|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
37609
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$911.85 |
| Rate for Payer: Aetna Commercial |
$269.54
|
| Rate for Payer: Aetna Medicare |
$209.20
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$201.15
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: BCN Medicare Advantage |
$201.15
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$269.54
|
| Rate for Payer: Cofinity Commercial |
$289.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.15
|
| Rate for Payer: Mclaren Medicaid |
$130.14
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$211.21
|
| Rate for Payer: PACE SWMI |
$201.15
|
| Rate for Payer: PHP Medicare Advantage |
$201.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.49
|
| Rate for Payer: Priority Health Medicare |
$201.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.15
|
| Rate for Payer: UHC Medicare Advantage |
$207.18
|
|
|
PR LIGATION DIRECT ESOPHAGEAL VARICES
|
Professional
|
Both
|
$3,073.00
|
|
|
Service Code
|
HCPCS 43400
|
| Min. Negotiated Rate |
$972.56 |
| Max. Negotiated Rate |
$2,672.92 |
| Rate for Payer: Aetna Commercial |
$2,032.27
|
| Rate for Payer: Aetna Medicare |
$1,577.28
|
| Rate for Payer: BCBS Complete |
$1,021.19
|
| Rate for Payer: BCBS MAPPO |
$1,516.62
|
| Rate for Payer: BCBS Trust/PPO |
$986.56
|
| Rate for Payer: BCN Commercial |
$2,221.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,516.62
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cofinity Commercial |
$2,183.93
|
| Rate for Payer: Cofinity Commercial |
$2,032.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,516.62
|
| Rate for Payer: Mclaren Medicaid |
$972.56
|
| Rate for Payer: Meridian Medicaid |
$1,021.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,592.45
|
| Rate for Payer: PACE SWMI |
$1,516.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,516.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$972.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,672.92
|
| Rate for Payer: Priority Health Medicare |
$1,516.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,672.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,516.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,516.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,562.12
|
|
|
PR LIGATION HEMORRHOID BUNDLE W/US
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 0249T
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: BCBS Complete |
$820.00
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.00
|
|
|
PR LIGATION INTERNAL/COMMON CAROTID ARTERY
|
Professional
|
Both
|
$1,957.00
|
|
|
Service Code
|
HCPCS 37605
|
| Min. Negotiated Rate |
$462.42 |
| Max. Negotiated Rate |
$1,369.90 |
| Rate for Payer: Aetna Commercial |
$976.83
|
| Rate for Payer: Aetna Medicare |
$758.14
|
| Rate for Payer: BCBS Complete |
$485.54
|
| Rate for Payer: BCBS MAPPO |
$728.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.94
|
| Rate for Payer: BCN Commercial |
$1,055.06
|
| Rate for Payer: BCN Medicare Advantage |
$728.98
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cofinity Commercial |
$976.83
|
| Rate for Payer: Cofinity Commercial |
$1,049.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.98
|
| Rate for Payer: Mclaren Medicaid |
$462.42
|
| Rate for Payer: Meridian Medicaid |
$485.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$765.43
|
| Rate for Payer: PACE SWMI |
$728.98
|
| Rate for Payer: PHP Medicare Advantage |
$728.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.49
|
| Rate for Payer: Priority Health Medicare |
$728.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,148.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.98
|
| Rate for Payer: UHC Medicare Advantage |
$750.85
|
|
|
PR LIGATION MAJOR ARTERY ABDOMEN
|
Professional
|
Both
|
$3,207.00
|
|
|
Service Code
|
HCPCS 37617
|
| Min. Negotiated Rate |
$837.30 |
| Max. Negotiated Rate |
$2,244.90 |
| Rate for Payer: Aetna Commercial |
$1,747.31
|
| Rate for Payer: Aetna Medicare |
$1,356.12
|
| Rate for Payer: BCBS Complete |
$879.16
|
| Rate for Payer: BCBS MAPPO |
$1,303.96
|
| Rate for Payer: BCBS Trust/PPO |
$999.54
|
| Rate for Payer: BCN Commercial |
$1,902.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.96
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cofinity Commercial |
$1,877.70
|
| Rate for Payer: Cofinity Commercial |
$1,747.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.96
|
| Rate for Payer: Mclaren Medicaid |
$837.30
|
| Rate for Payer: Meridian Medicaid |
$879.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,369.16
|
| Rate for Payer: PACE SWMI |
$1,303.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,244.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,071.45
|
| Rate for Payer: Priority Health Medicare |
$1,303.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,071.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,303.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,343.08
