|
HC STRIP PASTE
|
Facility
|
OP
|
$4.50
|
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: ASR ASR |
$4.36
|
| Rate for Payer: ASR Commercial |
$4.36
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$3.69
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.50
|
| Rate for Payer: Healthscope Whirlpool |
$4.36
|
| Rate for Payer: Mclaren Commercial |
$4.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.82
|
| Rate for Payer: Nomi Health Commercial |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.94
|
| Rate for Payer: Priority Health Narrow Network |
$3.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.96
|
|
|
HC STRIP PASTE
|
Facility
|
IP
|
$4.50
|
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: ASR ASR |
$4.36
|
| Rate for Payer: ASR Commercial |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.50
|
| Rate for Payer: Healthscope Whirlpool |
$4.36
|
| Rate for Payer: Mclaren Commercial |
$4.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.82
|
| Rate for Payer: Nomi Health Commercial |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.96
|
|
|
HC STRONGYLOIDES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$87.31
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$87.31 |
| Rate for Payer: Aetna Commercial |
$78.58
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: ASR ASR |
$84.69
|
| Rate for Payer: ASR Commercial |
$84.69
|
| Rate for Payer: BCBS Complete |
$7.32
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$71.50
|
| Rate for Payer: BCN Commercial |
$67.69
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Cofinity Commercial |
$82.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$87.31
|
| Rate for Payer: Healthscope Whirlpool |
$84.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.01
|
| Rate for Payer: Mclaren Commercial |
$78.58
|
| Rate for Payer: Mclaren Medicaid |
$6.97
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$7.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.21
|
| Rate for Payer: Nomi Health Commercial |
$71.59
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Medicaid |
$6.97
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.50
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health Narrow Network |
$61.20
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$20.17
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP DNSP |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$6.97
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC STRONGYLOIDES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$87.31
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$87.31 |
| Rate for Payer: Aetna Commercial |
$78.58
|
| Rate for Payer: ASR ASR |
$84.69
|
| Rate for Payer: ASR Commercial |
$84.69
|
| Rate for Payer: BCBS Trust/PPO |
$71.15
|
| Rate for Payer: BCN Commercial |
$67.69
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Cofinity Commercial |
$82.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.85
|
| Rate for Payer: Healthscope Commercial |
$87.31
|
| Rate for Payer: Healthscope Whirlpool |
$84.69
|
| Rate for Payer: Mclaren Commercial |
$78.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.21
|
| Rate for Payer: Nomi Health Commercial |
$71.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.83
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: ASR Commercial |
$37.83
|
| Rate for Payer: BCBS Trust/PPO |
$31.78
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Nomi Health Commercial |
$31.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: ASR Commercial |
$37.83
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$31.94
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Nomi Health Commercial |
$31.98
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,700.82
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,360.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
IP
|
$132.60
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$119.34
|
| Rate for Payer: ASR ASR |
$128.62
|
| Rate for Payer: ASR Commercial |
$128.62
|
| Rate for Payer: BCBS Trust/PPO |
$108.06
|
| Rate for Payer: BCN Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cofinity Commercial |
$124.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Healthscope Commercial |
$132.60
|
| Rate for Payer: Healthscope Whirlpool |
$128.62
|
| Rate for Payer: Mclaren Commercial |
$119.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.71
|
| Rate for Payer: Nomi Health Commercial |
$108.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.69
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
OP
|
$132.60
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$119.34
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.02
|
| Rate for Payer: ASR ASR |
$128.62
|
| Rate for Payer: ASR Commercial |
$128.62
|
| Rate for Payer: BCBS Complete |
$4.51
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$108.59
|
| Rate for Payer: BCN Commercial |
$102.80
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cofinity Commercial |
$124.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$132.60
|
| Rate for Payer: Healthscope Whirlpool |
$128.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.02
|
| Rate for Payer: Mclaren Commercial |
$119.34
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: Meridian Medicaid |
$4.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.71
|
| Rate for Payer: Nomi Health Commercial |
$108.73
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: PHP Medicaid |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.18
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow Network |
$92.95
