|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna Commercial |
$22.77
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: ASR ASR |
$24.54
|
| Rate for Payer: ASR Commercial |
$24.54
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$23.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Healthscope Whirlpool |
$24.54
|
| Rate for Payer: Mclaren Commercial |
$22.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna Commercial |
$22.77
|
| Rate for Payer: ASR ASR |
$24.54
|
| Rate for Payer: ASR Commercial |
$24.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$23.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Healthscope Whirlpool |
$24.54
|
| Rate for Payer: Mclaren Commercial |
$22.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna Commercial |
$22.77
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: ASR ASR |
$24.54
|
| Rate for Payer: ASR Commercial |
$24.54
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$23.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Healthscope Whirlpool |
$24.54
|
| Rate for Payer: Mclaren Commercial |
$22.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna Commercial |
$22.77
|
| Rate for Payer: ASR ASR |
$24.54
|
| Rate for Payer: ASR Commercial |
$24.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$23.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Healthscope Whirlpool |
$24.54
|
| Rate for Payer: Mclaren Commercial |
$22.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,811.27 |
| Max. Negotiated Rate |
$5,237.81 |
| Rate for Payer: Aetna Commercial |
$4,110.62
|
| Rate for Payer: Aetna Medicare |
$3,379.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: ASR ASR |
$4,430.34
|
| Rate for Payer: ASR Commercial |
$4,430.34
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,740.21
|
| Rate for Payer: BCN Commercial |
$3,541.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$4,293.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$4,567.36
|
| Rate for Payer: Healthscope Whirlpool |
$4,430.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,379.23
|
| Rate for Payer: Mclaren Commercial |
$4,110.62
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$3,745.24
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$3,717.15
|
| Rate for Payer: PHP Medicaid |
$1,811.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,350.96
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,680.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,019.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,237.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP DNSP |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,968.78 |
| Max. Negotiated Rate |
$4,567.36 |
| Rate for Payer: Aetna Commercial |
$4,110.62
|
| Rate for Payer: ASR ASR |
$4,430.34
|
| Rate for Payer: ASR Commercial |
$4,430.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,721.94
|
| Rate for Payer: BCN Commercial |
$3,541.07
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$4,293.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Healthscope Commercial |
$4,567.36
|
| Rate for Payer: Healthscope Whirlpool |
$4,430.34
|
| Rate for Payer: Mclaren Commercial |
$4,110.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$3,745.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,019.28
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$45.39
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: ASR ASR |
$44.03
|
| Rate for Payer: ASR Commercial |
$44.03
|
| Rate for Payer: BCBS Trust/PPO |
$36.99
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$42.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.31
|
| Rate for Payer: Healthscope Commercial |
$45.39
|
| Rate for Payer: Healthscope Whirlpool |
$44.03
|
| Rate for Payer: Mclaren Commercial |
$40.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.58
|
| Rate for Payer: Nomi Health Commercial |
$37.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.94
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$45.39
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$44.03
|
| Rate for Payer: ASR Commercial |
$44.03
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$42.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$45.39
|
| Rate for Payer: Healthscope Whirlpool |
$44.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$40.85
|
| Rate for Payer: Mclaren Medicaid |
$8.03
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.58
|
| Rate for Payer: Nomi Health Commercial |
$37.22
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.77
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$31.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.23
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: UHCCP DNSP |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$8.03
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$136.15 |
| Rate for Payer: Aetna Commercial |
$111.24
|
| Rate for Payer: Aetna Medicare |
$61.80
|
| Rate for Payer: ASR ASR |
$119.89
|
| Rate for Payer: ASR Commercial |
$119.89
|
| Rate for Payer: BCBS Complete |
$49.44
|
| Rate for Payer: BCBS Trust/PPO |
$101.22
|
| Rate for Payer: BCN Commercial |
$95.83
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$116.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Healthscope Whirlpool |
$119.89
|
| Rate for Payer: Mclaren Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: Nomi Health Commercial |
$101.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.15
|
| Rate for Payer: Priority Health Narrow Network |
$108.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.77
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna Commercial |
$111.24
|
| Rate for Payer: ASR ASR |
$119.89
|
| Rate for Payer: ASR Commercial |
$119.89
|
| Rate for Payer: BCBS Trust/PPO |
$100.72
|
| Rate for Payer: BCN Commercial |
$95.83
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$116.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Healthscope Whirlpool |
$119.89
|
| Rate for Payer: Mclaren Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: Nomi Health Commercial |
$101.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.77
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: ASR ASR |
$52.17
|
| Rate for Payer: ASR Commercial |
$52.17
|
| Rate for Payer: BCBS Trust/PPO |
$43.83
|
| Rate for Payer: BCN Commercial |
$41.70
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$50.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$53.78
|
| Rate for Payer: Healthscope Whirlpool |
$52.17
|
| Rate for Payer: Mclaren Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.33
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: Aetna Medicare |
$26.89
|
| Rate for Payer: ASR ASR |
$52.17
|
| Rate for Payer: ASR Commercial |
$52.17
|
| Rate for Payer: BCBS Complete |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$44.04
|
| Rate for Payer: BCN Commercial |
$41.70
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$50.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$53.78
|
| Rate for Payer: Healthscope Whirlpool |
$52.17
|
| Rate for Payer: Mclaren Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.31
|
| Rate for Payer: Priority Health Narrow Network |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.33
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$931.08 |
| Rate for Payer: Aetna Commercial |
$139.35
|
| Rate for Payer: Aetna Medicare |
