|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 43200
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$388.99 |
| Rate for Payer: Aetna Commercial |
$114.53
|
| Rate for Payer: Aetna Medicare |
$85.47
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS MAPPO |
$85.47
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: BCN Commercial |
$388.99
|
| Rate for Payer: BCN Medicare Advantage |
$85.47
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$114.53
|
| Rate for Payer: Cofinity Commercial |
$123.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.47
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Healthscope Whirlpool |
$102.56
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.74
|
| Rate for Payer: PACE SWMI |
$85.47
|
| Rate for Payer: PHP Medicare Advantage |
$85.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.29
|
| Rate for Payer: Priority Health Medicare |
$85.47
|
| Rate for Payer: Priority Health Narrow Network |
$152.29
|
| Rate for Payer: UHC Medicare Advantage |
$88.03
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 43231
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$606.90 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$153.06
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS MAPPO |
$153.06
|
| Rate for Payer: BCBS Trust/PPO |
$176.98
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$153.06
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$220.41
|
| Rate for Payer: Cofinity Commercial |
$205.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.06
|
| Rate for Payer: Healthscope Commercial |
$183.67
|
| Rate for Payer: Healthscope Whirlpool |
$183.67
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$160.71
|
| Rate for Payer: PACE SWMI |
$153.06
|
| Rate for Payer: PHP Medicare Advantage |
$153.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.24
|
| Rate for Payer: Priority Health Medicare |
$153.06
|
| Rate for Payer: Priority Health Narrow Network |
$272.24
|
| Rate for Payer: UHC Medicare Advantage |
$157.65
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$541.80 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna Commercial |
$696.60
|
| Rate for Payer: ASR ASR |
$750.78
|
| Rate for Payer: BCBS Trust/PPO |
$600.08
|
| Rate for Payer: BCN Commercial |
$600.08
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$727.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.20
|
| Rate for Payer: Healthscope Commercial |
$774.00
|
| Rate for Payer: Healthscope Whirlpool |
$750.78
|
| Rate for Payer: Mclaren Commercial |
$696.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$681.12
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna Commercial |
$134.01
|
| Rate for Payer: Aetna Medicare |
$100.01
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$100.01
|
| Rate for Payer: BCBS Trust/PPO |
$31.17
|
| Rate for Payer: BCN Commercial |
$526.80
|
| Rate for Payer: BCN Medicare Advantage |
$100.01
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$144.01
|
| Rate for Payer: Cofinity Commercial |
$134.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$120.01
|
| Rate for Payer: Healthscope Whirlpool |
$120.01
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.01
|
| Rate for Payer: PACE SWMI |
$100.01
|
| Rate for Payer: PHP Medicare Advantage |
$100.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.16
|
| Rate for Payer: Priority Health Medicare |
$100.01
|
| Rate for Payer: Priority Health Narrow Network |
$178.16
|
| Rate for Payer: UHC Medicare Advantage |
$103.01
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$541.80 |
| Max. Negotiated Rate |
$2,114.21 |
| Rate for Payer: Aetna Commercial |
$696.60
|
| Rate for Payer: Aetna Medicare |
$1,691.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: ASR ASR |
$750.78
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$600.08
|
| Rate for Payer: BCN Commercial |
$600.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$727.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$774.00
|
| Rate for Payer: Healthscope Whirlpool |
$750.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,691.37
|
| Rate for Payer: Mclaren Commercial |
$696.60
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.90
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$1,860.51
|
| Rate for Payer: PHP Medicaid |
$925.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.34