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$12.43
|
| Rate for Payer: UHC Medicare Advantage |
$8.02
|
| Rate for Payer: UHCCP DNSP |
$8.02
|
| Rate for Payer: UHCCP Medicaid |
$4.30
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
OP
|
$8,109.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,703.14 |
| Max. Negotiated Rate |
$8,109.00 |
| Rate for Payer: Aetna Commercial |
$7,298.10
|
| Rate for Payer: Aetna Medicare |
$3,177.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: ASR ASR |
$7,865.73
|
| Rate for Payer: ASR Commercial |
$7,865.73
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,640.46
|
| Rate for Payer: BCN Commercial |
$6,286.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$7,622.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$8,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,865.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,177.50
|
| Rate for Payer: Mclaren Commercial |
$7,298.10
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$3,495.25
|
| Rate for Payer: PHP Medicaid |
$1,703.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,105.11
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$5,684.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,135.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$4,925.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP DNSP |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
IP
|
$8,109.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,270.85 |
| Max. Negotiated Rate |
$8,109.00 |
| Rate for Payer: Aetna Commercial |
$7,298.10
|
| Rate for Payer: ASR ASR |
$7,865.73
|
| Rate for Payer: ASR Commercial |
$7,865.73
|
| Rate for Payer: BCBS Trust/PPO |
$6,608.02
|
| Rate for Payer: BCN Commercial |
$6,286.91
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$7,622.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Healthscope Commercial |
$8,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,865.73
|
| Rate for Payer: Mclaren Commercial |
$7,298.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,135.92
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$12,163.50
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,906.28 |
| Max. Negotiated Rate |
$12,163.50 |
| Rate for Payer: Aetna Commercial |
$10,947.15
|
| Rate for Payer: ASR ASR |
$11,798.60
|
| Rate for Payer: ASR Commercial |
$11,798.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,912.04
|
| Rate for Payer: BCN Commercial |
$9,430.36
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cofinity Commercial |
$11,433.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,730.80
|
| Rate for Payer: Healthscope Commercial |
$12,163.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,798.60
|
| Rate for Payer: Mclaren Commercial |
$10,947.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,338.98
|
| Rate for Payer: Nomi Health Commercial |
$9,974.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,906.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,703.88
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$12,163.50
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,703.14 |
| Max. Negotiated Rate |
$12,163.50 |
| Rate for Payer: Aetna Commercial |
$10,947.15
|
| Rate for Payer: Aetna Medicare |
$3,177.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: ASR ASR |
$11,798.60
|
| Rate for Payer: ASR Commercial |
$11,798.60
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$9,960.69
|
| Rate for Payer: BCN Commercial |
$9,430.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cofinity Commercial |
$11,433.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,730.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$12,163.50
|
| Rate for Payer: Healthscope Whirlpool |
$11,798.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,177.50
|
| Rate for Payer: Mclaren Commercial |
$10,947.15
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,338.98
|
| Rate for Payer: Nomi Health Commercial |
$9,974.07
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$3,495.25
|
| Rate for Payer: PHP Medicaid |
$1,703.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,906.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,657.66
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$8,526.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,703.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$4,925.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP DNSP |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$32.13
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$28.92
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: ASR ASR |
$31.17
|
| Rate for Payer: ASR Commercial |
$31.17
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Trust/PPO |
$26.31
|
| Rate for Payer: BCN Commercial |
$24.91
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$30.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Healthscope Whirlpool |
$31.17
|
| Rate for Payer: Mclaren Commercial |
$28.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.15
|
| Rate for Payer: Priority Health Narrow Network |
$22.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$32.13
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$28.92
|
| Rate for Payer: ASR ASR |
$31.17
|
| Rate for Payer: ASR Commercial |
$31.17
|
| Rate for Payer: BCBS Trust/PPO |
$26.18
|
| Rate for Payer: BCN Commercial |
$24.91
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$30.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Healthscope Whirlpool |
$31.17
|
| Rate for Payer: Mclaren Commercial |
$28.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$44.37
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Aetna Commercial |
