Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$78.00

Service Code	HCPCS 94617
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$124.68
Rate for Payer: Aetna Commercial	$100.14
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$124.68
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.78
Rate for Payer: Priority Health Narrow Network	$41.78
Rate for Payer: Priority Health SBD	$116.78

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$157.00

Service Code	HCPCS 94619
Min. Negotiated Rate	$29.65
Max. Negotiated Rate	$225.12
Rate for Payer: Aetna Commercial	$77.64
Rate for Payer: BCBS Complete	$62.80
Rate for Payer: BCBS Trust/PPO	$225.12
Rate for Payer: Cash Price	$125.60
Rate for Payer: Cash Price	$125.60
Rate for Payer: Priority Health Cigna Priority Health	$109.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.65
Rate for Payer: Priority Health Narrow Network	$29.65
Rate for Payer: Priority Health SBD	$102.40

PR XTRNL ECG & 48 HR RECORDING

Professional

Both

$118.00

Service Code	HCPCS 93225
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$2,547.99
Rate for Payer: Aetna Commercial	$24.92
Rate for Payer: BCBS Complete	$47.20
Rate for Payer: BCBS Trust/PPO	$2,547.99
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.01
Rate for Payer: Priority Health Narrow Network	$26.01
Rate for Payer: Priority Health SBD	$26.01

PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I

Professional

Both

$230.00

Service Code	HCPCS 93224
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$1,872.30
Rate for Payer: Aetna Commercial	$100.86
Rate for Payer: BCBS Complete	$92.00
Rate for Payer: BCBS Trust/PPO	$1,872.30
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Priority Health Cigna Priority Health	$161.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.62
Rate for Payer: Priority Health Narrow Network	$102.62
Rate for Payer: Priority Health SBD	$102.62

PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS

Professional

Both

$196.00

Service Code	HCPCS 93227
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$2,081.50
Rate for Payer: Aetna Commercial	$24.84
Rate for Payer: BCBS Complete	$12.08
Rate for Payer: BCBS Trust/PPO	$2,081.50
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Mclaren Medicaid	$11.50
Rate for Payer: Meridian Medicaid	$12.08
Rate for Payer: Priority Health Choice Medicaid	$11.50
Rate for Payer: Priority Health Cigna Priority Health	$137.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.54
Rate for Payer: Priority Health Narrow Network	$25.54
Rate for Payer: Priority Health SBD	$25.54

PR XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT

Professional

Both

$3,819.00

Service Code	HCPCS 20697
Min. Negotiated Rate	$578.50
Max. Negotiated Rate	$2,803.47
Rate for Payer: Aetna Commercial	$2,627.28
Rate for Payer: BCBS Complete	$1,527.60
Rate for Payer: BCBS Trust/PPO	$578.50
Rate for Payer: Cash Price	$3,055.20
Rate for Payer: Cash Price	$3,055.20
Rate for Payer: Priority Health Cigna Priority Health	$2,673.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,803.47
Rate for Payer: Priority Health Narrow Network	$2,803.47
Rate for Payer: Priority Health SBD	$2,803.47

PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS

Professional

Both

$57.00

Service Code	HCPCS 93228
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$454.34
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: BCBS Complete	$16.55
Rate for Payer: BCBS Trust/PPO	$454.34
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Mclaren Medicaid	$15.76
Rate for Payer: Meridian Medicaid	$16.55
Rate for Payer: Priority Health Choice Medicaid	$15.76
Rate for Payer: Priority Health Cigna Priority Health	$39.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.47
Rate for Payer: Priority Health Narrow Network	$35.47
Rate for Payer: Priority Health SBD	$35.47

PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS

Professional

Both

$641.00

Service Code	HCPCS 93271
Min. Negotiated Rate	$206.02
Max. Negotiated Rate	$867.47
Rate for Payer: Aetna Commercial	$206.02
Rate for Payer: BCBS Complete	$256.40
Rate for Payer: BCBS Trust/PPO	$867.47
Rate for Payer: Cash Price	$512.80
Rate for Payer: Cash Price	$512.80
Rate for Payer: Priority Health Cigna Priority Health	$448.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$206.65
Rate for Payer: Priority Health Narrow Network	$206.65
Rate for Payer: Priority Health SBD	$206.65

PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS

Professional

Both

$121.00

Service Code	HCPCS 93270
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$1,098.86
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS Trust/PPO	$1,098.86
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$84.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.82
Rate for Payer: Priority Health Narrow Network	$11.82
Rate for Payer: Priority Health SBD	$11.82

PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS

Professional

Both

$854.00

Service Code	HCPCS 93268
Min. Negotiated Rate	$250.35
Max. Negotiated Rate	$869.58
Rate for Payer: Aetna Commercial	$250.35
Rate for Payer: BCBS Complete	$341.60
Rate for Payer: BCBS Trust/PPO	$869.58
Rate for Payer: Cash Price	$683.20
Rate for Payer: Cash Price	$683.20
Rate for Payer: Priority Health Cigna Priority Health	$597.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$252.04
Rate for Payer: Priority Health Narrow Network	$252.04
Rate for Payer: Priority Health SBD	$252.04

PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS

Professional

Both

$171.00

Service Code	HCPCS 93272
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$934.03
Rate for Payer: Aetna Commercial	$33.14
Rate for Payer: BCBS Complete	$15.88
Rate for Payer: BCBS Trust/PPO	$934.03
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Mclaren Medicaid	$15.12
Rate for Payer: Meridian Medicaid	$15.88
Rate for Payer: Priority Health Choice Medicaid	$15.12
Rate for Payer: Priority Health Cigna Priority Health	$119.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$33.57
Rate for Payer: Priority Health Narrow Network	$33.57
Rate for Payer: Priority Health SBD	$33.57

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL

Professional

Both

$596.00

Service Code	HCPCS 41015
Min. Negotiated Rate	$191.27
Max. Negotiated Rate	$1,058.71
Rate for Payer: Aetna Commercial	$398.41
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCBS Trust/PPO	$1,058.71
Rate for Payer: Cash Price	$476.80
Rate for Payer: Cash Price	$476.80
Rate for Payer: Mclaren Medicaid	$191.27
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health	$417.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$523.30
Rate for Payer: Priority Health Narrow Network	$523.30
Rate for Payer: Priority Health SBD	$523.30

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB

Professional

Both

$884.00

Service Code	HCPCS 41017
Min. Negotiated Rate	$219.39
Max. Negotiated Rate	$640.30
Rate for Payer: Aetna Commercial	$454.51
Rate for Payer: BCBS Complete	$230.36
Rate for Payer: BCBS Trust/PPO	$640.30
Rate for Payer: Cash Price	$707.20
Rate for Payer: Cash Price	$707.20
Rate for Payer: Mclaren Medicaid	$219.39
Rate for Payer: Meridian Medicaid	$230.36
Rate for Payer: Priority Health Choice Medicaid	$219.39
Rate for Payer: Priority Health Cigna Priority Health	$618.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$604.44
Rate for Payer: Priority Health Narrow Network	$604.44
Rate for Payer: Priority Health SBD	$604.44

PR ZINC PASTE BAND W >=3<5/YD

Professional

Both

$18.00

Service Code	HCPCS A6456
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$1.18
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$12.60

PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE

Professional

Both

$242.00

Service Code	HCPCS 90736
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$221.01
Rate for Payer: Aetna Commercial	$216.92
Rate for Payer: BCBS Complete	$96.80
Rate for Payer: BCBS Trust/PPO	$221.01
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Priority Health Cigna Priority Health	$169.40

PSEUDOEPHEDRINE 30 MG TABLET

Facility

$70.50

Service Code	NDC 0904-6990-61
Hospital Charge Code	6714
Hospital Revenue Code	637
Min. Negotiated Rate	$44.42
Max. Negotiated Rate	$63.45
Rate for Payer: Aetna Commercial	$59.92
Rate for Payer: Aetna New Business (MI Preferred)	$45.82
Rate for Payer: Cash Price	$56.40
Rate for Payer: Cofinity Commercial	$49.35
Rate for Payer: Cofinity Commercial	$60.63
Rate for Payer: Healthscope Commercial	$63.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.92
Rate for Payer: PHP Commercial	$59.92
Rate for Payer: Priority Health Cigna Priority Health	$49.35
Rate for Payer: Priority Health SBD	$44.42