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$549.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$681.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 43202
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna Commercial |
$134.01
|
| Rate for Payer: Aetna Medicare |
$100.01
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$100.01
|
| Rate for Payer: BCBS Trust/PPO |
$31.17
|
| Rate for Payer: BCN Commercial |
$526.80
|
| Rate for Payer: BCN Medicare Advantage |
$100.01
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$134.01
|
| Rate for Payer: Cofinity Commercial |
$144.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$120.01
|
| Rate for Payer: Healthscope Whirlpool |
$120.01
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.01
|
| Rate for Payer: PACE SWMI |
$100.01
|
| Rate for Payer: PHP Medicare Advantage |
$100.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.16
|
| Rate for Payer: Priority Health Medicare |
$100.01
|
| Rate for Payer: Priority Health Narrow Network |
$178.16
|
| Rate for Payer: UHC Medicare Advantage |
$103.01
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 43201
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$383.13 |
| Rate for Payer: Aetna Commercial |
$134.99
|
| Rate for Payer: Aetna Medicare |
$100.74
|
| Rate for Payer: BCBS Complete |
$68.88
|
| Rate for Payer: BCBS MAPPO |
$100.74
|
| Rate for Payer: BCBS Trust/PPO |
$30.11
|
| Rate for Payer: BCN Commercial |
$383.13
|
| Rate for Payer: BCN Medicare Advantage |
$100.74
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$134.99
|
| Rate for Payer: Cofinity Commercial |
$145.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.74
|
| Rate for Payer: Healthscope Commercial |
$120.89
|
| Rate for Payer: Healthscope Whirlpool |
$120.89
|
| Rate for Payer: Meridian Medicaid |
$68.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.78
|
| Rate for Payer: PACE SWMI |
$100.74
|
| Rate for Payer: PHP Medicare Advantage |
$100.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.34
|
| Rate for Payer: Priority Health Medicare |
$100.74
|
| Rate for Payer: Priority Health Narrow Network |
$179.34
|
| Rate for Payer: UHC Medicare Advantage |
$103.76
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 43227
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$876.20 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: Aetna Medicare |
$160.15
|
| Rate for Payer: BCBS Complete |
$109.14
|
| Rate for Payer: BCBS MAPPO |
$160.15
|
| Rate for Payer: BCBS Trust/PPO |
$43.32
|
| Rate for Payer: BCN Commercial |
$876.20
|
| Rate for Payer: BCN Medicare Advantage |
$160.15
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$230.62
|
| Rate for Payer: Cofinity Commercial |
$214.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.15
|
| Rate for Payer: Healthscope Commercial |
$192.18
|
| Rate for Payer: Healthscope Whirlpool |
$192.18
|
| Rate for Payer: Meridian Medicaid |
$109.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.16
|
| Rate for Payer: PACE SWMI |
$160.15
|
| Rate for Payer: PHP Medicare Advantage |
$160.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.57
|
| Rate for Payer: Priority Health Medicare |
$160.15
|
| Rate for Payer: Priority Health Narrow Network |
$284.57
|
| Rate for Payer: UHC Medicare Advantage |
$164.95
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 43204
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$757.40 |
| Rate for Payer: Aetna Commercial |
$175.67
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$131.10
|
| Rate for Payer: BCBS Trust/PPO |
$249.36
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: BCN Medicare Advantage |
$131.10
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$188.78
|
| Rate for Payer: Cofinity Commercial |
$175.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.10
|
| Rate for Payer: Healthscope Commercial |
$157.32
|
| Rate for Payer: Healthscope Whirlpool |
$157.32
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.66
|
| Rate for Payer: PACE SWMI |
$131.10
|
| Rate for Payer: PHP Medicare Advantage |
$131.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.42
|
| Rate for Payer: Priority Health Medicare |
$131.10
|
| Rate for Payer: Priority Health Narrow Network |
$233.42
|
| Rate for Payer: UHC Medicare Advantage |
$135.03
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 43229
|
| Min. Negotiated Rate |
$123.53 |
| Max. Negotiated Rate |
$1,048.21 |
| Rate for Payer: Aetna Commercial |
$256.02
|
| Rate for Payer: Aetna Medicare |
