|
HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 95984
|
| Hospital Charge Code |
76100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna Commercial |
$63.90
|
| Rate for Payer: ASR ASR |
$68.87
|
| Rate for Payer: BCBS Trust/PPO |
$58.31
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$66.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$68.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.00
|
| Rate for Payer: Mclaren Commercial |
$63.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.35
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.48
|
|
|
HC ELEC ALYS IMPLT COMPLEX CN NPGT PRGRMG
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Medicare |
$94.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$223.44
|
| Rate for Payer: BCN Commercial |
$223.44
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$262.87
|
| Rate for Payer: Healthscope Whirlpool |
$271.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$94.73
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: Mclaren Medicaid |
$94.73
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$52.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$104.20
|
| Rate for Payer: PHP Medicaid |
$50.78
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$148.37
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health Narrow Network |
$118.69
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$146.83
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP DNSP |
$94.73
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ELEC ALYS IMPLT COMPLEX CN NPGT PRGRMG
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.25 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: ASR ASR |
$262.87
|
| Rate for Payer: BCBS Trust/PPO |
$222.55
|
| Rate for Payer: BCN Commercial |
$222.55
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$254.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Healthscope Commercial |
$262.87
|
| Rate for Payer: Healthscope Whirlpool |
$271.00
|
| Rate for Payer: Mclaren Commercial |
$243.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.48
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$198.44
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$148.83 |
| Max. Negotiated Rate |
$198.44 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: ASR ASR |
$192.49
|
| Rate for Payer: BCBS Trust/PPO |
$162.96
|
| Rate for Payer: BCN Commercial |
$162.96
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$186.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Healthscope Commercial |
$192.49
|
| Rate for Payer: Healthscope Whirlpool |
$198.44
|
| Rate for Payer: Mclaren Commercial |
$178.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.63
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$198.44
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$198.44 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Medicare |
$94.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: ASR ASR |
$192.49
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$163.61
|
| Rate for Payer: BCN Commercial |
$163.61
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$186.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$192.49
|
| Rate for Payer: Healthscope Whirlpool |
$198.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$94.73
|
| Rate for Payer: Mclaren Commercial |
$178.60
|
| Rate for Payer: Mclaren Medicaid |
$94.73
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$52.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.83
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$104.20
|
| Rate for Payer: PHP Medicaid |
$50.78
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$173.87
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health Narrow Network |
$139.11
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$146.83
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP DNSP |
$94.73
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$173.54
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$173.54 |
| Rate for Payer: Aetna Commercial |
$156.19
|
| Rate for Payer: ASR ASR |
$168.33
|
| Rate for Payer: BCBS Trust/PPO |
$142.51
|
| Rate for Payer: BCN Commercial |
$142.51
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cofinity Commercial |
$163.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.83
|
| Rate for Payer: Healthscope Commercial |
$168.33
|
| Rate for Payer: Healthscope Whirlpool |
$173.54
|
| Rate for Payer: Mclaren Commercial |
$156.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.51
|
| Rate for Payer: Nomi Health Commercial |
$142.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.72
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$173.54
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$156.19
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$168.33
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$143.08
|
| Rate for Payer: BCN Commercial |
$143.08
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cofinity Commercial |
$163.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$168.33
|
| Rate for Payer: Healthscope Whirlpool |
$173.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$156.19
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.51
|
| Rate for Payer: Nomi Health Commercial |
$142.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.16
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.06
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$121.65
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$180.53
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$180.53 |
| Rate for Payer: Aetna Commercial |
$162.48
|
| Rate for Payer: ASR ASR |
$175.11
|
| Rate for Payer: BCBS Trust/PPO |
$148.25
|
| Rate for Payer: BCN Commercial |
$148.25
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$169.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$175.11
|
