$1,106.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,106.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,264.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$1,422.90
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,343.85
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$1,343.85
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$996.03
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
IP
|
$1,662.60
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,047.44 |
| Max. Negotiated Rate |
$1,496.34 |
| Rate for Payer: Aetna Commercial |
$1,413.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.69
|
| Rate for Payer: Cash Price |
$1,330.08
|
| Rate for Payer: Cofinity Commercial |
$1,163.82
|
| Rate for Payer: Cofinity Commercial |
$1,429.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,163.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,330.08
|
| Rate for Payer: Healthscope Commercial |
$1,496.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.21
|
| Rate for Payer: PHP Commercial |
$1,413.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.69
|
| Rate for Payer: Priority Health SBD |
$1,047.44
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
OP
|
$1,662.60
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$1,413.21
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$1,330.08
|
| Rate for Payer: Cash Price |
$1,330.08
|
| Rate for Payer: Cofinity Commercial |
$1,429.84
|
| Rate for Payer: Cofinity Commercial |
$1,163.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,163.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,330.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$1,496.34
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.21
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$1,413.21
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.69
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$1,047.44
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
IP
|
$1,069.35
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$673.69 |
| Max. Negotiated Rate |
$962.41 |
| Rate for Payer: Aetna Commercial |
$908.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.08
|
| Rate for Payer: Cash Price |
$855.48
|
| Rate for Payer: Cofinity Commercial |
$748.54
|
| Rate for Payer: Cofinity Commercial |
$919.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.48
|
| Rate for Payer: Healthscope Commercial |
$962.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.95
|
| Rate for Payer: PHP Commercial |
$908.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.08
|
| Rate for Payer: Priority Health SBD |
$673.69
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
OP
|
$1,069.35
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$1,697.33 |
| Rate for Payer: Aetna Commercial |
$908.95
|
| Rate for Payer: Aetna Medicare |
$627.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$855.48
|
| Rate for Payer: Cash Price |
$855.48
|
| Rate for Payer: Cofinity Commercial |
$919.64
|
| Rate for Payer: Cofinity Commercial |
$748.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$962.41
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.95
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$908.95
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.08
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health SBD |
$673.69
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,697.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$339.48
|
| Rate for Payer: VA VA |
$602.98
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
OP
|
$4,637.18
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$3,941.60
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,014.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$3,709.74
|
| Rate for Payer: Cash Price |
$3,709.74
|
| Rate for Payer: Cofinity Commercial |
$3,987.97
|
| Rate for Payer: Cofinity Commercial |
$3,246.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,246.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,709.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$4,173.46
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,941.60
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$3,941.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,014.17
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$2,921.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
IP
|
$4,637.18
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,921.42 |
| Max. Negotiated Rate |
$4,173.46 |
| Rate for Payer: Aetna Commercial |
$3,941.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,014.17
|
| Rate for Payer: Cash Price |
$3,709.74
|
| Rate for Payer: Cofinity Commercial |
$3,246.03
|
| Rate for Payer: Cofinity Commercial |
$3,987.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,246.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,709.74
|
| Rate for Payer: Healthscope Commercial |
$4,173.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,941.60
|
| Rate for Payer: PHP Commercial |
$3,941.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,014.17
|
| Rate for Payer: Priority Health SBD |
$2,921.42
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
OP
|
$4,291.95
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$3,648.16
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,789.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$3,433.56
|
| Rate for Payer: Cash Price |
$3,433.56
|
| Rate for Payer: Cofinity Commercial |
$3,691.08
|
| Rate for Payer: Cofinity Commercial |
$3,004.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,004.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,433.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$3,862.76
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,648.16
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$3,648.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,789.77
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$2,703.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
IP
|
