|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$22.27
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$21.60
|
| Rate for Payer: ASR Commercial |
$21.60
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$18.24
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$20.04
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.88
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$52.70
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$22.27
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: ASR ASR |
$21.60
|
| Rate for Payer: ASR Commercial |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.60
|
| Rate for Payer: Mclaren Commercial |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.60
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$37.85
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$102.11 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: Aetna Medicare |
$52.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.44
|
| Rate for Payer: ASR ASR |
$36.71
|
| Rate for Payer: ASR Commercial |
$36.71
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$52.35
|
| Rate for Payer: BCBS Trust/PPO |
$31.00
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: BCN Medicare Advantage |
$52.35
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$35.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$37.85
|
| Rate for Payer: Healthscope Whirlpool |
$36.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.35
|
| Rate for Payer: Mclaren Commercial |
$34.06
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Mclaren Medicare |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.97
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: PACE Medicare |
$49.73
|
| Rate for Payer: PACE SWMI |
$52.35
|
| Rate for Payer: PHP Commercial |
$57.58
|
| Rate for Payer: PHP Medicaid |
$28.06
|
| Rate for Payer: PHP Medicare Advantage |
$52.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.11
|
| Rate for Payer: Priority Health Medicare |
$52.35
|
| Rate for Payer: Priority Health Narrow Network |
$81.69
|
| Rate for Payer: Railroad Medicare Medicare |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.35
|
| Rate for Payer: UHC Exchange |
$81.14
|
| Rate for Payer: UHC Medicare Advantage |
$52.35
|
| Rate for Payer: UHCCP DNSP |
$52.35
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: VA VA |
$52.35
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$37.85
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$37.85 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: ASR ASR |
$36.71
|
| Rate for Payer: ASR Commercial |
$36.71
|
| Rate for Payer: BCBS Trust/PPO |
$30.84
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$35.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Healthscope Commercial |
$37.85
|
| Rate for Payer: Healthscope Whirlpool |
$36.71
|
| Rate for Payer: Mclaren Commercial |
$34.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.31
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,805.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: Aetna Medicare |
$1,402.50
|
| Rate for Payer: ASR ASR |
$2,720.85
|
| Rate for Payer: ASR Commercial |
$2,720.85
|
| Rate for Payer: BCBS Complete |
$1,122.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,297.01
|
| Rate for Payer: BCN Commercial |
$2,174.72
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$2,636.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,244.00
|
| Rate for Payer: Healthscope Commercial |
$2,805.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,720.85
|
| Rate for Payer: Mclaren Commercial |
$2,524.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,384.25
|
| Rate for Payer: Nomi Health Commercial |
$2,300.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,457.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,966.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,468.40
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,805.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,823.25 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: ASR ASR |
$2,720.85
|
| Rate for Payer: ASR Commercial |
$2,720.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,285.79
|
| Rate for Payer: BCN Commercial |
$2,174.72
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$2,636.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,244.00
|
| Rate for Payer: Healthscope Commercial |
$2,805.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,720.85
|
| Rate for Payer: Mclaren Commercial |
$2,524.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,384.25
|
| Rate for Payer: Nomi Health Commercial |
$2,300.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,468.40
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: ASR Commercial |
$20.58
|
| Rate for Payer: BCBS Complete |
$1.27
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.25
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$1.21
|
| Rate for Payer: Mclaren Medicare |
$2.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$1.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PACE Medicare |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: PHP Medicaid |
$1.21
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: UHCCP DNSP |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$1.21
|
| Rate for Payer: VA VA |
$2.25
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: ASR Commercial |
$20.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.29
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: ASR Commercial |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.17
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Healthscope Whirlpool |
$12.11
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.35
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: ASR Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$10.22
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Healthscope Whirlpool |
$12.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Mclaren Medicare |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: Meridian Medicaid |
$1.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: PHP Medicaid |
$1.87
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health Narrow Network |
