|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$167.08
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$150.37
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: ASR ASR |
$162.07
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$137.76
|
| Rate for Payer: BCN Commercial |
$137.76
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cofinity Commercial |
$157.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$162.07
|
| Rate for Payer: Healthscope Whirlpool |
$167.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$150.37
|
| Rate for Payer: Mclaren Medicaid |
$51.31
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.02
|
| Rate for Payer: Nomi Health Commercial |
$137.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.31
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: PHP Medicaid |
$27.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$64.76
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$51.81
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$79.53
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP DNSP |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$167.08
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$150.37
|
| Rate for Payer: ASR ASR |
$162.07
|
| Rate for Payer: BCBS Trust/PPO |
$137.21
|
| Rate for Payer: BCN Commercial |
$137.21
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cofinity Commercial |
$157.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.66
|
| Rate for Payer: Healthscope Commercial |
$162.07
|
| Rate for Payer: Healthscope Whirlpool |
$167.08
|
| Rate for Payer: Mclaren Commercial |
$150.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.02
|
| Rate for Payer: Nomi Health Commercial |
$137.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.03
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
IP
|
$222.85
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$222.85 |
| Rate for Payer: Aetna Commercial |
$200.56
|
| Rate for Payer: ASR ASR |
$216.16
|
| Rate for Payer: BCBS Trust/PPO |
$183.00
|
| Rate for Payer: BCN Commercial |
$183.00
|
| Rate for Payer: Cash Price |
$178.28
|
| Rate for Payer: Cofinity Commercial |
$209.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.28
|
| Rate for Payer: Healthscope Commercial |
$216.16
|
| Rate for Payer: Healthscope Whirlpool |
$222.85
|
| Rate for Payer: Mclaren Commercial |
$200.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.42
|
| Rate for Payer: Nomi Health Commercial |
$182.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.11
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
OP
|
$222.85
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$222.85 |
| Rate for Payer: Aetna Commercial |
$200.56
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$216.16
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$183.74
|
| Rate for Payer: BCN Commercial |
$183.74
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$178.28
|
| Rate for Payer: Cash Price |
$178.28
|
| Rate for Payer: Cofinity Commercial |
$209.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$216.16
|
| Rate for Payer: Healthscope Whirlpool |
$222.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$200.56
|
| Rate for Payer: Mclaren Medicaid |
$142.63
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.42
|
| Rate for Payer: Nomi Health Commercial |
$182.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.14
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$195.26
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$156.22
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: ASR ASR |
$252.20
|
| Rate for Payer: BCBS Trust/PPO |
$213.51
|
| Rate for Payer: BCN Commercial |
$213.51
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$244.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$252.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.00
|
| Rate for Payer: Mclaren Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.80
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$252.20
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$214.37
|
| Rate for Payer: BCN Commercial |
$214.37
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$244.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$252.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$234.00
|
| Rate for Payer: Mclaren Medicaid |
$142.63
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.81
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$182.26
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
IP
|
$255.32
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$255.32 |
| Rate for Payer: Aetna Commercial |
$229.79
|
| Rate for Payer: ASR ASR |
$247.66
|
| Rate for Payer: BCBS Trust/PPO |
$209.67
|
| Rate for Payer: BCN Commercial |
$209.67
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cofinity Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.26
|
| Rate for Payer: Healthscope Commercial |
$247.66
|
| Rate for Payer: Healthscope Whirlpool |
$255.32
|
| Rate for Payer: Mclaren Commercial |
$229.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.02
|
| Rate for Payer: Nomi Health Commercial |
$209.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.68
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
OP
|
$255.32
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$255.32 |
| Rate for Payer: Aetna Commercial |
$229.79
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$247.66
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$210.51
|
| Rate for Payer: BCN Commercial |
$210.51
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cofinity Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$247.66
|
| Rate for Payer: Healthscope Whirlpool |
$255.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$229.79
|
| Rate for Payer: Mclaren Medicaid |
$142.63
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.02
