|
HC PERENNIAL RYE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200097
|
|
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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| 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 PERFUSION OPEN HEART
|
Facility
|
IP
|
$6,525.68
|
|
| Hospital Charge Code |
27000107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,241.69 |
| Max. Negotiated Rate |
$6,525.68 |
| Rate for Payer: Aetna Commercial |
$5,873.11
|
| Rate for Payer: ASR ASR |
$6,329.91
|
| Rate for Payer: ASR Commercial |
$6,329.91
|
| Rate for Payer: BCBS Trust/PPO |
$5,317.78
|
| Rate for Payer: BCN Commercial |
$5,059.36
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$6,134.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$6,525.68
|
| Rate for Payer: Healthscope Whirlpool |
$6,329.91
|
| Rate for Payer: Mclaren Commercial |
$5,873.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: Nomi Health Commercial |
$5,351.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,742.60
|
|
|
HC PERFUSION OPEN HEART
|
Facility
|
OP
|
$6,525.68
|
|
| Hospital Charge Code |
27000107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,610.27 |
| Max. Negotiated Rate |
$6,525.68 |
| Rate for Payer: Aetna Commercial |
$5,873.11
|
| Rate for Payer: Aetna Medicare |
$3,262.84
|
| Rate for Payer: ASR ASR |
$6,329.91
|
| Rate for Payer: ASR Commercial |
$6,329.91
|
| Rate for Payer: BCBS Complete |
$2,610.27
|
| Rate for Payer: BCBS Trust/PPO |
$5,343.88
|
| Rate for Payer: BCN Commercial |
$5,059.36
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$6,134.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$6,525.68
|
| Rate for Payer: Healthscope Whirlpool |
$6,329.91
|
| Rate for Payer: Mclaren Commercial |
$5,873.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: Nomi Health Commercial |
$5,351.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,717.80
|
| Rate for Payer: Priority Health Narrow Network |
$4,574.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,742.60
|
|
|
HC PERIDARDIOCENTESIS WITH GUIDANCE
|
Facility
|
IP
|
$2,545.27
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
36100582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,654.43 |
| Max. Negotiated Rate |
$2,545.27 |
| Rate for Payer: Aetna Commercial |
$2,290.74
|
| Rate for Payer: ASR ASR |
$2,468.91
|
| Rate for Payer: ASR Commercial |
$2,468.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,074.14
|
| Rate for Payer: BCN Commercial |
$1,973.35
|
| Rate for Payer: Cash Price |
$2,036.22
|
| Rate for Payer: Cofinity Commercial |
$2,392.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,036.22
|
| Rate for Payer: Healthscope Commercial |
$2,545.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,468.91
|
| Rate for Payer: Mclaren Commercial |
$2,290.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,163.48
|
| Rate for Payer: Nomi Health Commercial |
$2,087.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,239.84
|
|
|
HC PERIDARDIOCENTESIS WITH GUIDANCE
|
Facility
|
OP
|
$2,545.27
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
36100582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$815.81 |
| Max. Negotiated Rate |
$2,545.27 |
| Rate for Payer: Aetna Commercial |
$2,290.74
|
| Rate for Payer: Aetna Medicare |
$1,522.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: ASR ASR |
$2,468.91
|
| Rate for Payer: ASR Commercial |
$2,468.91
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,084.32
|
| Rate for Payer: BCN Commercial |
$1,973.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Cash Price |
$2,036.22
|
| Rate for Payer: Cash Price |
$2,036.22
|
| Rate for Payer: Cofinity Commercial |
$2,392.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,036.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Healthscope Commercial |
$2,545.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,468.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,522.03
|
| Rate for Payer: Mclaren Commercial |
$2,290.74
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,163.48
|
| Rate for Payer: Nomi Health Commercial |
$2,087.12
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Commercial |
$1,674.23
|
| Rate for Payer: PHP Medicaid |
$815.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,867.28
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,493.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,239.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$2,359.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP DNSP |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
OP
|
$103.24
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$103.24 |
| Rate for Payer: Aetna Commercial |
$92.92
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$100.14
|
| Rate for Payer: ASR Commercial |
$100.14
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$84.54
|
| Rate for Payer: BCN Commercial |
$80.04
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Commercial |
$97.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$103.24
|
| Rate for Payer: Healthscope Whirlpool |
