|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$427.74 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$573.17
|
| Rate for Payer: Aetna Medicare |
$444.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.17
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$427.74
|
| Rate for Payer: BCN Medicare Advantage |
$427.74
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$615.95
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.74
|
| Rate for Payer: Healthscope Commercial |
$684.38
|
| Rate for Payer: Healthscope Commercial |
$791.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,025.05
|
| Rate for Payer: Nomi Health Commercial |
$513.29
|
| Rate for Payer: PACE SWMI |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$427.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$427.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.74
|
| Rate for Payer: UHC Medicare Advantage |
$427.74
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$993.51 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$993.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$427.74 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$573.17
|
| Rate for Payer: Aetna Medicare |
$444.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.17
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$427.74
|
| Rate for Payer: BCN Medicare Advantage |
$427.74
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$615.95
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.74
|
| Rate for Payer: Healthscope Commercial |
$791.32
|
| Rate for Payer: Healthscope Commercial |
$684.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,025.05
|
| Rate for Payer: Nomi Health Commercial |
$513.29
|
| Rate for Payer: PACE SWMI |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$427.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$427.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.74
|
| Rate for Payer: UHC Medicare Advantage |
$427.74
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$993.51 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.05
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health SBD |
$993.51
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
38510
|
| Min. Negotiated Rate |
$403.02 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$540.05
|
| Rate for Payer: Aetna Medicare |
$419.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.35
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$403.02
|
| Rate for Payer: BCN Medicare Advantage |
$403.02
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$580.35
|
| Rate for Payer: Cofinity Commercial |
$540.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.02
|
| Rate for Payer: Healthscope Commercial |
$644.83
|
| Rate for Payer: Healthscope Commercial |
$745.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,025.05
|
| Rate for Payer: Nomi Health Commercial |
$483.62
|
| Rate for Payer: PACE SWMI |
$403.02
|
| Rate for Payer: PHP Medicare Advantage |
$403.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$403.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.02
|
| Rate for Payer: UHC Medicare Advantage |
$403.02
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$993.51 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.05
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health SBD |
$993.51
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$993.51 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$993.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$403.02 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$540.05
|
| Rate for Payer: Aetna Medicare |
$419.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.05
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$403.02
|
| Rate for Payer: BCN Medicare Advantage |
$403.02
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$580.35
|
| Rate for Payer: Cofinity Commercial |
$540.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.02
|
| Rate for Payer: Healthscope Commercial |
$644.83
|
| Rate for Payer: Healthscope Commercial |
$745.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,025.05
|
| Rate for Payer: Nomi Health Commercial |
$483.62
|
| Rate for Payer: PACE SWMI |
$403.02
|
| Rate for Payer: PHP Medicare Advantage |
$403.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$403.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.02
|
| Rate for Payer: UHC Medicare Advantage |
$403.02
|
|
|
PR BX/EXC LYMPH NODE OPEN INT MAMMARY NODE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 38530
|
| Min. Negotiated Rate |
$548.84 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$735.45
|
| Rate for Payer: Aetna Medicare |
$570.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$790.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$548.84
|
| Rate for Payer: BCN Medicare Advantage |
$548.84
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$790.33
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.84
|
| Rate for Payer: Healthscope Commercial |
$878.14
|
| Rate for Payer: Healthscope Commercial |
$1,015.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.65
|
| Rate for Payer: Nomi Health Commercial |
$658.61
|
| Rate for Payer: PACE SWMI |
$548.84
|
| Rate for Payer: PHP Medicare Advantage |
$548.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$548.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.84
|
| Rate for Payer: UHC Medicare Advantage |
$548.84
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
38500
|
| Min. Negotiated Rate |
$246.15 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$329.84
|
| Rate for Payer: Aetna Medicare |
$256.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.46
|
| Rate for Payer: BCBS Complete |
$378.80
|
| Rate for Payer: BCBS MAPPO |
$246.15
|
| Rate for Payer: BCN Medicare Advantage |
$246.15
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$329.84
|
| Rate for Payer: Cofinity Commercial |
$354.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.15
|
| Rate for Payer: Healthscope Commercial |
$455.38
|
| Rate for Payer: Healthscope Commercial |
$393.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.55
|
| Rate for Payer: Nomi Health Commercial |
$295.38
|
| Rate for Payer: PACE SWMI |
$246.15
|
| Rate for Payer: PHP Medicare Advantage |
$246.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health Medicare |
$246.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.15
|
| Rate for Payer: UHC Medicare Advantage |
$246.15
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$596.61 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Aetna Commercial |
$804.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.55