$6.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.48
|
| Rate for Payer: UHC Exchange |
$5.39
|
| Rate for Payer: UHC Medicare Advantage |
$3.48
|
| Rate for Payer: UHCCP DNSP |
$3.48
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$3.48
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.81
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.66
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.05
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$1.63
|
| Rate for Payer: Mclaren Medicare |
$3.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Meridian Medicaid |
$1.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Medicare |
$2.90
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.36
|
| Rate for Payer: PHP Medicaid |
$1.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.05
|
| Rate for Payer: UHC Exchange |
$4.73
|
| Rate for Payer: UHC Medicare Advantage |
$3.05
|
| Rate for Payer: UHCCP DNSP |
$3.05
|
| Rate for Payer: UHCCP Medicaid |
$1.63
|
| Rate for Payer: VA VA |
$3.05
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: Aetna Medicare |
$42.14
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: ASR Commercial |
$81.74
|
| Rate for Payer: BCBS Complete |
$33.71
|
| Rate for Payer: BCBS Trust/PPO |
$69.01
|
| Rate for Payer: BCN Commercial |
$65.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$84.27
|
| Rate for Payer: Healthscope Whirlpool |
$81.74
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.56
|
| Rate for Payer: Priority Health Narrow Network |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: ASR Commercial |
$81.74
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCN Commercial |
$65.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$84.27
|
| Rate for Payer: Healthscope Whirlpool |
$81.74
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
IP
|
$9,635.14
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,262.84 |
| Max. Negotiated Rate |
$9,635.14 |
| Rate for Payer: Aetna Commercial |
$8,671.63
|
| Rate for Payer: ASR ASR |
$9,346.09
|
| Rate for Payer: ASR Commercial |
$9,346.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,851.68
|
| Rate for Payer: BCN Commercial |
$7,470.12
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cofinity Commercial |
$9,057.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,708.11
|
| Rate for Payer: Healthscope Commercial |
$9,635.14
|
| Rate for Payer: Healthscope Whirlpool |
$9,346.09
|
| Rate for Payer: Mclaren Commercial |
$8,671.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,189.87
|
| Rate for Payer: Nomi Health Commercial |
$7,900.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,262.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,478.92
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,635.14
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,883.48 |
| Max. Negotiated Rate |
$11,230.20 |
| Rate for Payer: Aetna Commercial |
$8,671.63
|
| Rate for Payer: Aetna Medicare |
$7,245.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,056.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,056.61
|
| Rate for Payer: ASR ASR |
$9,346.09
|
| Rate for Payer: ASR Commercial |
$9,346.09
|
| Rate for Payer: BCBS Complete |
$4,077.65
|
| Rate for Payer: BCBS MAPPO |
$7,245.29
|
| Rate for Payer: BCBS Trust/PPO |
$7,890.22
|
| Rate for Payer: BCN Commercial |
$7,470.12
|
| Rate for Payer: BCN Medicare Advantage |
$7,245.29
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cofinity Commercial |
$9,057.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,708.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,245.29
|
| Rate for Payer: Healthscope Commercial |
$9,635.14
|
| Rate for Payer: Healthscope Whirlpool |
$9,346.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,245.29
|
| Rate for Payer: Mclaren Commercial |
$8,671.63
|
| Rate for Payer: Mclaren Medicaid |
$3,883.48
|
| Rate for Payer: Mclaren Medicare |
$7,245.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,607.55
|
| Rate for Payer: Meridian Medicaid |
$4,077.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,332.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,189.87
|
| Rate for Payer: Nomi Health Commercial |
$7,900.81
|
| Rate for Payer: PACE Medicare |
$6,883.03
|
| Rate for Payer: PACE SWMI |
$7,245.29
|
| Rate for Payer: PHP Commercial |
$7,969.82
|
| Rate for Payer: PHP Medicaid |
$3,883.48
|
| Rate for Payer: PHP Medicare Advantage |
$7,245.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,883.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,262.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,442.31
|
| Rate for Payer: Priority Health Medicare |
$7,245.29
|
| Rate for Payer: Priority Health Narrow Network |
$6,754.23
|
| Rate for Payer: Railroad Medicare Medicare |
$7,245.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,478.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,245.29
|
| Rate for Payer: UHC Exchange |
$11,230.20
|
| Rate for Payer: UHC Medicare Advantage |
$7,245.29
|
| Rate for Payer: UHCCP DNSP |
$7,245.29
|
| Rate for Payer: UHCCP Medicaid |
$3,883.48
|
| Rate for Payer: VA VA |
$7,245.29
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
IP
|
$244.45
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$244.45 |
| Rate for Payer: Aetna Commercial |
$220.00
|
| Rate for Payer: ASR ASR |
$237.12
|
| Rate for Payer: ASR Commercial |
$237.12
|
| Rate for Payer: BCBS Trust/PPO |
$199.20
|
| Rate for Payer: BCN Commercial |
$189.52
|
| Rate for Payer: Cash Price |
$195.56
|
| Rate for Payer: Cofinity Commercial |
$229.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.56
|
| Rate for Payer: Healthscope Commercial |
$244.45
|
| Rate for Payer: Healthscope Whirlpool |
$237.12
|
| Rate for Payer: Mclaren Commercial |
$220.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.78
|
| Rate for Payer: Nomi Health Commercial |
$200.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.12
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
OP
|
$244.45
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$97.78 |
| Max. Negotiated Rate |
$258.04 |
| Rate for Payer: Aetna Commercial |
$220.00
|
| Rate for Payer: Aetna Medicare |
$122.22