$100.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$92.92
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: Nomi Health Commercial |
$84.66
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.46
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$72.37
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
IP
|
$103.24
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$103.24 |
| Rate for Payer: Aetna Commercial |
$92.92
|
| Rate for Payer: ASR ASR |
$100.14
|
| Rate for Payer: ASR Commercial |
$100.14
|
| Rate for Payer: BCBS Trust/PPO |
$84.13
|
| Rate for Payer: BCN Commercial |
$80.04
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Commercial |
$97.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$103.24
|
| Rate for Payer: Healthscope Whirlpool |
$100.14
|
| Rate for Payer: Mclaren Commercial |
$92.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: Nomi Health Commercial |
$84.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.85
|
|
|
HC PERIPHERAL DIAGNOSTIC CATHETER
|
Facility
|
IP
|
$283.83
|
|
| Hospital Charge Code |
27200145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.49 |
| Max. Negotiated Rate |
$283.83 |
| Rate for Payer: Aetna Commercial |
$255.45
|
| Rate for Payer: ASR ASR |
$275.32
|
| Rate for Payer: ASR Commercial |
$275.32
|
| Rate for Payer: BCBS Trust/PPO |
$231.29
|
| Rate for Payer: BCN Commercial |
$220.05
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Commercial |
$266.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$283.83
|
| Rate for Payer: Healthscope Whirlpool |
$275.32
|
| Rate for Payer: Mclaren Commercial |
$255.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: Nomi Health Commercial |
$232.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.77
|
|
|
HC PERIPHERAL DIAGNOSTIC CATHETER
|
Facility
|
OP
|
$283.83
|
|
| Hospital Charge Code |
27200145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$283.83 |
| Rate for Payer: Aetna Commercial |
$255.45
|
| Rate for Payer: Aetna Medicare |
$141.92
|
| Rate for Payer: ASR ASR |
$275.32
|
| Rate for Payer: ASR Commercial |
$275.32
|
| Rate for Payer: BCBS Complete |
$113.53
|
| Rate for Payer: BCBS Trust/PPO |
$232.43
|
| Rate for Payer: BCN Commercial |
$220.05
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Commercial |
$266.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$283.83
|
| Rate for Payer: Healthscope Whirlpool |
$275.32
|
| Rate for Payer: Mclaren Commercial |
$255.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: Nomi Health Commercial |
$232.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.69
|
| Rate for Payer: Priority Health Narrow Network |
$198.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.77
|
|
|
HC PERIPHERAL INTRODUCER
|
Facility
|
IP
|
$684.29
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.79 |
| Max. Negotiated Rate |
$684.29 |
| Rate for Payer: Aetna Commercial |
$615.86
|
| Rate for Payer: ASR ASR |
$663.76
|
| Rate for Payer: ASR Commercial |
$663.76
|
| Rate for Payer: BCBS Trust/PPO |
$557.63
|
| Rate for Payer: BCN Commercial |
$530.53
|
| Rate for Payer: Cash Price |
$547.43
|
| Rate for Payer: Cofinity Commercial |
$643.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.43
|
| Rate for Payer: Healthscope Commercial |
$684.29
|
| Rate for Payer: Healthscope Whirlpool |
$663.76
|
| Rate for Payer: Mclaren Commercial |
$615.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.65
|
| Rate for Payer: Nomi Health Commercial |
$561.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.18
|
|
|
HC PERIPHERAL INTRODUCER
|
Facility
|
OP
|
$684.29
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.72 |
| Max. Negotiated Rate |
$684.29 |
| Rate for Payer: Aetna Commercial |
$615.86
|
| Rate for Payer: Aetna Medicare |
$342.14
|
| Rate for Payer: ASR ASR |
$663.76
|
| Rate for Payer: ASR Commercial |
$663.76
|
| Rate for Payer: BCBS Complete |
$273.72
|
| Rate for Payer: BCBS Trust/PPO |
$560.37
|
| Rate for Payer: BCN Commercial |
$530.53
|
| Rate for Payer: Cash Price |
$547.43
|
| Rate for Payer: Cofinity Commercial |
$643.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.43
|
| Rate for Payer: Healthscope Commercial |
$684.29
|
| Rate for Payer: Healthscope Whirlpool |
$663.76
|
| Rate for Payer: Mclaren Commercial |
$615.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.65
|
| Rate for Payer: Nomi Health Commercial |
$561.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.57
|
| Rate for Payer: Priority Health Narrow Network |
$479.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.18
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
OP
|
$957.03
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$223.62 |
| Max. Negotiated Rate |
$957.03 |
| Rate for Payer: Aetna Commercial |
$861.33
|
| Rate for Payer: Aetna Medicare |
$417.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.51
|
| Rate for Payer: ASR ASR |
$928.32
|
| Rate for Payer: ASR Commercial |
$928.32
|
| Rate for Payer: BCBS Complete |
$234.81
|
| Rate for Payer: BCBS MAPPO |
$417.21
|
| Rate for Payer: BCBS Trust/PPO |
$783.71
|
| Rate for Payer: BCN Commercial |
$741.99