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$662.90
|
| Rate for Payer: Cofinity Commercial |
$814.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$662.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.60
|
| Rate for Payer: Healthscope Commercial |
$852.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.95
|
| Rate for Payer: PHP Commercial |
$804.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health SBD |
$596.61
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$246.15 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$329.84
|
| Rate for Payer: Aetna Medicare |
$256.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.84
|
| Rate for Payer: BCBS Complete |
$378.80
|
| Rate for Payer: BCBS MAPPO |
$246.15
|
| Rate for Payer: BCN Medicare Advantage |
$246.15
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$354.46
|
| Rate for Payer: Cofinity Commercial |
$329.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.15
|
| Rate for Payer: Healthscope Commercial |
$393.84
|
| Rate for Payer: Healthscope Commercial |
$455.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.55
|
| Rate for Payer: Nomi Health Commercial |
$295.38
|
| Rate for Payer: PACE SWMI |
$246.15
|
| Rate for Payer: PHP Medicare Advantage |
$246.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health Medicare |
$246.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.15
|
| Rate for Payer: UHC Medicare Advantage |
$246.15
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$596.61 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$804.95
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$814.42
|
| Rate for Payer: Cofinity Commercial |
$662.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$662.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$852.30
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.95
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$804.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$596.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$1,163.61 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$1,569.95
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,588.42
|
| Rate for Payer: Cofinity Commercial |
$1,292.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,292.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,662.30
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.95
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$1,569.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$1,163.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$452.61 |
| Max. Negotiated Rate |
$1,200.55 |
| Rate for Payer: Aetna Commercial |
$606.50
|
| Rate for Payer: Aetna Medicare |
$470.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.50
|
| Rate for Payer: BCBS Complete |
$738.80
|
| Rate for Payer: BCBS MAPPO |
$452.61
|
| Rate for Payer: BCN Medicare Advantage |
$452.61
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$651.76
|
| Rate for Payer: Cofinity Commercial |
$606.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.61
|
| Rate for Payer: Healthscope Commercial |
$837.33
|
| Rate for Payer: Healthscope Commercial |
$724.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.55
|
| Rate for Payer: Nomi Health Commercial |
$543.13
|
| Rate for Payer: PACE SWMI |
$452.61
|
| Rate for Payer: PHP Medicare Advantage |
$452.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health Medicare |
$452.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.61
|
| Rate for Payer: UHC Medicare Advantage |
$452.61
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$1,163.61 |
| Max. Negotiated Rate |
$1,662.30 |
| Rate for Payer: Aetna Commercial |
$1,569.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.55
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,292.90
|
| Rate for Payer: Cofinity Commercial |
$1,588.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,292.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.60
|
| Rate for Payer: Healthscope Commercial |
$1,662.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.95
|
| Rate for Payer: PHP Commercial |
$1,569.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health SBD |
$1,163.61
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 38520
|
| Min. Negotiated Rate |
$452.61 |
| Max. Negotiated Rate |
$1,200.55 |
| Rate for Payer: Aetna Commercial |
$606.50
|
| Rate for Payer: Aetna Medicare |
$470.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.50
|
| Rate for Payer: BCBS Complete |
$738.80
|
| Rate for Payer: BCBS MAPPO |
$452.61
|
| Rate for Payer: BCN Medicare Advantage |
$452.61
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$651.76
|
| Rate for Payer: Cofinity Commercial |
$606.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.61
|
| Rate for Payer: Healthscope Commercial |
$837.33
|
| Rate for Payer: Healthscope Commercial |
$724.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.55
|
| Rate for Payer: Nomi Health Commercial |
$543.13
|
| Rate for Payer: PACE SWMI |
$452.61
|
| Rate for Payer: PHP Medicare Advantage |
$452.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health Medicare |
$452.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.61
|
| Rate for Payer: UHC Medicare Advantage |
$452.61
|
|
|
PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 44100
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$237.25 |
| Rate for Payer: Aetna Commercial |
$134.35
|
| Rate for Payer: Aetna Medicare |
$104.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.35
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: BCBS MAPPO |
$100.26
|
| Rate for Payer: BCN Medicare Advantage |
$100.26
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$144.37
|
| Rate for Payer: Cofinity Commercial |
$134.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.26
|
| Rate for Payer: Healthscope Commercial |
$160.42
|
| Rate for Payer: Healthscope Commercial |
$185.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.25
|
| Rate for Payer: Nomi Health Commercial |
$120.31
|
| Rate for Payer: PACE SWMI |
$100.26
|
| Rate for Payer: PHP Medicare Advantage |
$100.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health Medicare |
$100.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.26
|
| Rate for Payer: UHC Medicare Advantage |
$100.26
|
|
|
PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$187.35 |
| Rate for Payer: Aetna Commercial |
$135.70
|
| Rate for Payer: Aetna Medicare |
$105.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.70
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$101.27
|
| Rate for Payer: BCN Medicare Advantage |
$101.27
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$145.83