|
|
|
PR LIGATION MAJOR ARTERY CHEST
|
Professional
|
Both
|
$3,321.00
|
|
|
Service Code
|
HCPCS 37616
|
| Min. Negotiated Rate |
$713.55 |
| Max. Negotiated Rate |
$2,324.70 |
| Rate for Payer: Aetna Commercial |
$1,463.21
|
| Rate for Payer: Aetna Medicare |
$1,135.63
|
| Rate for Payer: BCBS Complete |
$749.23
|
| Rate for Payer: BCBS MAPPO |
$1,091.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$1,598.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.95
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cofinity Commercial |
$1,463.21
|
| Rate for Payer: Cofinity Commercial |
$1,572.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.95
|
| Rate for Payer: Mclaren Medicaid |
$713.55
|
| Rate for Payer: Meridian Medicaid |
$749.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,146.55
|
| Rate for Payer: PACE SWMI |
$1,091.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,324.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,740.03
|
| Rate for Payer: Priority Health Medicare |
$1,091.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,740.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,091.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,091.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,124.71
|
|
|
PR LIGATION MAJOR ARTERY EXTREMITY
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
HCPCS 37618
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$848.45 |
| Rate for Payer: Aetna Commercial |
$513.33
|
| Rate for Payer: Aetna Medicare |
$398.40
|
| Rate for Payer: BCBS Complete |
$262.34
|
| Rate for Payer: BCBS MAPPO |
$383.08
|
| Rate for Payer: BCBS Trust/PPO |
$848.45
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: BCN Medicare Advantage |
$383.08
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cofinity Commercial |
$513.33
|
| Rate for Payer: Cofinity Commercial |
$551.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.08
|
| Rate for Payer: Mclaren Medicaid |
$249.85
|
| Rate for Payer: Meridian Medicaid |
$262.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.23
|
| Rate for Payer: PACE SWMI |
$383.08
|
| Rate for Payer: PHP Medicare Advantage |
$383.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.47
|
| Rate for Payer: Priority Health Medicare |
$383.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.08
|
| Rate for Payer: UHC Medicare Advantage |
$394.57
|
|
|
PR LIGATION MAJOR ARTERY NECK
|
Professional
|
Both
|
$1,189.00
|
|
|
Service Code
|
HCPCS 37615
|
| Min. Negotiated Rate |
$329.09 |
| Max. Negotiated Rate |
$1,021.20 |
| Rate for Payer: Aetna Commercial |
$678.62
|
| Rate for Payer: Aetna Medicare |
$526.69
|
| Rate for Payer: BCBS Complete |
$345.54
|
| Rate for Payer: BCBS MAPPO |
$506.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.20
|
| Rate for Payer: BCN Commercial |
$750.61
|
| Rate for Payer: BCN Medicare Advantage |
$506.43
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Cash Price |
$951.20
|
| Rate for Payer: Cofinity Commercial |
$729.26
|
| Rate for Payer: Cofinity Commercial |
$678.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.43
|
| Rate for Payer: Mclaren Medicaid |
$329.09
|
| Rate for Payer: Meridian Medicaid |
$345.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$531.75
|
| Rate for Payer: PACE SWMI |
$506.43
|
| Rate for Payer: PHP Medicare Advantage |
$506.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.09
|
| Rate for Payer: Priority Health Medicare |
$506.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$817.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.43
|
| Rate for Payer: UHC Medicare Advantage |
$521.62
|
|
|
PR LIGATION OF FEMORAL VEIN
|
Professional
|
Both
|
$1,646.00
|
|
|
Service Code
|
HCPCS 37650
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$1,285.88 |
| Rate for Payer: Aetna Commercial |
$607.45
|
| Rate for Payer: Aetna Medicare |
$471.45
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$453.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.88
|
| Rate for Payer: BCN Commercial |
$658.74
|
| Rate for Payer: BCN Medicare Advantage |
$453.32
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Cofinity Commercial |
$607.45
|
| Rate for Payer: Cofinity Commercial |
$652.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.32
|
| Rate for Payer: Mclaren Medicaid |
$288.83
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$475.99
|
| Rate for Payer: PACE SWMI |
$453.32
|
| Rate for Payer: PHP Medicare Advantage |
$453.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.08
|
| Rate for Payer: Priority Health Medicare |
$453.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.32
|
| Rate for Payer: UHC Medicare Advantage |
$466.92
|
|
|
PR LIGATION OF INFERIOR VENA CAVA
|
Professional
|
Both
|
$3,374.00
|
|
|
Service Code
|
HCPCS 37619
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$2,732.14 |
| Rate for Payer: Aetna Commercial |
$2,302.36
|
| Rate for Payer: Aetna Medicare |
$1,786.91
|
| Rate for Payer: BCBS Complete |