|
| Rate for Payer: BCN Medicare Advantage |
$417.21
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cofinity Commercial |
$899.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.21
|
| Rate for Payer: Healthscope Commercial |
$957.03
|
| Rate for Payer: Healthscope Whirlpool |
$928.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$417.21
|
| Rate for Payer: Mclaren Commercial |
$861.33
|
| Rate for Payer: Mclaren Medicaid |
$223.62
|
| Rate for Payer: Mclaren Medicare |
$417.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.07
|
| Rate for Payer: Meridian Medicaid |
$234.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.48
|
| Rate for Payer: Nomi Health Commercial |
$784.76
|
| Rate for Payer: PACE Medicare |
$396.35
|
| Rate for Payer: PACE SWMI |
$417.21
|
| Rate for Payer: PHP Commercial |
$458.93
|
| Rate for Payer: PHP Medicaid |
$223.62
|
| Rate for Payer: PHP Medicare Advantage |
$417.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$838.55
|
| Rate for Payer: Priority Health Medicare |
$417.21
|
| Rate for Payer: Priority Health Narrow Network |
$670.88
|
| Rate for Payer: Railroad Medicare Medicare |
$417.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.21
|
| Rate for Payer: UHC Exchange |
$646.68
|
| Rate for Payer: UHC Medicare Advantage |
$417.21
|
| Rate for Payer: UHCCP DNSP |
$417.21
|
| Rate for Payer: UHCCP Medicaid |
$223.62
|
| Rate for Payer: VA VA |
$417.21
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
IP
|
$957.03
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$622.07 |
| Max. Negotiated Rate |
$957.03 |
| Rate for Payer: Aetna Commercial |
$861.33
|
| Rate for Payer: ASR ASR |
$928.32
|
| Rate for Payer: ASR Commercial |
$928.32
|
| Rate for Payer: BCBS Trust/PPO |
$779.88
|
| Rate for Payer: BCN Commercial |
$741.99
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cofinity Commercial |
$899.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.62
|
| Rate for Payer: Healthscope Commercial |
$957.03
|
| Rate for Payer: Healthscope Whirlpool |
$928.32
|
| Rate for Payer: Mclaren Commercial |
$861.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.48
|
| Rate for Payer: Nomi Health Commercial |
$784.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.19
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
OP
|
$707.40
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$282.96 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: Aetna Medicare |
$353.70
|
| Rate for Payer: ASR ASR |
$686.18
|
| Rate for Payer: ASR Commercial |
$686.18
|
| Rate for Payer: BCBS Complete |
$282.96
|
| Rate for Payer: BCBS Trust/PPO |
$579.29
|
| Rate for Payer: BCN Commercial |
$548.45
|
| Rate for Payer: Cash Price |
$565.92
|
| Rate for Payer: Cofinity Commercial |
$664.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.92
|
| Rate for Payer: Healthscope Commercial |
$707.40
|
| Rate for Payer: Healthscope Whirlpool |
$686.18
|
| Rate for Payer: Mclaren Commercial |
$636.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.29
|
| Rate for Payer: Nomi Health Commercial |
$580.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.82
|
| Rate for Payer: Priority Health Narrow Network |
$495.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.51
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
IP
|
$707.40
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$459.81 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: ASR ASR |
$686.18
|
| Rate for Payer: ASR Commercial |
$686.18
|
| Rate for Payer: BCBS Trust/PPO |
$576.46
|
| Rate for Payer: BCN Commercial |
$548.45
|
| Rate for Payer: Cash Price |
$565.92
|
| Rate for Payer: Cofinity Commercial |
$664.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.92
|
| Rate for Payer: Healthscope Commercial |
$707.40
|
| Rate for Payer: Healthscope Whirlpool |
$686.18
|
| Rate for Payer: Mclaren Commercial |
$636.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.29
|
| Rate for Payer: Nomi Health Commercial |
$580.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.51
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$832.68 |
| Rate for Payer: Aetna Commercial |
$511.80
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$551.61
|
| Rate for Payer: ASR Commercial |
$551.61
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$465.68
|
| Rate for Payer: BCN Commercial |
$440.89
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$534.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$568.67
|
| Rate for Payer: Healthscope Whirlpool |
$551.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren Commercial |
$511.80
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$466.31
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.27
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$398.64
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$369.64 |
| Max. Negotiated Rate |
$568.67 |
| Rate for Payer: Aetna Commercial |
$511.80
|
| Rate for Payer: ASR ASR |
$551.61
|
| Rate for Payer: ASR Commercial |
$551.61
|
| Rate for Payer: BCBS Trust/PPO |
$463.41
|
| Rate for Payer: BCN Commercial |
$440.89
