|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
IP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Aetna Commercial |
$24.44
|
| Rate for Payer: ASR ASR |
$26.35
|
| Rate for Payer: ASR Commercial |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$22.13
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$25.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Mclaren Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.09
|
| Rate for Payer: Nomi Health Commercial |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.90
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
OP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Aetna Commercial |
$24.44
|
| Rate for Payer: Aetna Medicare |
$13.58
|
| Rate for Payer: ASR ASR |
$26.35
|
| Rate for Payer: ASR Commercial |
$26.35
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$22.24
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$25.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Mclaren Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.09
|
| Rate for Payer: Nomi Health Commercial |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.80
|
| Rate for Payer: Priority Health Narrow Network |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.90
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: ASR ASR |
$9.49
|
| Rate for Payer: ASR Commercial |
$9.49
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.01
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$9.78
|
| Rate for Payer: Healthscope Whirlpool |
$9.49
|
| Rate for Payer: Mclaren Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.31
|
| Rate for Payer: Nomi Health Commercial |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.57
|
| Rate for Payer: Priority Health Narrow Network |
$6.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.61
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: ASR ASR |
$9.49
|
| Rate for Payer: ASR Commercial |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.97
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$9.78
|
| Rate for Payer: Healthscope Whirlpool |
$9.49
|
| Rate for Payer: Mclaren Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.31
|
| Rate for Payer: Nomi Health Commercial |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.61
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
IP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$21.87 |
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR Commercial |
$21.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$21.87 |
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR Commercial |
$21.21
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.91
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.16
|
| Rate for Payer: Priority Health Narrow Network |
$15.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$20.22
|
| Rate for Payer: Aetna Medicare |
$11.24
|
| Rate for Payer: ASR ASR |
$21.80
|
| Rate for Payer: ASR Commercial |
$21.80
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$17.42
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Healthscope Whirlpool |
$21.80
|
| Rate for Payer: Mclaren Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.69
|
| Rate for Payer: Priority Health Narrow Network |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.77
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Mclaren Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Aetna Commercial |
$20.22
|
| Rate for Payer: ASR ASR |
$21.80
|
| Rate for Payer: ASR Commercial |
$21.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.31
|
| Rate for Payer: BCN Commercial |
$17.42
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Healthscope Whirlpool |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.77
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$545.92 |
| Max. Negotiated Rate |
$839.87 |
| Rate for Payer: Aetna Commercial |
$755.88
|
| Rate for Payer: ASR ASR |
$814.67
|
| Rate for Payer: ASR Commercial |
$814.67
|
| Rate for Payer: BCBS Trust/PPO |
$684.41
|
| Rate for Payer: BCN Commercial |
$651.15
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$789.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Healthscope Commercial |
$839.87
|
| Rate for Payer: Healthscope Whirlpool |
$814.67
|
| Rate for Payer: Mclaren Commercial |
$755.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.09
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$839.87 |
| Rate for Payer: Aetna Commercial |
$755.88
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$814.67
|
| Rate for Payer: ASR Commercial |
$814.67
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$687.77
|
| Rate for Payer: BCN Commercial |
$651.15
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$789.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$839.87
|
| Rate for Payer: Healthscope Whirlpool |
$814.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$755.88
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.89
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$588.75
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$454.93 |
| Max. Negotiated Rate |
$699.89 |
| Rate for Payer: Aetna Commercial |
$629.90
|
| Rate for Payer: ASR ASR |
$678.89
|
| Rate for Payer: ASR Commercial |
$678.89
|
| Rate for Payer: BCBS Trust/PPO |
$570.34
|
| Rate for Payer: BCN Commercial |
$542.62
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$657.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Healthscope Commercial |
$699.89
|
| Rate for Payer: Healthscope Whirlpool |
$678.89
|
| Rate for Payer: Mclaren Commercial |
$629.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$573.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$699.89 |
| Rate for Payer: Aetna Commercial |
$629.90
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$678.89
|
| Rate for Payer: ASR Commercial |
$678.89
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$573.14
|
| Rate for Payer: BCN Commercial |
$542.62
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$657.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$699.89
|
| Rate for Payer: Healthscope Whirlpool |
$678.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$629.90
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$573.91
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.24
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$490.62
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: ASR Commercial |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$5.18