$600.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$750.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$750.88
|
| Rate for Payer: ASR ASR |
$150.19
|
| Rate for Payer: ASR Commercial |
$150.19
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$600.70
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: BCN Commercial |
$120.04
|
| Rate for Payer: BCN Medicare Advantage |
$600.70
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$145.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.70
|
| Rate for Payer: Healthscope Commercial |
$154.83
|
| Rate for Payer: Healthscope Whirlpool |
$150.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$600.70
|
| Rate for Payer: Mclaren Commercial |
$139.35
|
| Rate for Payer: Mclaren Medicaid |
$321.98
|
| Rate for Payer: Mclaren Medicare |
$600.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.74
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$690.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PACE Medicare |
$570.66
|
| Rate for Payer: PACE SWMI |
$600.70
|
| Rate for Payer: PHP Commercial |
$660.77
|
| Rate for Payer: PHP Medicaid |
$321.98
|
| Rate for Payer: PHP Medicare Advantage |
$600.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.00
|
| Rate for Payer: Priority Health Medicare |
$600.70
|
| Rate for Payer: Priority Health Narrow Network |
$92.00
|
| Rate for Payer: Railroad Medicare Medicare |
$600.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.70
|
| Rate for Payer: UHC Exchange |
$931.08
|
| Rate for Payer: UHC Medicare Advantage |
$600.70
|
| Rate for Payer: UHCCP DNSP |
$600.70
|
| Rate for Payer: UHCCP Medicaid |
$321.98
|
| Rate for Payer: VA VA |
$600.70
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$154.83 |
| Rate for Payer: Aetna Commercial |
$139.35
|
| Rate for Payer: ASR ASR |
$150.19
|
| Rate for Payer: ASR Commercial |
$150.19
|
| Rate for Payer: BCBS Trust/PPO |
$126.17
|
| Rate for Payer: BCN Commercial |
$120.04
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$145.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$154.83
|
| Rate for Payer: Healthscope Whirlpool |
$150.19
|
| Rate for Payer: Mclaren Commercial |
$139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.25
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Aetna Commercial |
$59.08
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$63.68
|
| Rate for Payer: ASR Commercial |
$63.68
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$53.76
|
| Rate for Payer: BCN Commercial |
$50.90
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$61.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Healthscope Whirlpool |
$63.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$59.08
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: Nomi Health Commercial |
$53.83
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.18
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Aetna Commercial |
$59.08
|
| Rate for Payer: ASR ASR |
$63.68
|
| Rate for Payer: ASR Commercial |
$63.68
|
| Rate for Payer: BCBS Trust/PPO |
$53.50
|
| Rate for Payer: BCN Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$61.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Healthscope Whirlpool |
$63.68
|
| Rate for Payer: Mclaren Commercial |
$59.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: Nomi Health Commercial |
$53.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.77
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$22.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.17
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Mclaren Medicaid |
$11.88
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$12.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$24.39
|
| Rate for Payer: PHP Medicaid |
$11.88
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.17
|
| Rate for Payer: UHC Exchange |
$34.36
|
| Rate for Payer: UHC Medicare Advantage |
$22.17
|
| Rate for Payer: UHCCP DNSP |
$22.17
|
| Rate for Payer: UHCCP Medicaid |
$11.88
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC DISASTER COVERAGE
|
Facility
|
OP
|
$144.84
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$144.84 |
| Rate for Payer: Aetna Commercial |
$130.36
|
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: ASR ASR |
$140.49
|
| Rate for Payer: ASR Commercial |
$140.49
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: BCBS Trust/PPO |
$118.61
|
| Rate for Payer: BCN Commercial |
$112.29
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Cofinity Commercial |
$136.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.87
|
| Rate for Payer: Healthscope Commercial |
$144.84
|
| Rate for Payer: Healthscope Whirlpool |
$140.49
|
| Rate for Payer: Mclaren Commercial |
$130.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.11
|
| Rate for Payer: Nomi Health Commercial |
$118.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.91
|
| Rate for Payer: Priority Health Narrow Network |
$101.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.46
|
|
|
HC DISASTER COVERAGE
|
Facility
|
IP
|
$144.84
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$144.84 |
| Rate for Payer: Aetna Commercial |
$130.36
|
| Rate for Payer: ASR ASR |
$140.49
|
| Rate for Payer: ASR Commercial |
$140.49
|
| Rate for Payer: BCBS Trust/PPO |
$118.03
|
| Rate for Payer: BCN Commercial |
$112.29
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Cofinity Commercial |
$136.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.87
|
| Rate for Payer: Healthscope Commercial |
$144.84
|
| Rate for Payer: Healthscope Whirlpool |
$140.49
|
| Rate for Payer: Mclaren Commercial |
$130.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.11
|
| Rate for Payer: Nomi Health Commercial |
$118.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.46
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$314.92 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: ASR ASR |
$469.96
|
| Rate for Payer: ASR Commercial |
$469.96
|
| Rate for Payer: BCBS Trust/PPO |
$394.82
|
| Rate for Payer: BCN Commercial |
$375.63
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$455.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$484.50
|
| Rate for Payer: Healthscope Whirlpool |
$469.96
|
| Rate for Payer: Mclaren Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna Medicare |
$242.25
|
| Rate for Payer: ASR ASR |
$469.96
|
| Rate for Payer: ASR Commercial |
$469.96
|
| Rate for Payer: BCBS Complete |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$396.76
|
| Rate for Payer: BCN Commercial |
$375.63
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$455.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$484.50
|
| Rate for Payer: Healthscope Whirlpool |
$469.96
|
| Rate for Payer: Mclaren Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.52
|
| Rate for Payer: Priority Health Narrow Network |
$339.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$229.70
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Narrow Network |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.74
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Medicaid |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.24
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health Narrow Network |
$28.99
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Exchange |
$21.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.74
|
| Rate for Payer: UHCCP DNSP |
$13.74
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$13.74
|
|
