|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.38
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$3.77
|
| Rate for Payer: BCBS MAPPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$20.81
|
| 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: Health Alliance Plan Medicare Advantage |
$6.70
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.70
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.59
|
| Rate for Payer: Mclaren Medicare |
$6.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.04
|
| Rate for Payer: Meridian Medicaid |
$3.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$6.37
|
| Rate for Payer: PACE SWMI |
$6.70
|
| Rate for Payer: PHP Commercial |
$7.37
|
| Rate for Payer: PHP Medicaid |
$3.59
|
| Rate for Payer: PHP Medicare Advantage |
$6.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.59
|
| 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 Medicare |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.70
|
| Rate for Payer: UHC Exchange |
$10.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.70
|
| Rate for Payer: UHCCP DNSP |
$6.70
|
| Rate for Payer: UHCCP Medicaid |
$3.59
|
| Rate for Payer: VA VA |
$6.70
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: ASR Commercial |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.52
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: ASR Commercial |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.52
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.28
|
| Rate for Payer: Priority Health Narrow Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.67
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$62.98
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.99
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Medicaid |
$3.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.39
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health Narrow Network |
$53.91
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.99
|
| Rate for Payer: UHC Exchange |
$9.28
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
| Rate for Payer: UHCCP DNSP |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$3.21
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,330.39
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.75 |
| Max. Negotiated Rate |
$1,330.39 |
| Rate for Payer: Aetna Commercial |
$1,197.35
|
| Rate for Payer: ASR ASR |
$1,290.48
|
| Rate for Payer: ASR Commercial |
$1,290.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.13
|
| Rate for Payer: BCN Commercial |
$1,031.45
|
| Rate for Payer: Cash Price |
$1,064.31
|
| Rate for Payer: Cofinity Commercial |
$1,250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.31
|
| Rate for Payer: Healthscope Commercial |
$1,330.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,290.48
|
| Rate for Payer: Mclaren Commercial |
$1,197.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.83
|
| Rate for Payer: Nomi Health Commercial |
$1,090.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,170.74
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,330.39
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$532.16 |
| Max. Negotiated Rate |
$1,330.39 |
| Rate for Payer: Aetna Commercial |
$1,197.35
|
| Rate for Payer: Aetna Medicare |
$665.20
|
| Rate for Payer: ASR ASR |
$1,290.48
|
| Rate for Payer: ASR Commercial |
$1,290.48
|
| Rate for Payer: BCBS Complete |
$532.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.46
|
| Rate for Payer: BCN Commercial |
$1,031.45
|
| Rate for Payer: Cash Price |
$1,064.31
|
| Rate for Payer: Cofinity Commercial |
$1,250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.31
|
| Rate for Payer: Healthscope Commercial |
$1,330.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,290.48
|
| Rate for Payer: Mclaren Commercial |
$1,197.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.83
|
| Rate for Payer: Nomi Health Commercial |
$1,090.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,165.69
|
| Rate for Payer: Priority Health Narrow Network |
$932.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,170.74
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
OP
|
$430.14
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$172.06 |
| Max. Negotiated Rate |
$430.14 |
| Rate for Payer: Aetna Commercial |
$387.13
|
| Rate for Payer: Aetna Medicare |
$215.07
|
| Rate for Payer: ASR ASR |
$417.24
|
| Rate for Payer: ASR Commercial |
$417.24
|
| Rate for Payer: BCBS Complete |
$172.06
|
| Rate for Payer: BCBS Trust/PPO |
$352.24
|
| Rate for Payer: BCN Commercial |
$333.49
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cofinity Commercial |
$404.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$430.14
|
| Rate for Payer: Healthscope Whirlpool |
$417.24
|
| Rate for Payer: Mclaren Commercial |
$387.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.62
|
| Rate for Payer: Nomi Health Commercial |
$352.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.89
|
| Rate for Payer: Priority Health Narrow Network |
$301.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.52
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
IP
|
$430.14
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$279.59 |
| Max. Negotiated Rate |
$430.14 |
| Rate for Payer: Aetna Commercial |
$387.13
|
| Rate for Payer: ASR ASR |
$417.24
|
| Rate for Payer: ASR Commercial |
$417.24
|
| Rate for Payer: BCBS Trust/PPO |
$350.52
|
| Rate for Payer: BCN Commercial |
$333.49
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cofinity Commercial |
$404.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$430.14
|
| Rate for Payer: Healthscope Whirlpool |
$417.24
|
| Rate for Payer: Mclaren Commercial |
$387.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.62
|
| Rate for Payer: Nomi Health Commercial |
$352.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.52
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
OP
|
$424.41
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Aetna Commercial |
$381.97
|
| Rate for Payer: Aetna Medicare |
$212.21
|
| Rate for Payer: ASR ASR |
$411.68
|
| Rate for Payer: ASR Commercial |
$411.68
|
| Rate for Payer: BCBS Complete |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$347.55
|
| Rate for Payer: BCN Commercial |
$329.05
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$398.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.53
|
| Rate for Payer: Healthscope Commercial |