$39.93
|
| Rate for Payer: ASR ASR |
$43.04
|
| Rate for Payer: ASR Commercial |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$36.16
|
| Rate for Payer: BCN Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$41.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$44.37
|
| Rate for Payer: Healthscope Whirlpool |
$43.04
|
| Rate for Payer: Mclaren Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.05
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$44.37
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Aetna Commercial |
$39.93
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: ASR ASR |
$43.04
|
| Rate for Payer: ASR Commercial |
$43.04
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS Trust/PPO |
$36.33
|
| Rate for Payer: BCN Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$41.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$44.37
|
| Rate for Payer: Healthscope Whirlpool |
$43.04
|
| Rate for Payer: Mclaren Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.88
|
| Rate for Payer: Priority Health Narrow Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.05
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: ASR ASR |
$152.39
|
| Rate for Payer: ASR Commercial |
$152.39
|
| Rate for Payer: BCBS Trust/PPO |
$128.02
|
| Rate for Payer: BCN Commercial |
$121.80
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$157.10
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$141.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.25
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
OP
|
$157.10
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: ASR ASR |
$152.39
|
| Rate for Payer: ASR Commercial |
$152.39
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS Trust/PPO |
$128.65
|
| Rate for Payer: BCN Commercial |
$121.80
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$157.10
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$141.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.65
|
| Rate for Payer: Priority Health Narrow Network |
$110.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.25
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
OP
|
$86.70
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$155.91 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: ASR ASR |
$84.10
|
| Rate for Payer: ASR Commercial |
$84.10
|
| Rate for Payer: BCBS Complete |
$13.57
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$71.00
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$81.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$86.70
|
| Rate for Payer: Healthscope Whirlpool |
$84.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$78.03
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$13.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$26.52
|
| Rate for Payer: PHP Medicaid |
$12.92
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.91
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$124.73
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP DNSP |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$12.92
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
IP
|
$86.70
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.36 |
| Max. Negotiated Rate |
$86.70 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: ASR ASR |
$84.10
|
| Rate for Payer: ASR Commercial |
$84.10
|
| Rate for Payer: BCBS Trust/PPO |
$70.65
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$81.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Healthscope Commercial |
$86.70
|
| Rate for Payer: Healthscope Whirlpool |
$84.10
|
| Rate for Payer: Mclaren Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$118.97
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: ASR ASR |
$115.40
|
| Rate for Payer: ASR Commercial |
$115.40
|
| Rate for Payer: BCBS Trust/PPO |
$96.95
|
| Rate for Payer: BCN Commercial |
$92.24
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cofinity Commercial |
$111.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.18
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Healthscope Whirlpool |
$115.40
|
| Rate for Payer: Mclaren Commercial |
$107.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.12
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.69
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$118.97
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$107.07
|
| Rate for Payer: Aetna Medicare |
$59.48
|
| Rate for Payer: ASR ASR |
$115.40
|
| Rate for Payer: ASR Commercial |
$115.40
|
| Rate for Payer: BCBS Complete |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$97.42
|
| Rate for Payer: BCN Commercial |
$92.24
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cofinity Commercial |
$111.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.18
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Healthscope Whirlpool |
$115.40
|
| Rate for Payer: Mclaren Commercial |
$107.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.12
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.24
|
| Rate for Payer: Priority Health Narrow Network |
$83.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.69
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: ASR ASR |
$72.46
|
| Rate for Payer: ASR Commercial |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$60.87
|
| Rate for Payer: BCN Commercial |
$57.91
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$70.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Healthscope Whirlpool |
$72.46
|
| Rate for Payer: Mclaren Commercial |
$67.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.50
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.74
|
|