| Rate for Payer: Healthscope Whirlpool |
$180.53
|
| Rate for Payer: Mclaren Commercial |
$162.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Nomi Health Commercial |
$148.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.87
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$180.53
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$180.53 |
| Rate for Payer: Aetna Commercial |
$162.48
|
| Rate for Payer: Aetna Medicare |
$94.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: ASR ASR |
$175.11
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$148.85
|
| Rate for Payer: BCN Commercial |
$148.85
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$169.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$175.11
|
| Rate for Payer: Healthscope Whirlpool |
$180.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$94.73
|
| Rate for Payer: Mclaren Commercial |
$162.48
|
| Rate for Payer: Mclaren Medicaid |
$94.73
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$52.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Nomi Health Commercial |
$148.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.40
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$104.20
|
| Rate for Payer: PHP Medicaid |
$50.78
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$158.18
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health Narrow Network |
$126.55
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$146.83
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP DNSP |
$94.73
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$210.68
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.01 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$189.61
|
| Rate for Payer: ASR ASR |
$204.36
|
| Rate for Payer: BCBS Trust/PPO |
$173.01
|
| Rate for Payer: BCN Commercial |
$173.01
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cofinity Commercial |
$198.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.54
|
| Rate for Payer: Healthscope Commercial |
$204.36
|
| Rate for Payer: Healthscope Whirlpool |
$210.68
|
| Rate for Payer: Mclaren Commercial |
$189.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.08
|
| Rate for Payer: Nomi Health Commercial |
$172.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.40
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$210.68
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$189.61
|
| Rate for Payer: Aetna Medicare |
$77.95
|
| Rate for Payer: ASR ASR |
$204.36
|
| Rate for Payer: BCBS Complete |
$84.27
|
| Rate for Payer: BCBS Trust/PPO |
$173.71
|
| Rate for Payer: BCN Commercial |
$173.71
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cofinity Commercial |
$198.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.54
|
| Rate for Payer: Healthscope Commercial |
$204.36
|
| Rate for Payer: Healthscope Whirlpool |
$210.68
|
| Rate for Payer: Mclaren Commercial |
$189.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.08
|
| Rate for Payer: Nomi Health Commercial |
$172.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$184.60
|
| Rate for Payer: Priority Health Narrow Network |
$147.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.40
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$94.45
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$94.45 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: ASR ASR |
$91.62
|
| Rate for Payer: BCBS Trust/PPO |
$77.56
|
| Rate for Payer: BCN Commercial |
$77.56
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Commercial |
$88.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Healthscope Commercial |
$91.62
|
| Rate for Payer: Healthscope Whirlpool |
$94.45
|
| Rate for Payer: Mclaren Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Nomi Health Commercial |
$77.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.12
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$94.45
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$94.45 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$34.95
|
| Rate for Payer: ASR ASR |
$91.62
|
| Rate for Payer: BCBS Complete |
$37.78
|
| Rate for Payer: BCBS Trust/PPO |
$77.87
|
| Rate for Payer: BCN Commercial |
$77.87
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Commercial |
$88.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Healthscope Commercial |
$91.62
|
| Rate for Payer: Healthscope Whirlpool |
$94.45
|
| Rate for Payer: Mclaren Commercial |
$85.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Nomi Health Commercial |
$77.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.76
|
| Rate for Payer: Priority Health Narrow Network |
$66.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.12
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
IP
|
$104.49
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$104.49 |
| Rate for Payer: Aetna Commercial |
$94.04
|
| Rate for Payer: ASR ASR |
$101.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.81
|
| Rate for Payer: BCN Commercial |
$85.81
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cofinity Commercial |
$98.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.59
|
| Rate for Payer: Healthscope Commercial |
$101.36
|
| Rate for Payer: Healthscope Whirlpool |
$104.49
|
| Rate for Payer: Mclaren Commercial |
$94.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.82
|
| Rate for Payer: Nomi Health Commercial |
$85.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.95
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$104.49
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$104.49 |
| Rate for Payer: Aetna Commercial |
$94.04
|
| Rate for Payer: Aetna Medicare |
$38.66
|
| Rate for Payer: ASR ASR |
$101.36
|
| Rate for Payer: BCBS Complete |
$41.80
|
| Rate for Payer: BCBS Trust/PPO |
$86.15
|
| Rate for Payer: BCN Commercial |
$86.15
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cofinity Commercial |