$424.41
|
| Rate for Payer: Healthscope Whirlpool |
$411.68
|
| Rate for Payer: Mclaren Commercial |
$381.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.75
|
| Rate for Payer: Nomi Health Commercial |
$348.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.87
|
| Rate for Payer: Priority Health Narrow Network |
$297.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.48
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
IP
|
$424.41
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$275.87 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Aetna Commercial |
$381.97
|
| Rate for Payer: ASR ASR |
$411.68
|
| Rate for Payer: ASR Commercial |
$411.68
|
| Rate for Payer: BCBS Trust/PPO |
$345.85
|
| Rate for Payer: BCN Commercial |
$329.05
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$398.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.53
|
| Rate for Payer: Healthscope Commercial |
$424.41
|
| Rate for Payer: Healthscope Whirlpool |
$411.68
|
| Rate for Payer: Mclaren Commercial |
$381.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.75
|
| Rate for Payer: Nomi Health Commercial |
$348.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.48
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$720.36
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$468.23 |
| Max. Negotiated Rate |
$720.36 |
| Rate for Payer: Aetna Commercial |
$648.32
|
| Rate for Payer: ASR ASR |
$698.75
|
| Rate for Payer: ASR Commercial |
$698.75
|
| Rate for Payer: BCBS Trust/PPO |
$587.02
|
| Rate for Payer: BCN Commercial |
$558.50
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cofinity Commercial |
$677.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.29
|
| Rate for Payer: Healthscope Commercial |
$720.36
|
| Rate for Payer: Healthscope Whirlpool |
$698.75
|
| Rate for Payer: Mclaren Commercial |
$648.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.31
|
| Rate for Payer: Nomi Health Commercial |
$590.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.92
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$720.36
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$648.32
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$698.75
|
| Rate for Payer: ASR Commercial |
$698.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$589.90
|
| Rate for Payer: BCN Commercial |
$558.50
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cofinity Commercial |
$677.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$720.36
|
| Rate for Payer: Healthscope Whirlpool |
$698.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$648.32
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.31
|
| Rate for Payer: Nomi Health Commercial |
$590.70
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$631.18
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$504.97
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
OP
|
$396.58
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.63 |
| Max. Negotiated Rate |
$396.58 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna Medicare |
$198.29
|
| Rate for Payer: ASR ASR |
$384.68
|
| Rate for Payer: ASR Commercial |
$384.68
|
| Rate for Payer: BCBS Complete |
$158.63
|
| Rate for Payer: BCBS Trust/PPO |
$324.76
|
| Rate for Payer: BCN Commercial |
$307.47
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$372.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Healthscope Commercial |
$396.58
|
| Rate for Payer: Healthscope Whirlpool |
$384.68
|
| Rate for Payer: Mclaren Commercial |
$356.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: Nomi Health Commercial |
$325.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.48
|
| Rate for Payer: Priority Health Narrow Network |
$278.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.99
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$396.58
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.78 |
| Max. Negotiated Rate |
$396.58 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: ASR ASR |
$384.68
|
| Rate for Payer: ASR Commercial |
$384.68
|
| Rate for Payer: BCBS Trust/PPO |
$323.17
|
| Rate for Payer: BCN Commercial |
$307.47
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$372.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Healthscope Commercial |
$396.58
|
| Rate for Payer: Healthscope Whirlpool |
$384.68
|
| Rate for Payer: Mclaren Commercial |
$356.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: Nomi Health Commercial |
$325.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.99
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,786.59
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,786.59 |
| Rate for Payer: Aetna Commercial |
$2,507.93
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,702.99
|
| Rate for Payer: ASR Commercial |
$2,702.99
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,281.94
|
| Rate for Payer: BCN Commercial |
$2,160.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$2,619.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,786.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,702.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$2,507.93
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: Nomi Health Commercial |
$2,285.00
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,441.61
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,953.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,452.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,786.59
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,811.28 |
| Max. Negotiated Rate |
$2,786.59 |
| Rate for Payer: Aetna Commercial |
$2,507.93
|
| Rate for Payer: ASR ASR |
$2,702.99
|
| Rate for Payer: ASR Commercial |
$2,702.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,270.79
|
| Rate for Payer: BCN Commercial |
$2,160.44
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$2,619.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Healthscope Commercial |
$2,786.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,702.99
|
| Rate for Payer: Mclaren Commercial |
$2,507.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: Nomi Health Commercial |
$2,285.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,452.20
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,177.28
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$765.23 |
| Max. Negotiated Rate |
$1,177.28 |
| Rate for Payer: Aetna Commercial |
$1,059.55
|
