|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,081.50 |
| Max. Negotiated Rate |
$1,663.84 |
| Rate for Payer: Aetna Commercial |
$1,497.46
|
| Rate for Payer: ASR ASR |
$1,613.92
|
| Rate for Payer: ASR Commercial |
$1,613.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.86
|
| Rate for Payer: BCN Commercial |
$1,289.98
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,564.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Healthscope Commercial |
$1,663.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,613.92
|
| Rate for Payer: Mclaren Commercial |
$1,497.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: Nomi Health Commercial |
$1,364.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,464.18
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: ASR Commercial |
$151.69
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: BCBS Trust/PPO |
$128.06
|
| Rate for Payer: BCN Commercial |
$121.24
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Healthscope Whirlpool |
$151.69
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Narrow Network |
$109.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.61
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$101.65 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$140.74
|
| Rate for Payer: ASR ASR |
$151.69
|
| Rate for Payer: ASR Commercial |
$151.69
|
| Rate for Payer: BCBS Trust/PPO |
$127.43
|
| Rate for Payer: BCN Commercial |
$121.24
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Healthscope Whirlpool |
$151.69
|
| Rate for Payer: Mclaren Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.61
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$988.97 |
| Max. Negotiated Rate |
$1,521.49 |
| Rate for Payer: Aetna Commercial |
$1,369.34
|
| Rate for Payer: ASR ASR |
$1,475.85
|
| Rate for Payer: ASR Commercial |
$1,475.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.86
|
| Rate for Payer: BCN Commercial |
$1,179.61
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,430.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Healthscope Commercial |
$1,521.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,475.85
|
| Rate for Payer: Mclaren Commercial |
$1,369.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,247.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.91
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,521.49 |
| Rate for Payer: Aetna Commercial |
$1,369.34
|
| Rate for Payer: Aetna Medicare |
$644.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: ASR ASR |
$1,475.85
|
| Rate for Payer: ASR Commercial |
$1,475.85
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.95
|
| Rate for Payer: BCN Commercial |
$1,179.61
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,430.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,521.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,475.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,369.34
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,247.62
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$709.24
|
| Rate for Payer: PHP Medicaid |
$345.59
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.13
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,066.56
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$999.38
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP DNSP |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$345.59
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,315.21 |
| Rate for Payer: Aetna Commercial |
$1,183.69
|
| Rate for Payer: Aetna Medicare |
$644.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: ASR ASR |
$1,275.75
|
| Rate for Payer: ASR Commercial |
$1,275.75
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.03
|
| Rate for Payer: BCN Commercial |
$1,019.68
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,236.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,315.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,275.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,183.69
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,078.47
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$709.24
|
| Rate for Payer: PHP Medicaid |
$345.59
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,152.39
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$921.96
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,157.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$999.38
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP DNSP |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$345.59
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$854.89 |
| Max. Negotiated Rate |
$1,315.21 |
| Rate for Payer: Aetna Commercial |
$1,183.69
|
| Rate for Payer: ASR ASR |
$1,275.75
|
| Rate for Payer: ASR Commercial |
$1,275.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,071.76
|
| Rate for Payer: BCN Commercial |
$1,019.68
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,236.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Healthscope Commercial |
$1,315.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,275.75
|
| Rate for Payer: Mclaren Commercial |
$1,183.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,078.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,157.38
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.05 |
| Max. Negotiated Rate |
$1,210.85 |
| Rate for Payer: Aetna Commercial |
$1,089.77
|
| Rate for Payer: ASR ASR |
$1,174.52
|
| Rate for Payer: ASR Commercial |
$1,174.52
|
| Rate for Payer: BCBS Trust/PPO |
$986.72
|
| Rate for Payer: BCN Commercial |
$938.77
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,138.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,210.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.52
|
| Rate for Payer: Mclaren Commercial |
$1,089.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: Nomi Health Commercial |
$992.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.55
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$1,210.85 |
| Rate for Payer: Aetna Commercial |
$1,089.77
|
| Rate for Payer: Aetna Medicare |
$605.42
|
| Rate for Payer: ASR ASR |
$1,174.52
|
| Rate for Payer: ASR Commercial |
$1,174.52
|
| Rate for Payer: BCBS Complete |
$484.34
|
| Rate for Payer: BCBS Trust/PPO |
$991.57
|
| Rate for Payer: BCN Commercial |
$938.77
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,138.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,210.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.52
|
| Rate for Payer: Mclaren Commercial |
$1,089.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: Nomi Health Commercial |
$992.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.95
|
| Rate for Payer: Priority Health Narrow Network |
$848.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.55
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.27 |
| Max. Negotiated Rate |
$1,525.03 |
| Rate for Payer: Aetna Commercial |
$1,372.53
|
| Rate for Payer: ASR ASR |
$1,479.28
|
| Rate for Payer: ASR Commercial |
$1,479.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.75
|
| Rate for Payer: BCN Commercial |
$1,182.36
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,433.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,525.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,479.28
|
| Rate for Payer: Mclaren Commercial |
$1,372.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: Nomi Health Commercial |
$1,250.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,342.03
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.01 |
| Max. Negotiated Rate |
$1,525.03 |
| Rate for Payer: Aetna Commercial |
$1,372.53
|
| Rate for Payer: Aetna Medicare |
$762.51
|
| Rate for Payer: ASR ASR |
$1,479.28
|
| Rate for Payer: ASR Commercial |
$1,479.28
|
| Rate for Payer: BCBS Complete |
$610.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.85