$4,291.95
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,703.93 |
| Max. Negotiated Rate |
$3,862.76 |
| Rate for Payer: Aetna Commercial |
$3,648.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,789.77
|
| Rate for Payer: Cash Price |
$3,433.56
|
| Rate for Payer: Cofinity Commercial |
$3,004.36
|
| Rate for Payer: Cofinity Commercial |
$3,691.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,004.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,433.56
|
| Rate for Payer: Healthscope Commercial |
$3,862.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,648.16
|
| Rate for Payer: PHP Commercial |
$3,648.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,789.77
|
| Rate for Payer: Priority Health SBD |
$2,703.93
|
|
|
HC REPAIR OF CIRCUMCISION
|
Facility
|
IP
|
$5,814.00
|
|
|
Service Code
|
CPT 54163
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,662.82 |
| Max. Negotiated Rate |
$5,232.60 |
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.10
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Commercial |
$4,069.80
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,069.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,779.10
|
| Rate for Payer: Priority Health SBD |
$3,662.82
|
|
|
HC REPAIR OF CIRCUMCISION
|
Facility
|
OP
|
$5,814.00
|
|
|
Service Code
|
CPT 54163
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Cofinity Commercial |
$4,069.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,069.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,779.10
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$3,662.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC REPAIR SINGLE ELECTRODE PACEMAKER OR ICD
|
Facility
|
IP
|
$4,885.51
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
36100569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,077.87 |
| Max. Negotiated Rate |
$4,396.96 |
| Rate for Payer: Aetna Commercial |
$4,152.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,175.58
|
| Rate for Payer: Cash Price |
$3,908.41
|
| Rate for Payer: Cofinity Commercial |
$3,419.86
|
| Rate for Payer: Cofinity Commercial |
$4,201.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,419.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,908.41
|
| Rate for Payer: Healthscope Commercial |
$4,396.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,152.68
|
| Rate for Payer: PHP Commercial |
$4,152.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,175.58
|
| Rate for Payer: Priority Health SBD |
$3,077.87
|
|
|
HC REPAIR SINGLE ELECTRODE PACEMAKER OR ICD
|
Facility
|
OP
|
$4,885.51
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
36100569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,902.45 |
| Max. Negotiated Rate |
$9,991.04 |
| Rate for Payer: Aetna Commercial |
$4,152.68
|
| Rate for Payer: Aetna Medicare |
$3,691.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,175.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,436.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,436.68
|
| Rate for Payer: BCBS Complete |
$1,997.57
|
| Rate for Payer: BCBS MAPPO |
$3,549.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,549.34
|
| Rate for Payer: Cash Price |
$3,908.41
|
| Rate for Payer: Cash Price |
$3,908.41
|
| Rate for Payer: Cofinity Commercial |
$4,201.54
|
| Rate for Payer: Cofinity Commercial |
$3,419.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,419.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,908.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,549.34
|
| Rate for Payer: Healthscope Commercial |
$4,396.96
|
| Rate for Payer: Mclaren Medicaid |
$1,902.45
|
| Rate for Payer: Mclaren Medicare |
$3,549.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,726.81
|
| Rate for Payer: Meridian Medicaid |
$1,997.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,081.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,152.68
|
| Rate for Payer: PACE Medicare |
$3,371.87
|
| Rate for Payer: PACE SWMI |
$3,549.34
|
| Rate for Payer: PHP Commercial |
$4,152.68
|
| Rate for Payer: PHP Medicare Advantage |
$3,549.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,902.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,175.58
|
| Rate for Payer: Priority Health Medicare |
$3,549.34
|
| Rate for Payer: Priority Health SBD |
$3,077.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3,549.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,991.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,549.34
|
| Rate for Payer: UHC Medicare Advantage |
$3,549.34
|
| Rate for Payer: UHCCP Medicaid |
$1,998.28
|
| Rate for Payer: VA VA |
$3,549.34
|
|
|
HC REPAIR SPICA/BODY CAST
|
Facility
|
OP
|
$193.91
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
70000017
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$122.16
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC REPAIR SPICA/BODY CAST
|
Facility
|
IP
|
$193.91
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
70000017
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$174.52 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.04
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health SBD |
$122.16
|
|
|
HC REPAIR TENDON HAND/FINGER
|
Facility
|
IP
|
$4,214.96
|
|
| Hospital Charge Code |
45000096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,655.42 |
| Max. Negotiated Rate |
$3,793.46 |
| Rate for Payer: Aetna Commercial |
$3,582.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,739.72
|
| Rate for Payer: Cash Price |
$3,371.97
|
| Rate for Payer: Cofinity Commercial |
$2,950.47
|
| Rate for Payer: Cofinity Commercial |
$3,624.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,950.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,371.97
|
| Rate for Payer: Healthscope Commercial |
$3,793.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,582.72
|
| Rate for Payer: PHP Commercial |
$3,582.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,739.72
|
| Rate for Payer: Priority Health SBD |
$2,655.42
|
|