| Rate for Payer: ASR ASR |
$1,141.96
|
| Rate for Payer: ASR Commercial |
$1,141.96
|
| Rate for Payer: BCBS Trust/PPO |
$959.37
|
| Rate for Payer: BCN Commercial |
$912.75
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,106.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,177.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,141.96
|
| Rate for Payer: Mclaren Commercial |
$1,059.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: Nomi Health Commercial |
$965.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,036.01
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,177.28
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.91 |
| Max. Negotiated Rate |
$1,177.28 |
| Rate for Payer: Aetna Commercial |
$1,059.55
|
| Rate for Payer: Aetna Medicare |
$588.64
|
| Rate for Payer: ASR ASR |
$1,141.96
|
| Rate for Payer: ASR Commercial |
$1,141.96
|
| Rate for Payer: BCBS Complete |
$470.91
|
| Rate for Payer: BCBS Trust/PPO |
$964.07
|
| Rate for Payer: BCN Commercial |
$912.75
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,106.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,177.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,141.96
|
| Rate for Payer: Mclaren Commercial |
$1,059.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: Nomi Health Commercial |
$965.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,031.53
|
| Rate for Payer: Priority Health Narrow Network |
$825.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,036.01
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$372.79
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$242.31 |
| Max. Negotiated Rate |
$372.79 |
| Rate for Payer: Aetna Commercial |
$335.51
|
| Rate for Payer: ASR ASR |
$361.61
|
| Rate for Payer: ASR Commercial |
$361.61
|
| Rate for Payer: BCBS Trust/PPO |
$303.79
|
| Rate for Payer: BCN Commercial |
$289.02
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$350.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$372.79
|
| Rate for Payer: Healthscope Whirlpool |
$361.61
|
| Rate for Payer: Mclaren Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: Nomi Health Commercial |
$305.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.06
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$372.79
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$149.12 |
| Max. Negotiated Rate |
$372.79 |
| Rate for Payer: Aetna Commercial |
$335.51
|
| Rate for Payer: Aetna Medicare |
$186.40
|
| Rate for Payer: ASR ASR |
$361.61
|
| Rate for Payer: ASR Commercial |
$361.61
|
| Rate for Payer: BCBS Complete |
$149.12
|
| Rate for Payer: BCBS Trust/PPO |
$305.28
|
| Rate for Payer: BCN Commercial |
$289.02
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$350.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$372.79
|
| Rate for Payer: Healthscope Whirlpool |
$361.61
|
| Rate for Payer: Mclaren Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: Nomi Health Commercial |
$305.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.64
|
| Rate for Payer: Priority Health Narrow Network |
$261.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.06
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$592.06
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$592.06 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$574.30
|
| Rate for Payer: ASR Commercial |
$574.30
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$484.84
|
| Rate for Payer: BCN Commercial |
$459.02
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cofinity Commercial |
$556.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$592.06
|
| Rate for Payer: Healthscope Whirlpool |
$574.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$532.85
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.25
|
| Rate for Payer: Nomi Health Commercial |
$485.49
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.76
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$415.03
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$592.06
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.84 |
| Max. Negotiated Rate |
$592.06 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: ASR ASR |
$574.30
|
| Rate for Payer: ASR Commercial |
$574.30
|
| Rate for Payer: BCBS Trust/PPO |
$482.47
|
| Rate for Payer: BCN Commercial |
$459.02
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cofinity Commercial |
$556.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.65
|
| Rate for Payer: Healthscope Commercial |
$592.06
|
| Rate for Payer: Healthscope Whirlpool |
$574.30
|
| Rate for Payer: Mclaren Commercial |
$532.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.25
|
| Rate for Payer: Nomi Health Commercial |
$485.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.01
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$714.47
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$464.41 |
| Max. Negotiated Rate |
$714.47 |
| Rate for Payer: Aetna Commercial |
$643.02
|
| Rate for Payer: ASR ASR |
$693.04
|
| Rate for Payer: ASR Commercial |
$693.04
|
| Rate for Payer: BCBS Trust/PPO |
$582.22
|
| Rate for Payer: BCN Commercial |
$553.93
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$671.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.58
|
| Rate for Payer: Healthscope Commercial |
$714.47
|
| Rate for Payer: Healthscope Whirlpool |
$693.04
|
| Rate for Payer: Mclaren Commercial |
$643.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.30
|
| Rate for Payer: Nomi Health Commercial |
$585.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.73
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
OP
|
$714.47
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$714.47 |
| Rate for Payer: Aetna Commercial |
$643.02
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$693.04
|
| Rate for Payer: ASR Commercial |
$693.04
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$585.08
|
| Rate for Payer: BCN Commercial |
$553.93
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$671.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$714.47
|
| Rate for Payer: Healthscope Whirlpool |
$693.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$643.02
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.30
|
| Rate for Payer: Nomi Health Commercial |
$585.87
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.02
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$500.84
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
