|
HC SHAVE LESION FACE, EARS,EYELIDS, NOSE, LIPS, MUC MEMB 0.6 CM TO 1.0 CM
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
76100088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$177.40
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 CM OR LESS
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health SBD |
$101.95
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 CM OR LESS
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.6 TO 1.0 CM
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health SBD |
$101.95
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.6 TO 1.0 CM
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$177.40
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health SBD |
$177.40
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA >2CM
|
Facility
|
IP
|
$498.35
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.96 |
| Max. Negotiated Rate |
$448.51 |
| Rate for Payer: Aetna Commercial |
$423.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.93
|
| Rate for Payer: Cash Price |
$398.68
|
| Rate for Payer: Cofinity Commercial |
$348.85
|
| Rate for Payer: Cofinity Commercial |
$428.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.68
|
| Rate for Payer: Healthscope Commercial |
$448.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.60
|
| Rate for Payer: PHP Commercial |
$423.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.93
|
| Rate for Payer: Priority Health SBD |
$313.96
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA >2CM
|
Facility
|
OP
|
$498.35
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$423.60
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$398.68
|
| Rate for Payer: Cash Price |
$398.68
|
| Rate for Payer: Cofinity Commercial |
$428.58
|
| Rate for Payer: Cofinity Commercial |
$348.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$448.51
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.60
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$423.60
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.93
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$313.96
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC SHAVE LESION TRUCK, ARM, LEGS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SHAVE LESION TRUCK, ARM, LEGS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health SBD |
$101.95
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 0.5 CM OR LESS
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health SBD |
$101.95
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health SBD |
$101.95
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$102.98
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health SBD |
$92.68
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$102.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$92.68
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SHINGLES VACCINE
|
Facility
|
OP
|
$276.95
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.78 |
| Max. Negotiated Rate |
$249.25 |
| Rate for Payer: Aetna Commercial |
$235.41
|
| Rate for Payer: Aetna Medicare |
$138.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.02
|
| Rate for Payer: BCBS Complete |
$110.78
|
| Rate for Payer: Cash Price |
$221.56
|
| Rate for Payer: Cofinity Commercial |
$193.87
|
| Rate for Payer: Cofinity Commercial |
$238.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.56
|
| Rate for Payer: Healthscope Commercial |
$249.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.41
|
| Rate for Payer: PHP Commercial |
$235.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.02
|
| Rate for Payer: Priority Health SBD |
$174.48
|
|
|
HC SHINGLES VACCINE
|
Facility
|
IP
|
$276.95
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.48 |
| Max. Negotiated Rate |
$249.25 |
| Rate for Payer: Aetna Commercial |
$235.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.02
|
| Rate for Payer: Cash Price |
$221.56
|
| Rate for Payer: Cofinity Commercial |
$193.87
|
| Rate for Payer: Cofinity Commercial |
$238.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.56
|
| Rate for Payer: Healthscope Commercial |
$249.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.41
|
| Rate for Payer: PHP Commercial |
$235.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.02
|
| Rate for Payer: Priority Health SBD |
$174.48
|
|
|
HC SHRIMP IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC SHRIMP IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