$1,152.02
|
| Rate for Payer: BCBS MAPPO |
$1,718.18
|
| Rate for Payer: BCBS Trust/PPO |
$980.00
|
| Rate for Payer: BCN Commercial |
$2,509.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,718.18
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Cofinity Commercial |
$2,302.36
|
| Rate for Payer: Cofinity Commercial |
$2,474.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,718.18
|
| Rate for Payer: Mclaren Medicaid |
$1,097.16
|
| Rate for Payer: Meridian Medicaid |
$1,152.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,804.09
|
| Rate for Payer: PACE SWMI |
$1,718.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,718.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,097.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,361.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,732.14
|
| Rate for Payer: Priority Health Medicare |
$1,718.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,732.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,718.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,718.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.73
|
|
|
PR LIGATION OF SPERM DUCT
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 55450
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$446.60 |
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.60
|
|
|
PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 37607
|
| Min. Negotiated Rate |
$235.79 |
| Max. Negotiated Rate |
$929.28 |
| Rate for Payer: Aetna Commercial |
$491.58
|
| Rate for Payer: Aetna Medicare |
$381.52
|
| Rate for Payer: BCBS Complete |
$247.58
|
| Rate for Payer: BCBS MAPPO |
$366.85
|
| Rate for Payer: BCBS Trust/PPO |
$929.28
|
| Rate for Payer: BCN Commercial |
$538.04
|
| Rate for Payer: BCN Medicare Advantage |
$366.85
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cofinity Commercial |
$491.58
|
| Rate for Payer: Cofinity Commercial |
$528.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.85
|
| Rate for Payer: Mclaren Medicaid |
$235.79
|
| Rate for Payer: Meridian Medicaid |
$247.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.19
|
| Rate for Payer: PACE SWMI |
$366.85
|
| Rate for Payer: PHP Medicare Advantage |
$366.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.69
|
| Rate for Payer: Priority Health Medicare |
$366.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$585.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.85
|
| Rate for Payer: UHC Medicare Advantage |
$377.86
|
|
|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$385.13 |
| Rate for Payer: Aetna Commercial |
$321.76
|
| Rate for Payer: Aetna Medicare |
$249.72
|
| Rate for Payer: BCBS Complete |
$162.37
|
| Rate for Payer: BCBS MAPPO |
$240.12
|
| Rate for Payer: BCBS Trust/PPO |
$150.57
|
| Rate for Payer: BCN Commercial |
$353.80
|
| Rate for Payer: BCN Medicare Advantage |
$240.12
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$345.77
|
| Rate for Payer: Cofinity Commercial |
$321.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.12
|
| Rate for Payer: Mclaren Medicaid |
$154.64
|
| Rate for Payer: Meridian Medicaid |
$162.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$252.13
|
| Rate for Payer: PACE SWMI |
$240.12
|
| Rate for Payer: PHP Medicare Advantage |
$240.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.13
|
| Rate for Payer: Priority Health Medicare |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.12
|
| Rate for Payer: UHC Medicare Advantage |
$247.32
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: BCBS Trust/PPO |
$734.16
|
| Rate for Payer: BCN Commercial |
$734.16
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$836.00
|
| Rate for Payer: UHC Core |
$793.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$225.62 |
| Max. Negotiated Rate |
$2,195.52 |
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: Aetna Medicare |
$247.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.88
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$237.50
|
| Rate for Payer: BCBS Trust/PPO |
$738.62
|
| Rate for Payer: BCN Commercial |
$738.62
|
| Rate for Payer: BCN Medicare Advantage |
$237.50
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.50
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PACE Senior Care Partners |
$225.62
|
| Rate for Payer: PACE SWMI |
$237.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: PHP Medicare Advantage |
$237.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.50
|
| Rate for Payer: Priority Health Medicare |
$237.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.40
|
| Rate for Payer: Railroad Medicare Medicare |
$237.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$836.00
|
| Rate for Payer: UHC Core |
$793.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.50
|
| Rate for Payer: UHC Medicare Advantage |
$244.62
|
| Rate for Payer: VA VA |
$237.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$333.86
|
| Rate for Payer: Aetna Medicare |
$259.12
|
| Rate for Payer: BCBS Complete |
