|
HC SHRIMP IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC SHRIMP IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| 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 |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$233.65 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare |
$46.25
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$103.06
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$103.06
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$121.25
|
| Rate for Payer: Healthscope Whirlpool |
$125.00
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.65
|
| Rate for Payer: Priority Health Narrow Network |
$186.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$102.65
|
| Rate for Payer: BCN Commercial |
$102.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$121.25
|
| Rate for Payer: Healthscope Whirlpool |
$125.00
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$369.54
|
| Rate for Payer: BCN Commercial |
$369.54
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Healthscope Whirlpool |
$450.00
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$166.50
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.02
|
| Rate for Payer: BCN Commercial |
$371.02
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Healthscope Whirlpool |
$450.00
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$394.29
|
| Rate for Payer: Priority Health Narrow Network |
$315.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$27.75
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.84
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$61.84
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$72.75
|
| Rate for Payer: Healthscope Whirlpool |
$75.00
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.59
|
| Rate for Payer: BCN Commercial |
$61.59
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$72.75
|
| Rate for Payer: Healthscope Whirlpool |
$75.00
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$111.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$247.35
|
| Rate for Payer: BCN Commercial |
$247.35
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.86
|
| Rate for Payer: Priority Health Narrow Network |
$210.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$246.36
|
| Rate for Payer: BCN Commercial |
$246.36
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC SICKLE CELL TEST
|
Facility
|
IP
|
$31.94
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$31.94 |
| Rate for Payer: Aetna Commercial |
$28.75
|
| Rate for Payer: ASR ASR |
$30.98
|
| Rate for Payer: BCBS Trust/PPO |
$26.23
|
| Rate for Payer: BCN Commercial |
$26.23
|
| Rate for Payer: Cash Price |
$25.55
|
| Rate for Payer: Cofinity Commercial |
$30.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.55
|
| Rate for Payer: Healthscope Commercial |
$30.98
|
| Rate for Payer: Healthscope Whirlpool |
$31.94
|
| Rate for Payer: Mclaren Commercial |
$28.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.11
|
|
|
HC SICKLE CELL TEST
|
Facility
|
OP
|
$31.94
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$31.94 |
| Rate for Payer: Aetna Commercial |
$28.75
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: ASR ASR |
$30.98
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$26.33
|
| Rate for Payer: BCN Commercial |
$26.33
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| Rate for Payer: Cash Price |
$25.55
|
| Rate for Payer: Cash Price |
$25.55
|
| Rate for Payer: Cofinity Commercial |
$30.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$30.98
|
| Rate for Payer: Healthscope Whirlpool |
$31.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.51
|
| Rate for Payer: Mclaren Commercial |
$28.75
|
| Rate for Payer: Mclaren Medicaid |
$5.51
|
| Rate for Payer: Mclaren Medicare |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: Meridian Medicaid |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$26.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.95
|
| Rate for Payer: PACE Medicare |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: PHP Medicaid |
$2.95
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.40
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health Narrow Network |
$17.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.51
|
| Rate for Payer: UHC Exchange |
$8.54
|
| Rate for Payer: UHC Medicaid |
$2.88
|
| Rate for Payer: UHCCP DNSP |
$5.51
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$5.51
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
OP
|
$1,185.73
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Aetna Commercial |
$1,067.16
|
| Rate for Payer: Aetna Medicare |
$926.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: ASR ASR |
$1,150.16
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$977.63
|
| Rate for Payer: BCN Commercial |
$977.63
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$1,114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$1,150.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,185.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$926.61
|
| Rate for Payer: Mclaren Commercial |
$1,067.16
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$508.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$972.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$1,019.27
|
| Rate for Payer: PHP Medicaid |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$967.24
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Narrow Network |
$773.79
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$1,436.25
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP DNSP |
$926.61
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
IP
|
$1,185.73
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.30 |
| Max. Negotiated Rate |
$1,185.73 |
| Rate for Payer: Aetna Commercial |
$1,067.16
|
| Rate for Payer: ASR ASR |
$1,150.16
|
| Rate for Payer: BCBS Trust/PPO |
$973.72
|
| Rate for Payer: BCN Commercial |
$973.72
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$1,114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Healthscope Commercial |
$1,150.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,185.73
|
| Rate for Payer: Mclaren Commercial |
$1,067.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$972.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.44
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,673.54
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$989.21 |
| Max. Negotiated Rate |
$2,673.54 |
| Rate for Payer: Aetna Commercial |
$2,406.19
|
| Rate for Payer: Aetna Medicare |
$989.21
|
| Rate for Payer: ASR ASR |
$2,593.33
|
| Rate for Payer: BCBS Complete |
$1,069.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,204.33
|
| Rate for Payer: BCN Commercial |
$2,204.33
|
| Rate for Payer: Cash Price |
$2,138.83
|
| Rate for Payer: Cofinity Commercial |
$2,513.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.83
|
| Rate for Payer: Healthscope Commercial |
$2,593.33
|
| Rate for Payer: Healthscope Whirlpool |
$2,673.54
|
| Rate for Payer: Mclaren Commercial |
$2,406.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,138.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,272.51
|
| Rate for Payer: Nomi Health Commercial |
$2,192.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,005.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,342.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,874.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,352.72
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,673.54
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.15 |
| Max. Negotiated Rate |
$2,673.54 |
| Rate for Payer: Aetna Commercial |
$2,406.19
|
| Rate for Payer: ASR ASR |
