|
HC INFUSION CATH LVL 12
|
Facility
|
IP
|
$1,272.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$1,272.93 |
| Rate for Payer: Aetna Commercial |
$1,145.64
|
| Rate for Payer: ASR ASR |
$1,234.74
|
| Rate for Payer: ASR Commercial |
$1,234.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.31
|
| Rate for Payer: BCN Commercial |
$986.90
|
| Rate for Payer: Cash Price |
$1,018.34
|
| Rate for Payer: Cofinity Commercial |
$1,196.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.34
|
| Rate for Payer: Healthscope Commercial |
$1,272.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,234.74
|
| Rate for Payer: Mclaren Commercial |
$1,145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.99
|
| Rate for Payer: Nomi Health Commercial |
$1,043.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,120.18
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Aetna Commercial |
$1,242.05
|
| Rate for Payer: Aetna Medicare |
$690.03
|
| Rate for Payer: ASR ASR |
$1,338.66
|
| Rate for Payer: ASR Commercial |
$1,338.66
|
| Rate for Payer: BCBS Complete |
$552.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.13
|
| Rate for Payer: BCN Commercial |
$1,069.96
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,380.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.66
|
| Rate for Payer: Mclaren Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,209.21
|
| Rate for Payer: Priority Health Narrow Network |
$967.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.45
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$897.04 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Aetna Commercial |
$1,242.05
|
| Rate for Payer: ASR ASR |
$1,338.66
|
| Rate for Payer: ASR Commercial |
$1,338.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.61
|
| Rate for Payer: BCN Commercial |
$1,069.96
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,380.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.66
|
| Rate for Payer: Mclaren Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.45
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
IP
|
$1,475.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.30 |
| Max. Negotiated Rate |
$1,475.84 |
| Rate for Payer: Aetna Commercial |
$1,328.26
|
| Rate for Payer: ASR ASR |
$1,431.56
|
| Rate for Payer: ASR Commercial |
$1,431.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.66
|
| Rate for Payer: BCN Commercial |
$1,144.22
|
| Rate for Payer: Cash Price |
$1,180.67
|
| Rate for Payer: Cofinity Commercial |
$1,387.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.67
|
| Rate for Payer: Healthscope Commercial |
$1,475.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.56
|
| Rate for Payer: Mclaren Commercial |
$1,328.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.46
|
| Rate for Payer: Nomi Health Commercial |
$1,210.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.74
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
OP
|
$1,475.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.34 |
| Max. Negotiated Rate |
$1,475.84 |
| Rate for Payer: Aetna Commercial |
$1,328.26
|
| Rate for Payer: Aetna Medicare |
$737.92
|
| Rate for Payer: ASR ASR |
$1,431.56
|
| Rate for Payer: ASR Commercial |
$1,431.56
|
| Rate for Payer: BCBS Complete |
$590.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,208.57
|
| Rate for Payer: BCN Commercial |
$1,144.22
|
| Rate for Payer: Cash Price |
$1,180.67
|
| Rate for Payer: Cofinity Commercial |
$1,387.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.67
|
| Rate for Payer: Healthscope Commercial |
$1,475.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.56
|
| Rate for Payer: Mclaren Commercial |
$1,328.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.46
|
| Rate for Payer: Nomi Health Commercial |
$1,210.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,293.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,034.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.74
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$375.88
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.18
|
| Rate for Payer: Priority Health Narrow Network |
$321.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Trust/PPO |
$374.04
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$595.35 |
| Rate for Payer: Aetna Commercial |
$535.82
|
| Rate for Payer: Aetna Medicare |
$297.68
|
| Rate for Payer: ASR ASR |
$577.49
|
| Rate for Payer: ASR Commercial |
$577.49
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: BCBS Trust/PPO |
$487.53
|
| Rate for Payer: BCN Commercial |
$461.57
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$559.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$595.35
|
| Rate for Payer: Healthscope Whirlpool |
$577.49
|
| Rate for Payer: Mclaren Commercial |
$535.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: Nomi Health Commercial |
$488.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.65
|
| Rate for Payer: Priority Health Narrow Network |
$417.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.91
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