$169.52
|
| Rate for Payer: BCBS MAPPO |
$249.15
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$249.15
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$358.78
|
| Rate for Payer: Cofinity Commercial |
$333.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.15
|
| Rate for Payer: Mclaren Medicaid |
$161.45
|
| Rate for Payer: Meridian Medicaid |
$169.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$261.61
|
| Rate for Payer: PACE SWMI |
$249.15
|
| Rate for Payer: PHP Medicare Advantage |
$249.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.03
|
| Rate for Payer: Priority Health Medicare |
$249.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.15
|
| Rate for Payer: UHC Medicare Advantage |
$256.62
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$333.86
|
| Rate for Payer: Aetna Medicare |
$259.12
|
| Rate for Payer: BCBS Complete |
$169.52
|
| Rate for Payer: BCBS MAPPO |
$249.15
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$249.15
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$358.78
|
| Rate for Payer: Cofinity Commercial |
$333.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.15
|
| Rate for Payer: Mclaren Medicaid |
$161.45
|
| Rate for Payer: Meridian Medicaid |
$169.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$261.61
|
| Rate for Payer: PACE SWMI |
$249.15
|
| Rate for Payer: PHP Medicare Advantage |
$249.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.03
|
| Rate for Payer: Priority Health Medicare |
$249.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.15
|
| Rate for Payer: UHC Medicare Advantage |
$256.62
|
|
|
PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$199.26 |
| Max. Negotiated Rate |
$2,195.52 |
| Rate for Payer: Aetna Commercial |
$713.15
|
| Rate for Payer: Aetna Medicare |
$218.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.19
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$209.75
|
| Rate for Payer: BCBS Trust/PPO |
$652.32
|
| Rate for Payer: BCN Commercial |
$652.32
|
| Rate for Payer: BCN Medicare Advantage |
$209.75
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$721.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.75
|
| Rate for Payer: Healthscope Commercial |
$755.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.25
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$713.15
|
| Rate for Payer: PACE Senior Care Partners |
$199.26
|
| Rate for Payer: PACE SWMI |
$209.75
|
| Rate for Payer: PHP Commercial |
$713.15
|
| Rate for Payer: PHP Medicare Advantage |
$209.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$729.93
|
| Rate for Payer: Priority Health Medicare |
$209.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.71
|
| Rate for Payer: Railroad Medicare Medicare |
$209.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.32
|
| Rate for Payer: UHC Core |
$700.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.75
|
| Rate for Payer: UHC Medicare Advantage |
$216.04
|
| Rate for Payer: VA VA |
$209.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.25
|
|
|
PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$511.71 |
| Max. Negotiated Rate |
$755.10 |
| Rate for Payer: Aetna Commercial |
$713.15
|
| Rate for Payer: BCBS Trust/PPO |
$648.38
|
| Rate for Payer: BCN Commercial |
$648.38
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$721.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.20
|
| Rate for Payer: Healthscope Commercial |
$755.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$713.15
|
| Rate for Payer: PHP Commercial |
$713.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$729.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.32
|
| Rate for Payer: UHC Core |
$700.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.25
|
|
|
PR LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$728.26 |
| Rate for Payer: Aetna Commercial |
$614.20
|
| Rate for Payer: Aetna Medicare |
$476.69
|
| Rate for Payer: BCBS Complete |
$304.84
|
| Rate for Payer: BCBS MAPPO |
$458.36
|
| Rate for Payer: BCBS Trust/PPO |
$407.85
|
| Rate for Payer: BCN Commercial |
$669.00
|
| Rate for Payer: BCN Medicare Advantage |
$458.36
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cofinity Commercial |
$660.04
|
| Rate for Payer: Cofinity Commercial |
$614.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.36
|
| Rate for Payer: Mclaren Medicaid |
$290.32
|
| Rate for Payer: Meridian Medicaid |
$304.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$481.28
|
| Rate for Payer: PACE SWMI |
$458.36
|
| Rate for Payer: PHP Medicare Advantage |
$458.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$728.26
|
| Rate for Payer: Priority Health Medicare |
$458.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$728.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.36
|
| Rate for Payer: UHC Medicare Advantage |
$472.11
|
|
|
PR LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$614.42 |
| Rate for Payer: Aetna Commercial |
$519.57
|