|
| Rate for Payer: Nomi Health Commercial |
$209.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.49
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$223.71
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$178.98
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 INF AB RSV PCR CEPHEID
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$187.43 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: BCBS Trust/PPO |
$205.22
|
| Rate for Payer: BCN Commercial |
$205.22
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$242.40
|
| Rate for Payer: Healthscope Whirlpool |
$249.90
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
|
|
HC SARSCOV2 INF AB RSV PCR CEPHEID
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$206.04
|
| Rate for Payer: BCN Commercial |
$206.04
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$242.40
|
| Rate for Payer: Healthscope Whirlpool |
$249.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$142.63
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.43
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$175.18
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$223.51
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$223.51 |
| Rate for Payer: Aetna Commercial |
$201.16
|
| Rate for Payer: ASR ASR |
$216.80
|
| Rate for Payer: BCBS Trust/PPO |
$183.55
|
| Rate for Payer: BCN Commercial |
$183.55
|
| Rate for Payer: Cash Price |
$178.81
|
| Rate for Payer: Cofinity Commercial |
$210.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.81
|
| Rate for Payer: Healthscope Commercial |
$216.80
|
| Rate for Payer: Healthscope Whirlpool |
$223.51
|
| Rate for Payer: Mclaren Commercial |
$201.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.98
|
| Rate for Payer: Nomi Health Commercial |
$183.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.69
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$223.51
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$223.51 |
| Rate for Payer: Aetna Commercial |
$201.16
|
| Rate for Payer: Aetna Medicare |
$82.70
|
| Rate for Payer: ASR ASR |
$216.80
|
| Rate for Payer: BCBS Complete |
$89.40
|
| Rate for Payer: BCBS Trust/PPO |
$184.28
|
| Rate for Payer: BCN Commercial |
$184.28
|
| Rate for Payer: Cash Price |
$178.81
|
| Rate for Payer: Cash Price |
$178.81
|
| Rate for Payer: Cofinity Commercial |
$210.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.81
|
| Rate for Payer: Healthscope Commercial |
$216.80
|
| Rate for Payer: Healthscope Whirlpool |
$223.51
|
| Rate for Payer: Mclaren Commercial |
$201.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.98
|
| Rate for Payer: Nomi Health Commercial |
$183.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.69
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$333.82
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.37 |
| Max. Negotiated Rate |
$333.82 |
| Rate for Payer: Aetna Commercial |
$300.44
|
| Rate for Payer: ASR ASR |
$323.81
|
| Rate for Payer: BCBS Trust/PPO |
$274.13
|
| Rate for Payer: BCN Commercial |
$274.13
|
| Rate for Payer: Cash Price |
$267.06
|
| Rate for Payer: Cofinity Commercial |
$313.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.06
|
| Rate for Payer: Healthscope Commercial |
$323.81
|
| Rate for Payer: Healthscope Whirlpool |
$333.82
|
| Rate for Payer: Mclaren Commercial |
$300.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.75
|
| Rate for Payer: Nomi Health Commercial |
$273.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.76
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$333.82
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$333.82 |
| Rate for Payer: Aetna Commercial |
$300.44
|
| Rate for Payer: Aetna Medicare |
$123.51
|
| Rate for Payer: ASR ASR |
$323.81
|
| Rate for Payer: BCBS Complete |
$133.53
|
| Rate for Payer: BCBS Trust/PPO |
$275.23
|
| Rate for Payer: BCN Commercial |
$275.23
|
| Rate for Payer: Cash Price |
$267.06
|
| Rate for Payer: Cash Price |
$267.06
|
| Rate for Payer: Cofinity Commercial |
$313.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.06
|
| Rate for Payer: Healthscope Commercial |
$323.81
|
| Rate for Payer: Healthscope Whirlpool |
$333.82
|
| Rate for Payer: Mclaren Commercial |
$300.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.75
|
| Rate for Payer: Nomi Health Commercial |
$273.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$192.59
|
| Rate for Payer: Priority Health Narrow Network |
$154.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.76
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$166.92
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$166.92 |
| Rate for Payer: Aetna Commercial |
$150.23
|
| Rate for Payer: Aetna Medicare |
$61.76
|
| Rate for Payer: ASR ASR |
$161.91
|
| Rate for Payer: BCBS Complete |
$66.77
|
| Rate for Payer: BCBS Trust/PPO |
$137.63
|
| Rate for Payer: BCN Commercial |
$137.63
|
| Rate for Payer: Cash Price |
$133.54
|
| Rate for Payer: Cash Price |
$133.54
|
| Rate for Payer: Cofinity Commercial |
$156.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.54
|
| Rate for Payer: Healthscope Commercial |
$161.91
|
| Rate for Payer: Healthscope Whirlpool |
$166.92
|
| Rate for Payer: Mclaren Commercial |
$150.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.88
|
| Rate for Payer: Nomi Health Commercial |
$136.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.55
|
| Rate for Payer: Priority Health Narrow Network |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.89
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$166.92
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.19 |
| Max. Negotiated Rate |
$166.92 |
| Rate for Payer: Aetna Commercial |
$150.23
|
| Rate for Payer: ASR ASR |
$161.91
|
| Rate for Payer: BCBS Trust/PPO |
$137.07
|
| Rate for Payer: BCN Commercial |
$137.07
|
| Rate for Payer: Cash Price |