IP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.98 |
| Max. Negotiated Rate |
$595.35 |
| Rate for Payer: Aetna Commercial |
$535.82
|
| Rate for Payer: ASR ASR |
$577.49
|
| Rate for Payer: ASR Commercial |
$577.49
|
| Rate for Payer: BCBS Trust/PPO |
$485.15
|
| Rate for Payer: BCN Commercial |
$461.57
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$559.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$595.35
|
| Rate for Payer: Healthscope Whirlpool |
$577.49
|
| Rate for Payer: Mclaren Commercial |
$535.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: Nomi Health Commercial |
$488.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.91
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$843.51 |
| Rate for Payer: Aetna Commercial |
$759.16
|
| Rate for Payer: Aetna Medicare |
$421.76
|
| Rate for Payer: ASR ASR |
$818.20
|
| Rate for Payer: ASR Commercial |
$818.20
|
| Rate for Payer: BCBS Complete |
$337.40
|
| Rate for Payer: BCBS Trust/PPO |
$690.75
|
| Rate for Payer: BCN Commercial |
$653.97
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$792.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$843.51
|
| Rate for Payer: Healthscope Whirlpool |
$818.20
|
| Rate for Payer: Mclaren Commercial |
$759.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.08
|
| Rate for Payer: Priority Health Narrow Network |
$591.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$742.29
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.28 |
| Max. Negotiated Rate |
$843.51 |
| Rate for Payer: Aetna Commercial |
$759.16
|
| Rate for Payer: ASR ASR |
$818.20
|
| Rate for Payer: ASR Commercial |
$818.20
|
| Rate for Payer: BCBS Trust/PPO |
$687.38
|
| Rate for Payer: BCN Commercial |
$653.97
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$792.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$843.51
|
| Rate for Payer: Healthscope Whirlpool |
$818.20
|
| Rate for Payer: Mclaren Commercial |
$759.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$742.29
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: ASR ASR |
$217.67
|
| Rate for Payer: ASR Commercial |
$217.67
|
| Rate for Payer: BCBS Trust/PPO |
$182.86
|
| Rate for Payer: BCN Commercial |
$173.98
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$224.40
|
| Rate for Payer: Healthscope Whirlpool |
$217.67
|
| Rate for Payer: Mclaren Commercial |
$201.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.47
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$112.20
|
| Rate for Payer: ASR ASR |
$217.67
|
| Rate for Payer: ASR Commercial |
$217.67
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS Trust/PPO |
$183.76
|
| Rate for Payer: BCN Commercial |
$173.98
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$224.40
|
| Rate for Payer: Healthscope Whirlpool |
$217.67
|
| Rate for Payer: Mclaren Commercial |
$201.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.16
|
| Rate for Payer: Priority Health Narrow Network |
$125.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.47
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$1,429.99 |
| Rate for Payer: Aetna Commercial |
$1,286.99
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$1,387.09
|
| Rate for Payer: ASR Commercial |
$1,387.09
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.02
|
| Rate for Payer: BCN Commercial |
$1,108.67
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,344.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,429.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,387.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$1,286.99
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.44
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$277.15
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$929.49 |
| Max. Negotiated Rate |
$1,429.99 |
| Rate for Payer: Aetna Commercial |
$1,286.99
|
| Rate for Payer: ASR ASR |
$1,387.09
|
| Rate for Payer: ASR Commercial |
$1,387.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.30
|
| Rate for Payer: BCN Commercial |
$1,108.67
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,344.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Healthscope Commercial |
$1,429.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,387.09
|
| Rate for Payer: Mclaren Commercial |
$1,286.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.39
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$321.78 |
| Max. Negotiated Rate |
$495.05 |
| Rate for Payer: Aetna Commercial |
$445.54
|
| Rate for Payer: ASR ASR |
$480.20
|
| Rate for Payer: ASR Commercial |
$480.20
|
| Rate for Payer: BCBS Trust/PPO |
$403.42
|
| Rate for Payer: BCN Commercial |
$383.81
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$465.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Healthscope Commercial |
$495.05
|
| Rate for Payer: Healthscope Whirlpool |
$480.20
|
| Rate for Payer: Mclaren Commercial |
$445.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.64
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$445.54
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$480.20
|
| Rate for Payer: ASR Commercial |
$480.20