PSEUDOEPHEDRINE 30 MG TABLET

Facility

$47.00

Service Code	NDC 0904-5053-59
Hospital Charge Code	6714
Hospital Revenue Code	637
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Commercial	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.95
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health Cigna Priority Health	$32.90
Rate for Payer: Priority Health SBD	$29.61

PSEUDOEPHEDRINE 30 MG TABLET

Facility

$61.10

Service Code	NDC 0904-6727-60
Hospital Charge Code	6714
Hospital Revenue Code	637
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$54.99
Rate for Payer: Aetna Commercial	$51.94
Rate for Payer: Aetna New Business (MI Preferred)	$39.72
Rate for Payer: Cash Price	$48.88
Rate for Payer: Cofinity Commercial	$42.77
Rate for Payer: Cofinity Commercial	$52.55
Rate for Payer: Healthscope Commercial	$54.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.94
Rate for Payer: PHP Commercial	$51.94
Rate for Payer: Priority Health Cigna Priority Health	$42.77
Rate for Payer: Priority Health SBD	$38.49

PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE

Facility

$31.83

Service Code	NDC 0904-6754-15
Hospital Charge Code	6716
Hospital Revenue Code	637
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$28.65
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna New Business (MI Preferred)	$20.69
Rate for Payer: Cash Price	$25.46
Rate for Payer: Cofinity Commercial	$22.28
Rate for Payer: Cofinity Commercial	$27.37
Rate for Payer: Healthscope Commercial	$28.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.06
Rate for Payer: PHP Commercial	$27.06
Rate for Payer: Priority Health Cigna Priority Health	$22.28
Rate for Payer: Priority Health SBD	$20.05

PSYCHOSES

Facility

$20,843.07

Service Code	MS-DRG 885
Min. Negotiated Rate	$9,816.60
Max. Negotiated Rate	$20,843.07
Rate for Payer: Aetna Medicare	$10,746.59
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,916.58
Rate for Payer: Amish Plain Church Group Commercial	$12,916.58
Rate for Payer: BCBS MAPPO	$10,333.26
Rate for Payer: BCBS Trust/PPO	$15,019.96
Rate for Payer: BCN Medicare Advantage	$10,333.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,333.26
Rate for Payer: Mclaren Medicare	$10,333.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,849.92
Rate for Payer: MI Amish Medical Board Commercial	$11,883.25
Rate for Payer: PACE Medicare	$9,816.60
Rate for Payer: PACE SWMI	$10,333.26
Rate for Payer: PHP Medicare Advantage	$10,333.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,607.73
Rate for Payer: Priority Health Medicare	$10,333.26
Rate for Payer: Priority Health Narrow Network	$15,686.18
Rate for Payer: Railroad Medicare Medicare	$10,333.26
Rate for Payer: UHC All Payor (Choice/PPO)	$20,843.07
Rate for Payer: UHC Core	$12,789.50
Rate for Payer: UHC Dual Complete DSNP	$10,333.26
Rate for Payer: UHC Exchange	$13,698.16
Rate for Payer: UHC Medicare Advantage	$10,643.26
Rate for Payer: VA VA	$10,333.26

PSYLLIUM ORAL PACKET

Facility

$42.68

Service Code	NDC 3848580857
Hospital Charge Code	11218
Hospital Revenue Code	637
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$38.41
Rate for Payer: Aetna Commercial	$36.28
Rate for Payer: Aetna New Business (MI Preferred)	$27.74
Rate for Payer: Cash Price	$34.14
Rate for Payer: Cofinity Commercial	$29.88
Rate for Payer: Cofinity Commercial	$36.70
Rate for Payer: Healthscope Commercial	$38.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.28
Rate for Payer: PHP Commercial	$36.28
Rate for Payer: Priority Health Cigna Priority Health	$29.88
Rate for Payer: Priority Health SBD	$26.89

PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$18,792.93

Service Code	MS-DRG 189
Min. Negotiated Rate	$8,897.07
Max. Negotiated Rate	$18,792.93
Rate for Payer: Aetna Medicare	$9,739.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,706.68
Rate for Payer: Amish Plain Church Group Commercial	$11,706.68
Rate for Payer: BCBS MAPPO	$9,365.34
Rate for Payer: BCBS Trust/PPO	$18,236.95
Rate for Payer: BCN Medicare Advantage	$9,365.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,365.34
Rate for Payer: Mclaren Medicare	$9,365.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,833.61
Rate for Payer: MI Amish Medical Board Commercial	$10,770.14
Rate for Payer: PACE Medicare	$8,897.07
Rate for Payer: PACE SWMI	$9,365.34
Rate for Payer: PHP Medicare Advantage	$9,365.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,679.10
Rate for Payer: Priority Health Medicare	$9,365.34
Rate for Payer: Priority Health Narrow Network	$14,143.28
Rate for Payer: Railroad Medicare Medicare	$9,365.34
Rate for Payer: UHC All Payor (Choice/PPO)	$18,792.93
Rate for Payer: UHC Core	$11,531.52
Rate for Payer: UHC Dual Complete DSNP	$9,365.34
Rate for Payer: UHC Exchange	$12,350.80
Rate for Payer: UHC Medicare Advantage	$9,646.30
Rate for Payer: VA VA	$9,365.34

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$22,955.94

Service Code	MS-DRG 175
Min. Negotiated Rate	$10,067.01
Max. Negotiated Rate	$22,955.94
Rate for Payer: Aetna Medicare	$11,020.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,246.06
Rate for Payer: Amish Plain Church Group Commercial	$13,246.06
Rate for Payer: BCBS MAPPO	$10,596.85
Rate for Payer: BCBS Trust/PPO	$22,955.94
Rate for Payer: BCN Medicare Advantage	$10,596.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,596.85
Rate for Payer: Mclaren Medicare	$10,596.85
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,126.69
Rate for Payer: MI Amish Medical Board Commercial	$12,186.38
Rate for Payer: PACE Medicare	$10,067.01
Rate for Payer: PACE SWMI	$10,596.85
Rate for Payer: PHP Medicare Advantage	$10,596.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,132.94
Rate for Payer: Priority Health Medicare	$10,596.85
Rate for Payer: Priority Health Narrow Network	$16,106.35
Rate for Payer: Railroad Medicare Medicare	$10,596.85
Rate for Payer: UHC All Payor (Choice/PPO)	$21,401.36
Rate for Payer: UHC Core	$13,132.08
Rate for Payer: UHC Dual Complete DSNP	$10,596.85
Rate for Payer: UHC Exchange	$14,065.08
Rate for Payer: UHC Medicare Advantage	$10,914.76
Rate for Payer: VA VA	$10,596.85

PULMONARY EMBOLISM WITHOUT MCC

Facility

$13,153.44

Service Code	MS-DRG 176
Min. Negotiated Rate	$6,048.18
Max. Negotiated Rate	$13,153.44
Rate for Payer: Aetna Medicare	$6,621.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,958.14
Rate for Payer: Amish Plain Church Group Commercial	$7,958.14
Rate for Payer: BCBS MAPPO	$6,366.51
Rate for Payer: BCBS Trust/PPO	$13,153.44
Rate for Payer: BCN Medicare Advantage	$6,366.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,366.51
Rate for Payer: Mclaren Medicare	$6,366.51
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,684.84
Rate for Payer: MI Amish Medical Board Commercial	$7,321.49
Rate for Payer: PACE Medicare	$6,048.18
Rate for Payer: PACE SWMI	$6,366.51
Rate for Payer: PHP Medicare Advantage	$6,366.51
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,703.79
Rate for Payer: Priority Health Medicare	$6,366.51
Rate for Payer: Priority Health Narrow Network	$9,363.03
Rate for Payer: Railroad Medicare Medicare	$6,366.51
Rate for Payer: UHC All Payor (Choice/PPO)	$12,441.16
Rate for Payer: UHC Core	$7,634.02
Rate for Payer: UHC Dual Complete DSNP	$6,366.51
Rate for Payer: UHC Exchange	$8,176.39
Rate for Payer: UHC Medicare Advantage	$6,557.51
Rate for Payer: VA VA	$6,366.51

PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST

Facility

$1,076.20

Service Code	CPT 10160
Hospital Revenue Code	361
Min. Negotiated Rate	$95.29
Max. Negotiated Rate	$1,076.20
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$162.28
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,076.20
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$860.96
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$104.82
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$95.29
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

Know your out-of-pocket cost for care.

All Charges