$133.54
|
| Rate for Payer: Cofinity Commercial |
$156.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.54
|
| Rate for Payer: Healthscope Commercial |
$161.91
|
| Rate for Payer: Healthscope Whirlpool |
$166.92
|
| Rate for Payer: Mclaren Commercial |
$150.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.88
|
| Rate for Payer: Nomi Health Commercial |
$136.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.89
|
|
|
HC SARSCOV2 VAC 5MCG/0.5ML IM NOVAVAX
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 91304
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC SARSCOV2 VAC 5MCG/0.5ML IM NOVAVAX
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 91304
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$191.92 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.92
|
| Rate for Payer: Priority Health Narrow Network |
$153.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE
|
Facility
|
OP
|
$345.69
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
63600276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$345.69 |
| Rate for Payer: Aetna Commercial |
$311.12
|
| Rate for Payer: Aetna Medicare |
$127.91
|
| Rate for Payer: ASR ASR |
$335.32
|
| Rate for Payer: BCBS Complete |
$138.28
|
| Rate for Payer: BCBS Trust/PPO |
$285.02
|
| Rate for Payer: BCN Commercial |
$285.02
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Commercial |
$324.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$335.32
|
| Rate for Payer: Healthscope Whirlpool |
$345.69
|
| Rate for Payer: Mclaren Commercial |
$311.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Nomi Health Commercial |
$283.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.06
|
| Rate for Payer: Priority Health Narrow Network |
$117.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.21
|
|
|
HC SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE
|
Facility
|
IP
|
$345.69
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
63600276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$259.27 |
| Max. Negotiated Rate |
$345.69 |
| Rate for Payer: Aetna Commercial |
$311.12
|
| Rate for Payer: ASR ASR |
$335.32
|
| Rate for Payer: BCBS Trust/PPO |
$283.88
|
| Rate for Payer: BCN Commercial |
$283.88
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Commercial |
$324.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$335.32
|
| Rate for Payer: Healthscope Whirlpool |
$345.69
|
| Rate for Payer: Mclaren Commercial |
$311.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Nomi Health Commercial |
$283.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.21
|
|
|
HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE
|
Facility
|
OP
|
$345.69
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
63600277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$345.69 |
| Rate for Payer: Aetna Commercial |
$311.12
|
| Rate for Payer: Aetna Medicare |
$127.91
|
| Rate for Payer: ASR ASR |
$335.32
|
| Rate for Payer: BCBS Complete |
$138.28
|
| Rate for Payer: BCBS Trust/PPO |
$285.02
|
| Rate for Payer: BCN Commercial |
$285.02
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Commercial |
$324.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$335.32
|
| Rate for Payer: Healthscope Whirlpool |
$345.69
|
| Rate for Payer: Mclaren Commercial |
$311.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Nomi Health Commercial |
$283.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$161.65
|
| Rate for Payer: Priority Health Narrow Network |
$129.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.21
|
|
|
HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE
|
Facility
|
IP
|
$345.69
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
63600277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$259.27 |
| Max. Negotiated Rate |
$345.69 |
| Rate for Payer: Aetna Commercial |
$311.12
|
| Rate for Payer: ASR ASR |
$335.32
|
| Rate for Payer: BCBS Trust/PPO |
$283.88
|
| Rate for Payer: BCN Commercial |
$283.88
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Commercial |
$324.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$335.32
|
| Rate for Payer: Healthscope Whirlpool |
$345.69
|
| Rate for Payer: Mclaren Commercial |
$311.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Nomi Health Commercial |
$283.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.21
|
|
|
HC SARSCOV AG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600336
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Medicare |
$35.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.33
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$35.33
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Meridian Medicaid |
$19.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$38.86
|
| Rate for Payer: PHP Medicaid |
$18.94
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.59
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health Narrow Network |
$35.67
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.33
|
| Rate for Payer: UHC Exchange |
$54.76
|
| Rate for Payer: UHC Medicaid |
$18.48
|
| Rate for Payer: UHCCP DNSP |
$35.33
|
| Rate for Payer: UHCCP Medicaid |
$18.48
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC SARSCOV AG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600336
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
|
|
HC SARSCOV CORONAVIRUS AG IA
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600331
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$63.25 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.35
|
| Rate for Payer: BCBS Trust/PPO |
$51.94
|
| Rate for Payer: BCN Commercial |
$51.94
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$61.35
|
| Rate for Payer: Healthscope Whirlpool |
$63.25
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$51.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.66
|
|