|
| Rate for Payer: ASR ASR |
$237.12
|
| Rate for Payer: ASR Commercial |
$237.12
|
| Rate for Payer: BCBS Complete |
$97.78
|
| Rate for Payer: BCBS Trust/PPO |
$200.18
|
| Rate for Payer: BCN Commercial |
$189.52
|
| Rate for Payer: Cash Price |
$195.56
|
| Rate for Payer: Cash Price |
$195.56
|
| Rate for Payer: Cofinity Commercial |
$229.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.56
|
| Rate for Payer: Healthscope Commercial |
$244.45
|
| Rate for Payer: Healthscope Whirlpool |
$237.12
|
| Rate for Payer: Mclaren Commercial |
$220.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.78
|
| Rate for Payer: Nomi Health Commercial |
$200.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.04
|
| Rate for Payer: Priority Health Narrow Network |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.12
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
OP
|
$213.64
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.46 |
| Max. Negotiated Rate |
$213.64 |
| Rate for Payer: Aetna Commercial |
$192.28
|
| Rate for Payer: Aetna Medicare |
$106.82
|
| Rate for Payer: ASR ASR |
$207.23
|
| Rate for Payer: ASR Commercial |
$207.23
|
| Rate for Payer: BCBS Complete |
$85.46
|
| Rate for Payer: BCBS Trust/PPO |
$174.95
|
| Rate for Payer: BCN Commercial |
$165.64
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Healthscope Commercial |
$213.64
|
| Rate for Payer: Healthscope Whirlpool |
$207.23
|
| Rate for Payer: Mclaren Commercial |
$192.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.19
|
| Rate for Payer: Priority Health Narrow Network |
$149.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.00
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
IP
|
$213.64
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$213.64 |
| Rate for Payer: Aetna Commercial |
$192.28
|
| Rate for Payer: ASR ASR |
$207.23
|
| Rate for Payer: ASR Commercial |
$207.23
|
| Rate for Payer: BCBS Trust/PPO |
$174.10
|
| Rate for Payer: BCN Commercial |
$165.64
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Healthscope Commercial |
$213.64
|
| Rate for Payer: Healthscope Whirlpool |
$207.23
|
| Rate for Payer: Mclaren Commercial |
$192.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.00
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
OP
|
$213.64
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.46 |
| Max. Negotiated Rate |
$213.64 |
| Rate for Payer: Aetna Commercial |
$192.28
|
| Rate for Payer: Aetna Medicare |
$106.82
|
| Rate for Payer: ASR ASR |
$207.23
|
| Rate for Payer: ASR Commercial |
$207.23
|
| Rate for Payer: BCBS Complete |
$85.46
|
| Rate for Payer: BCBS Trust/PPO |
$174.95
|
| Rate for Payer: BCN Commercial |
$165.64
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Healthscope Commercial |
$213.64
|
| Rate for Payer: Healthscope Whirlpool |
$207.23
|
| Rate for Payer: Mclaren Commercial |
$192.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.19
|
| Rate for Payer: Priority Health Narrow Network |
$149.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.00
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
IP
|
$213.64
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$213.64 |
| Rate for Payer: Aetna Commercial |
$192.28
|
| Rate for Payer: ASR ASR |
$207.23
|
| Rate for Payer: ASR Commercial |
$207.23
|
| Rate for Payer: BCBS Trust/PPO |
$174.10
|
| Rate for Payer: BCN Commercial |
$165.64
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Healthscope Commercial |
$213.64
|
| Rate for Payer: Healthscope Whirlpool |
$207.23
|
| Rate for Payer: Mclaren Commercial |
$192.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.00
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$330.35
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$330.35 |
| Rate for Payer: Aetna Commercial |
$297.32
|
| Rate for Payer: Aetna Medicare |
$165.18
|
| Rate for Payer: ASR ASR |
$320.44
|
| Rate for Payer: ASR Commercial |
$320.44
|
| Rate for Payer: BCBS Complete |
$132.14
|
| Rate for Payer: BCBS Trust/PPO |
$270.52
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$256.12
|
| Rate for Payer: Cash Price |
$264.28
|
| Rate for Payer: Cash Price |
$264.28
|
| Rate for Payer: Cofinity Commercial |
$310.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.28
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Healthscope Whirlpool |
$320.44
|
| Rate for Payer: Mclaren Commercial |
$297.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.80
|
| Rate for Payer: Nomi Health Commercial |
$270.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.45
|
| Rate for Payer: Priority Health Narrow Network |
$231.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.71
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$330.35
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$214.73 |
| Max. Negotiated Rate |
$330.35 |
| Rate for Payer: Aetna Commercial |
$297.32
|
| Rate for Payer: ASR ASR |
$320.44
|
| Rate for Payer: ASR Commercial |
$320.44
|
| Rate for Payer: BCBS Trust/PPO |
$269.20
|
| Rate for Payer: BCN Commercial |
$256.12
|
| Rate for Payer: Cash Price |
$264.28
|
| Rate for Payer: Cofinity Commercial |
$310.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.28
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Healthscope Whirlpool |
$320.44
|
| Rate for Payer: Mclaren Commercial |
$297.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.80
|
| Rate for Payer: Nomi Health Commercial |
$270.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.71
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$103.21
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$103.21 |
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: ASR ASR |
$100.11
|
| Rate for Payer: ASR Commercial |
$100.11
|
| Rate for Payer: BCBS Trust/PPO |
$84.11
|
| Rate for Payer: BCN Commercial |
$80.02
|
| Rate for Payer: Cash Price |
$82.57
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.57
|
| Rate for Payer: Healthscope Commercial |
$103.21
|
| Rate for Payer: Healthscope Whirlpool |
$100.11
|
| Rate for Payer: Mclaren Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.73
|
| Rate for Payer: Nomi Health Commercial |
$84.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.82
|
|