|
| Rate for Payer: BCN Commercial |
$1,182.36
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,433.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,525.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,479.28
|
| Rate for Payer: Mclaren Commercial |
$1,372.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: Nomi Health Commercial |
$1,250.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,336.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,342.03
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: ASR Commercial |
$45.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.30
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: ASR Commercial |
$45.59
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.18
|
| Rate for Payer: Priority Health Narrow Network |
$32.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,033.55
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$1,033.55 |
| Rate for Payer: Aetna Commercial |
$930.20
|
| Rate for Payer: Aetna Medicare |
$198.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$1,002.54
|
| Rate for Payer: ASR Commercial |
$1,002.54
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCBS Trust/PPO |
$846.37
|
| Rate for Payer: BCN Commercial |
$801.31
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cofinity Commercial |
$971.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$1,033.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,002.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$198.36
|
| Rate for Payer: Mclaren Commercial |
$930.20
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.52
|
| Rate for Payer: Nomi Health Commercial |
$847.51
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$218.20
|
| Rate for Payer: PHP Medicaid |
$106.32
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$905.60
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health Narrow Network |
$724.52
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$909.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$307.46
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP DNSP |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,033.55
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$671.81 |
| Max. Negotiated Rate |
$1,033.55 |
| Rate for Payer: Aetna Commercial |
$930.20
|
| Rate for Payer: ASR ASR |
$1,002.54
|
| Rate for Payer: ASR Commercial |
$1,002.54
|
| Rate for Payer: BCBS Trust/PPO |
$842.24
|
| Rate for Payer: BCN Commercial |
$801.31
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cofinity Commercial |
$971.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.84
|
| Rate for Payer: Healthscope Commercial |
$1,033.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,002.54
|
| Rate for Payer: Mclaren Commercial |
$930.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.52
|
| Rate for Payer: Nomi Health Commercial |
$847.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$909.52
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: ASR ASR |
$173.15
|
| Rate for Payer: ASR Commercial |
$173.15
|
| Rate for Payer: BCBS Trust/PPO |
$145.46
|
| Rate for Payer: BCN Commercial |
$138.39
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$178.50
|
| Rate for Payer: Healthscope Whirlpool |
$173.15
|
| Rate for Payer: Mclaren Commercial |
$160.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.08
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$89.25
|
| Rate for Payer: ASR ASR |
$173.15
|
| Rate for Payer: ASR Commercial |
$173.15
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: BCBS Trust/PPO |
$146.17
|
| Rate for Payer: BCN Commercial |
$138.39
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$178.50
|
| Rate for Payer: Healthscope Whirlpool |
$173.15
|
| Rate for Payer: Mclaren Commercial |
$160.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.40
|
| Rate for Payer: Priority Health Narrow Network |
$125.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.08
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$54.58
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna Commercial |
$49.12
|
| Rate for Payer: ASR ASR |
$52.94
|
| Rate for Payer: ASR Commercial |
$52.94
|
| Rate for Payer: BCBS Trust/PPO |
$44.48
|
| Rate for Payer: BCN Commercial |
$42.32
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$51.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$54.58
|
| Rate for Payer: Healthscope Whirlpool |
$52.94
|
| Rate for Payer: Mclaren Commercial |
$49.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.03
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$54.58
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna Commercial |
$49.12
|
| Rate for Payer: Aetna Medicare |
$27.29
|
| Rate for Payer: ASR ASR |
$52.94
|
| Rate for Payer: ASR Commercial |
$52.94
|
| Rate for Payer: BCBS Complete |
$21.83
|
| Rate for Payer: BCBS Trust/PPO |
$44.70
|
| Rate for Payer: BCN Commercial |
$42.32
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$51.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$54.58
|
| Rate for Payer: Healthscope Whirlpool |
$52.94
|
| Rate for Payer: Mclaren Commercial |
$49.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.82
|
| Rate for Payer: Priority Health Narrow Network |
$38.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.03
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
IP
|
$5,164.84
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,357.15 |
| Max. Negotiated Rate |
$5,164.84 |
| Rate for Payer: Aetna Commercial |
$4,648.36
|
| Rate for Payer: ASR ASR |
$5,009.89
|
| Rate for Payer: ASR Commercial |
$5,009.89
|
| Rate for Payer: BCBS Trust/PPO |
$4,208.83
|
| Rate for Payer: BCN Commercial |
$4,004.30
|
| Rate for Payer: Cash Price |
$4,131.87
|
| Rate for Payer: Cofinity Commercial |
$4,854.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,131.87
|
| Rate for Payer: Healthscope Commercial |
$5,164.84
|
| Rate for Payer: Healthscope Whirlpool |
$5,009.89
|
| Rate for Payer: Mclaren Commercial |
$4,648.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,390.11
|
| Rate for Payer: Nomi Health Commercial |
$4,235.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,357.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,545.06
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
OP
|
$5,164.84
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$5,334.82 |
| Rate for Payer: Aetna Commercial |
$4,648.36
|
| Rate for Payer: Aetna Medicare |
$3,441.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: ASR ASR |
$5,009.89
|
| Rate for Payer: ASR Commercial |
$5,009.89
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,229.49
|
| Rate for Payer: BCN Commercial |
$4,004.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$4,131.87
|
| Rate for Payer: Cash Price |
$4,131.87
|
| Rate for Payer: Cofinity Commercial |
$4,854.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,131.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$5,164.84
|
| Rate for Payer: Healthscope Whirlpool |
$5,009.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,441.82
|
| Rate for Payer: Mclaren Commercial |
$4,648.36
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,390.11
|
| Rate for Payer: Nomi Health Commercial |
$4,235.17
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$3,786.00
|
| Rate for Payer: PHP Medicaid |
$1,844.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,357.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,525.43
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health Narrow Network |
$3,620.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,545.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$5,334.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP DNSP |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.81
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