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.36
|
| Rate for Payer: Healthscope Whirlpool |
$6.17
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: ASR Commercial |
$6.17
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.21
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.36
|
| Rate for Payer: Healthscope Whirlpool |
$6.17
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3,753.41 |
| Rate for Payer: Aetna Commercial |
$3,378.07
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.25
|
| Rate for Payer: ASR ASR |
$3,640.81
|
| Rate for Payer: ASR Commercial |
$3,640.81
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,073.67
|
| Rate for Payer: BCN Commercial |
$2,910.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.80
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,528.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$3,753.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,640.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.80
|
| Rate for Payer: Mclaren Commercial |
$3,378.07
|
| Rate for Payer: Mclaren Medicaid |
$0.96
|
| Rate for Payer: Mclaren Medicare |
$1.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.89
|
| Rate for Payer: Meridian Medicaid |
$1.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: Nomi Health Commercial |
$3,077.80
|
| Rate for Payer: PACE Medicare |
$1.71
|
| Rate for Payer: PACE SWMI |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: PHP Medicaid |
$0.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.21
|
| Rate for Payer: Priority Health Medicare |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$2.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,303.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.80
|
| Rate for Payer: UHC Exchange |
$2.79
|
| Rate for Payer: UHC Medicare Advantage |
$1.80
|
| Rate for Payer: UHCCP DNSP |
$1.80
|
| Rate for Payer: UHCCP Medicaid |
$0.96
|
| Rate for Payer: VA VA |
$1.80
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,439.72 |
| Max. Negotiated Rate |
$3,753.41 |
| Rate for Payer: Aetna Commercial |
$3,378.07
|
| Rate for Payer: ASR ASR |
$3,640.81
|
| Rate for Payer: ASR Commercial |
$3,640.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,058.65
|
| Rate for Payer: BCN Commercial |
$2,910.02
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,528.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Healthscope Commercial |
$3,753.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,640.81
|
| Rate for Payer: Mclaren Commercial |
$3,378.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: Nomi Health Commercial |
$3,077.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,303.00
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.76
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.21
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Mclaren Medicare |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: Meridian Medicaid |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.10
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: PHP Medicaid |
$1.18
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.04
|
| Rate for Payer: Priority Health Medicare |
$2.21
|
| Rate for Payer: Priority Health Narrow Network |
$2.43
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Exchange |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: UHCCP DNSP |
$2.21
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$2.21
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.76
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.21
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Mclaren Medicare |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: Meridian Medicaid |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.10
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: PHP Medicaid |
$1.18
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.04
|
| Rate for Payer: Priority Health Medicare |
$2.21
|
| Rate for Payer: Priority Health Narrow Network |
$2.43
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Exchange |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: UHCCP DNSP |
$2.21
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$2.21
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$212.46 |
| Rate for Payer: Aetna Commercial |
$191.21
|
| Rate for Payer: Aetna Medicare |
$106.23
|
| Rate for Payer: ASR ASR |
$206.09
|
| Rate for Payer: ASR Commercial |
$206.09
|
| Rate for Payer: BCBS Complete |
$84.98
|
| Rate for Payer: BCBS Trust/PPO |
$173.98
|
| Rate for Payer: BCN Commercial |
$164.72
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$212.46
|
| Rate for Payer: Healthscope Whirlpool |
$206.09
|
| Rate for Payer: Mclaren Commercial |
$191.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.96
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$212.46 |
| Rate for Payer: Aetna Commercial |
$191.21
|
| Rate for Payer: ASR ASR |
$206.09
|
| Rate for Payer: ASR Commercial |
$206.09
|
| Rate for Payer: BCBS Trust/PPO |
$173.13
|
| Rate for Payer: BCN Commercial |
$164.72
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$212.46
|
| Rate for Payer: Healthscope Whirlpool |
$206.09
|
| Rate for Payer: Mclaren Commercial |
$191.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.96
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: ASR Commercial |
$61.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.19
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: ASR Commercial |
$61.55
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$51.96
|
| Rate for Payer: BCN Commercial |
$49.19
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.59
|
| Rate for Payer: Priority Health Narrow Network |
$44.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Aetna Medicare |
$10.77
|
| Rate for Payer: Aetna Medicare |
$11.66
|
| Rate for Payer: ASR ASR |
$22.63
|
| Rate for Payer: ASR ASR |
$20.89
|
| Rate for Payer: ASR Commercial |
$20.89
|
| Rate for Payer: ASR Commercial |
$22.63
|
| Rate for Payer: BCBS Complete |
$9.33
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCN Commercial |
$16.70
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Healthscope Whirlpool |
$22.63
|
| Rate for Payer: Healthscope Whirlpool |
$20.89
|
| Rate for Payer: Mclaren Commercial |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$19.13
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.57
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
|