$98.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.59
|
| Rate for Payer: Healthscope Commercial |
$101.36
|
| Rate for Payer: Healthscope Whirlpool |
$104.49
|
| Rate for Payer: Mclaren Commercial |
$94.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.82
|
| Rate for Payer: Nomi Health Commercial |
$85.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.27
|
| Rate for Payer: Priority Health Narrow Network |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.95
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
IP
|
$135.42
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.56 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$121.88
|
| Rate for Payer: ASR ASR |
$131.36
|
| Rate for Payer: BCBS Trust/PPO |
$111.21
|
| Rate for Payer: BCN Commercial |
$111.21
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Commercial |
$127.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$131.36
|
| Rate for Payer: Healthscope Whirlpool |
$135.42
|
| Rate for Payer: Mclaren Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.17
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
OP
|
$135.42
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$121.88
|
| Rate for Payer: Aetna Medicare |
$50.11
|
| Rate for Payer: ASR ASR |
$131.36
|
| Rate for Payer: BCBS Complete |
$54.17
|
| Rate for Payer: BCBS Trust/PPO |
$111.65
|
| Rate for Payer: BCN Commercial |
$111.65
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Commercial |
$127.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$131.36
|
| Rate for Payer: Healthscope Whirlpool |
$135.42
|
| Rate for Payer: Mclaren Commercial |
$121.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.10
|
| Rate for Payer: Priority Health Narrow Network |
$28.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.17
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$80.11 |
| Rate for Payer: Aetna Commercial |
$72.10
|
| Rate for Payer: ASR ASR |
$77.71
|
| Rate for Payer: BCBS Trust/PPO |
$65.79
|
| Rate for Payer: BCN Commercial |
$65.79
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$77.71
|
| Rate for Payer: Healthscope Whirlpool |
$80.11
|
| Rate for Payer: Mclaren Commercial |
$72.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.50
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$80.11 |
| Rate for Payer: Aetna Commercial |
$72.10
|
| Rate for Payer: Aetna Medicare |
$29.64
|
| Rate for Payer: ASR ASR |
$77.71
|
| Rate for Payer: BCBS Complete |
$32.04
|
| Rate for Payer: BCBS Trust/PPO |
$66.05
|
| Rate for Payer: BCN Commercial |
$66.05
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$77.71
|
| Rate for Payer: Healthscope Whirlpool |
$80.11
|
| Rate for Payer: Mclaren Commercial |
$72.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$70.19
|
| Rate for Payer: Priority Health Narrow Network |
$56.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.50
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$33.88
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$75.49
|
| Rate for Payer: BCN Commercial |
$75.49
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$88.81
|
| Rate for Payer: Healthscope Whirlpool |
$91.56
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Narrow Network |
$64.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$75.19
|
| Rate for Payer: BCN Commercial |
$75.19
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$88.81
|
| Rate for Payer: Healthscope Whirlpool |
$91.56
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
OP
|
$221.75
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$221.75 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$215.10
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$182.83
|
| Rate for Payer: BCN Commercial |
$182.83
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$177.40
|
| Rate for Payer: Cash Price |
$177.40
|
| Rate for Payer: Cofinity Commercial |
$208.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$215.10
|
| Rate for Payer: Healthscope Whirlpool |
$221.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$199.57
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.49
|
| Rate for Payer: Nomi Health Commercial |
$181.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.31
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.90
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$174.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
IP
|
$221.75
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$166.31 |
| Max. Negotiated Rate |
$221.75 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: ASR ASR |
$215.10
|
| Rate for Payer: BCBS Trust/PPO |
$182.10
|
| Rate for Payer: BCN Commercial |
$182.10
|
| Rate for Payer: Cash Price |
$177.40
|
| Rate for Payer: Cofinity Commercial |
$208.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.40
|
| Rate for Payer: Healthscope Commercial |
$215.10
|
| Rate for Payer: Healthscope Whirlpool |
$221.75
|
| Rate for Payer: Mclaren Commercial |
$199.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.49
|
| Rate for Payer: Nomi Health Commercial |
$181.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.14
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$63.62
|
| Rate for Payer: BCN Commercial |
$63.62
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.87
|
| Rate for Payer: BCN Commercial |
$63.87
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.19
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$37.19
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$40.91
|
| Rate for Payer: PHP Medicaid |
$19.93
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.90
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$37.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$57.64
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP DNSP |
$37.19
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: VA VA |
$37.19
|
|