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$405.40
|
| Rate for Payer: BCN Commercial |
$383.81
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$465.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$495.05
|
| Rate for Payer: Healthscope Whirlpool |
$480.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$445.54
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.76
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$347.03
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$59.85
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.49
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Complete |
$8.77
|
| Rate for Payer: BCBS MAPPO |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$60.14
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: BCN Medicare Advantage |
$15.59
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.59
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$8.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Medicare |
$14.81
|
| Rate for Payer: PACE SWMI |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.15
|
| Rate for Payer: PHP Medicaid |
$8.36
|
| Rate for Payer: PHP Medicare Advantage |
$15.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.41
|
| Rate for Payer: Priority Health Medicare |
$15.59
|
| Rate for Payer: Priority Health Narrow Network |
$84.33
|
| Rate for Payer: Railroad Medicare Medicare |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.59
|
| Rate for Payer: UHC Exchange |
$24.16
|
| Rate for Payer: UHC Medicare Advantage |
$15.59
|
| Rate for Payer: UHCCP DNSP |
$15.59
|
| Rate for Payer: UHCCP Medicaid |
$8.36
|
| Rate for Payer: VA VA |
$15.59
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$162.84
|
| Rate for Payer: Aetna Medicare |
$126.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: ASR ASR |
$175.50
|
| Rate for Payer: ASR Commercial |
$175.50
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$148.16
|
| Rate for Payer: BCN Commercial |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$170.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$180.93
|
| Rate for Payer: Healthscope Whirlpool |
$175.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.26
|
| Rate for Payer: Mclaren Commercial |
$162.84
|
| Rate for Payer: Mclaren Medicaid |
$67.68
|
| Rate for Payer: Mclaren Medicare |
$126.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: PACE Medicare |
$119.95
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$138.89
|
| Rate for Payer: PHP Medicaid |
$67.68
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.53
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$126.83
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Exchange |
$195.70
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP DNSP |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$67.68
|
| Rate for Payer: VA VA |
$126.26
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$180.93 |
| Rate for Payer: Aetna Commercial |
$162.84
|
| Rate for Payer: ASR ASR |
$175.50
|
| Rate for Payer: ASR Commercial |
$175.50
|
| Rate for Payer: BCBS Trust/PPO |
$147.44
|
| Rate for Payer: BCN Commercial |
$140.28
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$170.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Healthscope Commercial |
$180.93
|
| Rate for Payer: Healthscope Whirlpool |
$175.50
|
| Rate for Payer: Mclaren Commercial |
$162.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.22
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$376.79 |
| Max. Negotiated Rate |
$579.68 |
| Rate for Payer: Aetna Commercial |
$521.71
|
| Rate for Payer: ASR ASR |
$562.29
|
| Rate for Payer: ASR Commercial |
$562.29
|
| Rate for Payer: BCBS Trust/PPO |
$472.38
|
| Rate for Payer: BCN Commercial |
$449.43
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$544.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Healthscope Commercial |
$579.68
|
| Rate for Payer: Healthscope Whirlpool |
$562.29
|
| Rate for Payer: Mclaren Commercial |
$521.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.12
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$579.68 |
| Rate for Payer: Aetna Commercial |
$521.71
|
| Rate for Payer: Aetna Medicare |
$324.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: ASR ASR |
$562.29
|
| Rate for Payer: ASR Commercial |
$562.29
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$474.70
|
| Rate for Payer: BCN Commercial |
$449.43
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$544.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$579.68
|
| Rate for Payer: Healthscope Whirlpool |
$562.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$324.98
|
| Rate for Payer: Mclaren Commercial |
$521.71
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$357.48
|
| Rate for Payer: PHP Medicaid |
$174.19
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.92
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$406.36
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$503.72
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP DNSP |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: VA VA |
$324.98
|
|