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$534.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Healthscope Commercial |
$568.67
|
| Rate for Payer: Healthscope Whirlpool |
$551.61
|
| Rate for Payer: Mclaren Commercial |
$511.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$466.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.43
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: ASR ASR |
$239.66
|
| Rate for Payer: ASR Commercial |
$239.66
|
| Rate for Payer: BCBS Trust/PPO |
$201.34
|
| Rate for Payer: BCN Commercial |
$191.55
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$247.07
|
| Rate for Payer: Healthscope Whirlpool |
$239.66
|
| Rate for Payer: Mclaren Commercial |
$222.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$202.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.42
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
OP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Aetna Commercial |
$222.36
|
| Rate for Payer: Aetna Medicare |
$123.54
|
| Rate for Payer: ASR ASR |
$239.66
|
| Rate for Payer: ASR Commercial |
$239.66
|
| Rate for Payer: BCBS Complete |
$98.83
|
| Rate for Payer: BCBS Trust/PPO |
$202.33
|
| Rate for Payer: BCN Commercial |
$191.55
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$247.07
|
| Rate for Payer: Healthscope Whirlpool |
$239.66
|
| Rate for Payer: Mclaren Commercial |
$222.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$202.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.48
|
| Rate for Payer: Priority Health Narrow Network |
$173.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.42
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.69 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna Commercial |
$303.05
|
| Rate for Payer: Aetna Medicare |
$168.36
|
| Rate for Payer: ASR ASR |
$326.62
|
| Rate for Payer: ASR Commercial |
$326.62
|
| Rate for Payer: BCBS Complete |
$134.69
|
| Rate for Payer: BCBS Trust/PPO |
$275.74
|
| Rate for Payer: BCN Commercial |
$261.06
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$316.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$336.72
|
| Rate for Payer: Healthscope Whirlpool |
$326.62
|
| Rate for Payer: Mclaren Commercial |
$303.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: Nomi Health Commercial |
$276.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.03
|
| Rate for Payer: Priority Health Narrow Network |
$236.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.31
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.87 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna Commercial |
$303.05
|
| Rate for Payer: ASR ASR |
$326.62
|
| Rate for Payer: ASR Commercial |
$326.62
|
| Rate for Payer: BCBS Trust/PPO |
$274.39
|
| Rate for Payer: BCN Commercial |
$261.06
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$316.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$336.72
|
| Rate for Payer: Healthscope Whirlpool |
$326.62
|
| Rate for Payer: Mclaren Commercial |
$303.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: Nomi Health Commercial |
$276.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.31
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$47.22 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Medicaid |
$8.08
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.22
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$37.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$23.37
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP DNSP |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,149.64 |
| Max. Negotiated Rate |
$1,768.68 |
| Rate for Payer: Aetna Commercial |
$1,591.81
|
| Rate for Payer: ASR ASR |
$1,715.62
|
| Rate for Payer: ASR Commercial |
$1,715.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.30
|
| Rate for Payer: BCN Commercial |
$1,371.26
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,662.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,768.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,715.62
|
| Rate for Payer: Mclaren Commercial |
$1,591.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: Nomi Health Commercial |
$1,450.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,556.44
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.67 |
| Max. Negotiated Rate |
$1,768.68 |
| Rate for Payer: Aetna Commercial |
$1,591.81
|
| Rate for Payer: Aetna Medicare |
$884.34
|
| Rate for Payer: ASR ASR |
$1,715.62
|
| Rate for Payer: ASR Commercial |
$1,715.62
|
| Rate for Payer: BCBS Complete |
$707.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,448.37
|
| Rate for Payer: BCN Commercial |
$1,371.26
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,662.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,768.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,715.62
|
| Rate for Payer: Mclaren Commercial |
$1,591.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: Nomi Health Commercial |
$1,450.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.84
|
| Rate for Payer: Priority Health Narrow Network |
$156.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,556.44
|
|