$2,593.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,195.51
|
| Rate for Payer: BCN Commercial |
$2,195.51
|
| Rate for Payer: Cash Price |
$2,138.83
|
| Rate for Payer: Cofinity Commercial |
$2,513.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.83
|
| Rate for Payer: Healthscope Commercial |
$2,593.33
|
| Rate for Payer: Healthscope Whirlpool |
$2,673.54
|
| Rate for Payer: Mclaren Commercial |
$2,406.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,272.51
|
| Rate for Payer: Nomi Health Commercial |
$2,192.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,005.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,352.72
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$1,290.13
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.60 |
| Max. Negotiated Rate |
$1,290.13 |
| Rate for Payer: Aetna Commercial |
$1,161.12
|
| Rate for Payer: ASR ASR |
$1,251.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.45
|
| Rate for Payer: BCN Commercial |
$1,059.45
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cofinity Commercial |
$1,212.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.10
|
| Rate for Payer: Healthscope Commercial |
$1,251.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,290.13
|
| Rate for Payer: Mclaren Commercial |
$1,161.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.61
|
| Rate for Payer: Nomi Health Commercial |
$1,057.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$967.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,135.31
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$1,290.13
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Aetna Commercial |
$1,161.12
|
| Rate for Payer: Aetna Medicare |
$926.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: ASR ASR |
$1,251.43
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.71
|
| Rate for Payer: BCN Commercial |
$1,063.71
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cofinity Commercial |
$1,212.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$1,251.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,290.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$926.61
|
| Rate for Payer: Mclaren Commercial |
$1,161.12
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$508.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.61
|
| Rate for Payer: Nomi Health Commercial |
$1,057.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$967.60
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$1,019.27
|
| Rate for Payer: PHP Medicaid |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,130.41
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Narrow Network |
$904.38
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,135.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$1,436.25
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP DNSP |
$926.61
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
IP
|
$257.93
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$193.45 |
| Max. Negotiated Rate |
$257.93 |
| Rate for Payer: Aetna Commercial |
$232.14
|
| Rate for Payer: ASR ASR |
$250.19
|
| Rate for Payer: BCBS Trust/PPO |
$211.81
|
| Rate for Payer: BCN Commercial |
$211.81
|
| Rate for Payer: Cash Price |
$206.34
|
| Rate for Payer: Cofinity Commercial |
$242.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.34
|
| Rate for Payer: Healthscope Commercial |
$250.19
|
| Rate for Payer: Healthscope Whirlpool |
$257.93
|
| Rate for Payer: Mclaren Commercial |
$232.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.24
|
| Rate for Payer: Nomi Health Commercial |
$211.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.98
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
OP
|
$257.93
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$257.93 |
| Rate for Payer: Aetna Commercial |
$232.14
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$250.19
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$212.66
|
| Rate for Payer: BCN Commercial |
$212.66
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$206.34
|
| Rate for Payer: Cash Price |
$206.34
|
| Rate for Payer: Cofinity Commercial |
$242.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$250.19
|
| Rate for Payer: Healthscope Whirlpool |
$257.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$232.14
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.24
|
| Rate for Payer: Nomi Health Commercial |
$211.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.45
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.00
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$180.81
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$41.16 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$3.30
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.01
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.01
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$3.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicaid |
$3.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.32
|
| Rate for Payer: UHC Medicaid |
$3.14
|
| Rate for Payer: UHCCP DNSP |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$3.14
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC SILVADENE 400 GM
|
Facility
|
IP
|
$258.59
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$193.94 |
| Max. Negotiated Rate |
$258.59 |
| Rate for Payer: Aetna Commercial |
$232.73
|
| Rate for Payer: ASR ASR |
$250.83
|
| Rate for Payer: BCBS Trust/PPO |
$212.35
|
| Rate for Payer: BCN Commercial |
$212.35
|
| Rate for Payer: Cash Price |
$206.87
|
| Rate for Payer: Cofinity Commercial |
$243.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.87
|
| Rate for Payer: Healthscope Commercial |
$250.83
|
| Rate for Payer: Healthscope Whirlpool |
$258.59
|
| Rate for Payer: Mclaren Commercial |
$232.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.80
|
| Rate for Payer: Nomi Health Commercial |
$212.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.56
|
|
|
HC SILVADENE 400 GM
|
Facility
|
OP
|
$258.59
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$258.59 |
| Rate for Payer: Aetna Commercial |
$232.73
|
| Rate for Payer: Aetna Medicare |
$95.68
|
| Rate for Payer: ASR ASR |
$250.83
|
| Rate for Payer: BCBS Complete |
$103.44
|
| Rate for Payer: BCBS Trust/PPO |
$213.21
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$206.87
|
| Rate for Payer: Cofinity Commercial |
$243.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.87
|
| Rate for Payer: Healthscope Commercial |
$250.83
|
| Rate for Payer: Healthscope Whirlpool |
$258.59
|
| Rate for Payer: Mclaren Commercial |
$232.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.80
|
| Rate for Payer: Nomi Health Commercial |
$212.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.58
|
| Rate for Payer: Priority Health Narrow Network |
$181.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.56
|
|
|
HC SILVADENE 85 GM
|
Facility
|
OP
|
$106.71
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$106.71 |
| Rate for Payer: Aetna Commercial |
$96.04
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: ASR ASR |
$103.51
|
| Rate for Payer: BCBS Complete |
$42.68
|
| Rate for Payer: BCBS Trust/PPO |
$87.98
|
| Rate for Payer: BCN Commercial |
$87.98
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.37
|
| Rate for Payer: Healthscope Commercial |
$103.51
|
| Rate for Payer: Healthscope Whirlpool |
$106.71
|
| Rate for Payer: Mclaren Commercial |
$96.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.70
|
| Rate for Payer: Nomi Health Commercial |
$87.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$93.50
|
| Rate for Payer: Priority Health Narrow Network |
$74.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.90
|
|