| Rate for Payer: Aetna Medicare |
$403.25
|
| Rate for Payer: BCBS Complete |
$259.65
|
| Rate for Payer: BCBS MAPPO |
$387.74
|
| Rate for Payer: BCBS Trust/PPO |
$219.24
|
| Rate for Payer: BCN Commercial |
$564.43
|
| Rate for Payer: BCN Medicare Advantage |
$387.74
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$558.35
|
| Rate for Payer: Cofinity Commercial |
$519.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.74
|
| Rate for Payer: Mclaren Medicaid |
$247.29
|
| Rate for Payer: Meridian Medicaid |
$259.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$407.13
|
| Rate for Payer: PACE SWMI |
$387.74
|
| Rate for Payer: PHP Medicare Advantage |
$387.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.42
|
| Rate for Payer: Priority Health Medicare |
$387.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$614.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.74
|
| Rate for Payer: UHC Medicare Advantage |
$399.37
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$310.09
|
| Rate for Payer: Aetna Medicare |
$240.67
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS MAPPO |
$231.41
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: BCN Medicare Advantage |
$231.41
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$333.23
|
| Rate for Payer: Cofinity Commercial |
$310.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.41
|
| Rate for Payer: Mclaren Medicaid |
$149.31
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.98
|
| Rate for Payer: PACE SWMI |
$231.41
|
| Rate for Payer: PHP Medicare Advantage |
$231.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.18
|
| Rate for Payer: Priority Health Medicare |
$231.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.41
|
| Rate for Payer: UHC Medicare Advantage |
$238.35
|
|
|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$2,190.00
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$812.38 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$1,660.61
|
| Rate for Payer: Aetna Medicare |
$1,288.83
|
| Rate for Payer: BCBS Complete |
$853.00
|
| Rate for Payer: BCBS MAPPO |
$1,239.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: BCN Commercial |
$1,846.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,239.26
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cofinity Commercial |
$1,784.53
|
| Rate for Payer: Cofinity Commercial |
$1,660.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,239.26
|
| Rate for Payer: Mclaren Medicaid |
$812.38
|
| Rate for Payer: Meridian Medicaid |
$853.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,301.22
|
| Rate for Payer: PACE SWMI |
$1,239.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,239.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,929.75
|
| Rate for Payer: Priority Health Medicare |
$1,239.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,929.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,239.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,239.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,276.44
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$338.67 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna Commercial |
$712.06
|
| Rate for Payer: Aetna Medicare |
$552.65
|
| Rate for Payer: BCBS Complete |
$355.60
|
| Rate for Payer: BCBS MAPPO |
$531.39
|
| Rate for Payer: BCBS Trust/PPO |
$898.64
|
| Rate for Payer: BCN Commercial |
$778.46
|
| Rate for Payer: BCN Medicare Advantage |
$531.39
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$712.06
|
| Rate for Payer: Cofinity Commercial |
$765.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.39
|
| Rate for Payer: Mclaren Medicaid |
$338.67
|
| Rate for Payer: Meridian Medicaid |
$355.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$557.96
|
| Rate for Payer: PACE SWMI |
$531.39
|
| Rate for Payer: PHP Medicare Advantage |
$531.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$847.40
|
| Rate for Payer: Priority Health Medicare |
$531.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$847.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.39
|
| Rate for Payer: UHC Medicare Advantage |
$547.33
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$47.93 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare |
$78.56
|
| Rate for Payer: BCBS Complete |
$50.33
|
| Rate for Payer: BCBS MAPPO |
$75.54
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Medicare Advantage |
$75.54
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$101.22
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.54
|
| Rate for Payer: Mclaren Medicaid |
$47.93
|
| Rate for Payer: Meridian Medicaid |
$50.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.32
|
| Rate for Payer: PACE SWMI |
$75.54
|
| Rate for Payer: PHP Medicare Advantage |
$75.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.00
|
| Rate for Payer: Priority Health Medicare |
$75.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.54
|
| Rate for Payer: UHC Medicare Advantage |
$77.81
|
|
