|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$120.47
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$138.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$103.12
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$147.11 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Trust/PPO |
$119.88
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$138.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$17.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.75
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.40
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.40
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.40
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$9.33
|
| Rate for Payer: Mclaren Medicare |
$17.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.27
|
| Rate for Payer: Meridian Medicaid |
$9.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$16.53
|
| Rate for Payer: PACE SWMI |
$17.40
|
| Rate for Payer: PHP Commercial |
$19.14
|
| Rate for Payer: PHP Medicaid |
$9.33
|
| Rate for Payer: PHP Medicare Advantage |
$17.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.88
|
| Rate for Payer: Priority Health Medicare |
$17.40
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.40
|
| Rate for Payer: UHC Exchange |
$26.97
|
| Rate for Payer: UHC Medicare Advantage |
$17.40
|
| Rate for Payer: UHCCP DNSP |
$17.40
|
| Rate for Payer: UHCCP Medicaid |
$9.33
|
| Rate for Payer: VA VA |
$17.40
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: VA VA |
$0.73
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Complete |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.19 |
| Max. Negotiated Rate |
$2,349.53 |
| Rate for Payer: Aetna Commercial |
$2,114.58
|
| Rate for Payer: ASR ASR |
$2,279.04
|
| Rate for Payer: ASR Commercial |
$2,279.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.63
|
| Rate for Payer: BCN Commercial |
$1,821.59
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$2,208.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,349.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,279.04
|
| Rate for Payer: Mclaren Commercial |
$2,114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: Nomi Health Commercial |
$1,926.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,067.59
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.81 |
| Max. Negotiated Rate |
$2,349.53 |
| Rate for Payer: Aetna Commercial |
$2,114.58
|
| Rate for Payer: Aetna Medicare |
$1,174.76
|
| Rate for Payer: ASR ASR |
$2,279.04
|
| Rate for Payer: ASR Commercial |
$2,279.04
|
| Rate for Payer: BCBS Complete |
$939.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.03
|
| Rate for Payer: BCN Commercial |
$1,821.59
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$2,208.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,349.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,279.04
|
| Rate for Payer: Mclaren Commercial |
$2,114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: Nomi Health Commercial |
$1,926.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,058.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,647.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,067.59
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: ASR Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Healthscope Whirlpool |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: ASR Commercial |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Healthscope Whirlpool |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$693.77 |
| Max. Negotiated Rate |
$1,067.34 |
| Rate for Payer: Aetna Commercial |
$960.61
|
| Rate for Payer: ASR ASR |
$1,035.32
|
| Rate for Payer: ASR Commercial |
$1,035.32
|
| Rate for Payer: BCBS Trust/PPO |
$869.78
|
| Rate for Payer: BCN Commercial |
$827.51
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$1,003.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$1,067.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.32
|
| Rate for Payer: Mclaren Commercial |
$960.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: Nomi Health Commercial |
$875.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.26
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.91 |
| Max. Negotiated Rate |
$1,067.34 |
| Rate for Payer: Aetna Commercial |
$960.61
|
| Rate for Payer: Aetna Medicare |
$533.67
|
| Rate for Payer: ASR ASR |
$1,035.32
|
| Rate for Payer: ASR Commercial |
$1,035.32
|
| Rate for Payer: BCBS Complete |
$426.94
|
| Rate for Payer: BCBS Trust/PPO |
$874.04
|
| Rate for Payer: BCN Commercial |
$827.51
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$1,003.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$1,067.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.32
|
| Rate for Payer: Mclaren Commercial |
$960.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: Nomi Health Commercial |
$875.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.39
|
| Rate for Payer: Priority Health Narrow Network |
$249.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.26
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$316.49
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$341.11
|
| Rate for Payer: ASR Commercial |
$341.11
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$287.97
|
| Rate for Payer: BCN Commercial |
$272.64
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$330.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$351.66
|
| Rate for Payer: Healthscope Whirlpool |
$341.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$316.49
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: Nomi Health Commercial |
$288.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.12
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$246.51
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.58 |
| Max. Negotiated Rate |
$351.66 |
| Rate for Payer: Aetna Commercial |
$316.49
|
| Rate for Payer: ASR ASR |
$341.11
|
| Rate for Payer: ASR Commercial |
$341.11
|
| Rate for Payer: BCBS Trust/PPO |
$286.57
|
| Rate for Payer: BCN Commercial |
$272.64
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$330.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Healthscope Commercial |
$351.66
|
| Rate for Payer: Healthscope Whirlpool |
$341.11
|
| Rate for Payer: Mclaren Commercial |
$316.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: Nomi Health Commercial |
$288.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.46
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$527.48 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$431.95
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.18
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$369.76
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.86 |
| Max. Negotiated Rate |
$527.48 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Trust/PPO |
$429.84
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$725.22
|
| Rate for Payer: Aetna Medicare |
$390.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: ASR ASR |
$781.63
|
| Rate for Payer: ASR Commercial |
$781.63
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$659.87
|
| Rate for Payer: BCN Commercial |
$624.74
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cofinity Commercial |
$757.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$805.80
|
| Rate for Payer: Healthscope Whirlpool |
$781.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$390.97
|
| Rate for Payer: Mclaren Commercial |
$725.22
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$660.76
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$430.07
|
| Rate for Payer: PHP Medicaid |
$209.56
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$706.04
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$564.87
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$709.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$606.00
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP DNSP |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