|
| Rate for Payer: Cofinity Commercial |
$135.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.27
|
| Rate for Payer: Healthscope Commercial |
$187.35
|
| Rate for Payer: Healthscope Commercial |
$162.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.20
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: PACE SWMI |
$101.27
|
| Rate for Payer: PHP Medicare Advantage |
$101.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health Medicare |
$101.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.27
|
| Rate for Payer: UHC Medicare Advantage |
$101.27
|
|
|
PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 42806
|
| Min. Negotiated Rate |
$133.35 |
| Max. Negotiated Rate |
$262.60 |
| Rate for Payer: Aetna Commercial |
$178.69
|
| Rate for Payer: Aetna Medicare |
$138.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.69
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$133.35
|
| Rate for Payer: BCN Medicare Advantage |
$133.35
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$192.02
|
| Rate for Payer: Cofinity Commercial |
$178.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.35
|
| Rate for Payer: Healthscope Commercial |
$213.36
|
| Rate for Payer: Healthscope Commercial |
$246.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.60
|
| Rate for Payer: Nomi Health Commercial |
$160.02
|
| Rate for Payer: PACE SWMI |
$133.35
|
| Rate for Payer: PHP Medicare Advantage |
$133.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$133.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.35
|
| Rate for Payer: UHC Medicare Advantage |
$133.35
|
|
|
PR BX OF BREAST, NEEDLE CORE, IMAGE GUIDE
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 19102
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Medicare |
$207.00
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
|
|
PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 55706
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$664.65 |
| Rate for Payer: Aetna Commercial |
$481.42
|
| Rate for Payer: Aetna Medicare |
$373.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.35
|
| Rate for Payer: BCBS Complete |
$286.00
|
| Rate for Payer: BCBS MAPPO |
$359.27
|
| Rate for Payer: BCN Medicare Advantage |
$359.27
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$517.35
|
| Rate for Payer: Cofinity Commercial |
$481.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.27
|
| Rate for Payer: Healthscope Commercial |
$664.65
|
| Rate for Payer: Healthscope Commercial |
$574.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.75
|
| Rate for Payer: Nomi Health Commercial |
$431.12
|
| Rate for Payer: PACE SWMI |
$359.27
|
| Rate for Payer: PHP Medicare Advantage |
$359.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.75
|
| Rate for Payer: Priority Health Medicare |
$359.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.27
|
| Rate for Payer: UHC Medicare Advantage |
$359.27
|
|
|
PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 35681
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$102.22
|
| Rate for Payer: Aetna Medicare |
$79.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.84
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$76.28
|
| Rate for Payer: BCN Medicare Advantage |
$76.28
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$102.22
|
| Rate for Payer: Cofinity Commercial |
$109.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.28
|
| Rate for Payer: Healthscope Commercial |
$122.05
|
| Rate for Payer: Healthscope Commercial |
$141.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.05
|
| Rate for Payer: Nomi Health Commercial |
$91.54
|
| Rate for Payer: PACE SWMI |
$76.28
|
| Rate for Payer: PHP Medicare Advantage |
$76.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$76.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.28
|
| Rate for Payer: UHC Medicare Advantage |
$76.28
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC
|
Professional
|
Both
|
$3,305.00
|
|
|
Service Code
|
HCPCS 35632
|
| Min. Negotiated Rate |
$1,322.00 |
| Max. Negotiated Rate |
$3,220.02 |
| Rate for Payer: Aetna Commercial |
$2,332.34
|
| Rate for Payer: Aetna Medicare |
$1,810.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,506.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,332.34
|
| Rate for Payer: BCBS Complete |
$1,322.00
|
| Rate for Payer: BCBS MAPPO |
$1,740.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,740.55
|
| Rate for Payer: Cash Price |
$2,644.00
|
| Rate for Payer: Cash Price |
$2,644.00
|
| Rate for Payer: Cofinity Commercial |
$2,506.39
|
| Rate for Payer: Cofinity Commercial |
$2,332.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,740.55
|
| Rate for Payer: Healthscope Commercial |
$3,220.02
|
| Rate for Payer: Healthscope Commercial |
$2,784.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,827.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,148.25
|
| Rate for Payer: Nomi Health Commercial |
$2,088.66
|
| Rate for Payer: PACE SWMI |
$1,740.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,740.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,148.25
|
| Rate for Payer: Priority Health Medicare |
$1,740.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,740.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,740.55
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
|
Professional
|
Both
|
$3,702.00
|
|
|
Service Code
|
HCPCS 35633
|
| Min. Negotiated Rate |
$1,480.80 |
| Max. Negotiated Rate |
$3,515.15 |
| Rate for Payer: Aetna Commercial |
$2,546.11
|
| Rate for Payer: Aetna Medicare |
$1,976.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,736.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,546.11
|
| Rate for Payer: BCBS Complete |
$1,480.80
|
| Rate for Payer: BCBS MAPPO |
$1,900.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,900.08
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cofinity Commercial |
$2,736.12
|
| Rate for Payer: Cofinity Commercial |
$2,546.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,900.08
|
| Rate for Payer: Healthscope Commercial |
$3,040.13
|
| Rate for Payer: Healthscope Commercial |
$3,515.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,995.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,406.30
|
| Rate for Payer: Nomi Health Commercial |
$2,280.10
|
| Rate for Payer: PACE SWMI |
$1,900.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,900.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,406.30
|
| Rate for Payer: Priority Health Medicare |
$1,900.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,900.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,900.08
|
|