$191.06
|
| Rate for Payer: BCBS Complete |
$129.94
|
| Rate for Payer: BCBS MAPPO |
$191.06
|
| Rate for Payer: BCBS Trust/PPO |
$123.53
|
| Rate for Payer: BCN Commercial |
$1,048.21
|
| Rate for Payer: BCN Medicare Advantage |
$191.06
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$275.13
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.06
|
| Rate for Payer: Healthscope Commercial |
$229.27
|
| Rate for Payer: Healthscope Whirlpool |
$229.27
|
| Rate for Payer: Meridian Medicaid |
$129.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.61
|
| Rate for Payer: PACE SWMI |
$191.06
|
| Rate for Payer: PHP Medicare Advantage |
$191.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.26
|
| Rate for Payer: Priority Health Medicare |
$191.06
|
| Rate for Payer: Priority Health Narrow Network |
$339.26
|
| Rate for Payer: UHC Medicare Advantage |
$196.79
|
|
|
PR ESOPHAGOSCOPY,INSERT TUBE/STENT
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 43219
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,026.90 |
| Rate for Payer: BCBS Complete |
$586.80
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.90
|
|
|
PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
|
Professional
|
Both
|
$1,014.00
|
|
|
Service Code
|
HCPCS 43232
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$709.80 |
| Rate for Payer: Aetna Commercial |
$256.88
|
| Rate for Payer: Aetna Medicare |
$191.70
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$191.70
|
| Rate for Payer: BCBS Trust/PPO |
$81.89
|
| Rate for Payer: BCN Commercial |
$282.95
|
| Rate for Payer: BCN Medicare Advantage |
$191.70
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cofinity Commercial |
$256.88
|
| Rate for Payer: Cofinity Commercial |
$276.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.70
|
| Rate for Payer: Healthscope Commercial |
$230.04
|
| Rate for Payer: Healthscope Whirlpool |
$230.04
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$201.28
|
| Rate for Payer: PACE SWMI |
$191.70
|
| Rate for Payer: PHP Medicare Advantage |
$191.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.44
|
| Rate for Payer: Priority Health Medicare |
$191.70
|
| Rate for Payer: Priority Health Narrow Network |
$340.44
|
| Rate for Payer: UHC Medicare Advantage |
$197.45
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 43195
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$323.98 |
| Rate for Payer: Aetna Commercial |
$243.64
|
| Rate for Payer: Aetna Medicare |
$181.82
|
| Rate for Payer: BCBS Complete |
$123.90
|
| Rate for Payer: BCBS MAPPO |
$181.82
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCN Commercial |
$269.26
|
| Rate for Payer: BCN Medicare Advantage |
$181.82
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cofinity Commercial |
$261.82
|
| Rate for Payer: Cofinity Commercial |
$243.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.82
|
| Rate for Payer: Healthscope Commercial |
$218.18
|
| Rate for Payer: Healthscope Whirlpool |
$218.18
|
| Rate for Payer: Meridian Medicaid |
$123.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.91
|
| Rate for Payer: PACE SWMI |
$181.82
|
| Rate for Payer: PHP Medicare Advantage |
$181.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.98
|
| Rate for Payer: Priority Health Medicare |
$181.82
|
| Rate for Payer: Priority Health Narrow Network |
$323.98
|
| Rate for Payer: UHC Medicare Advantage |
$187.27
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 43191
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$275.80 |
| Rate for Payer: Aetna Commercial |
$204.36
|
| Rate for Payer: Aetna Medicare |
$152.51
|
| Rate for Payer: BCBS Complete |
$104.22
|
| Rate for Payer: BCBS MAPPO |
$152.51
|
| Rate for Payer: BCBS Trust/PPO |
$63.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$152.51
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Cofinity Commercial |
$204.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.51
|
| Rate for Payer: Healthscope Commercial |
$183.01
|
| Rate for Payer: Healthscope Whirlpool |
$183.01
|
| Rate for Payer: Meridian Medicaid |
$104.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$160.14
|
| Rate for Payer: PACE SWMI |
$152.51
|
| Rate for Payer: PHP Medicare Advantage |
$152.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.24
|
| Rate for Payer: Priority Health Medicare |
$152.51
|
| Rate for Payer: Priority Health Narrow Network |
$272.24
|
| Rate for Payer: UHC Medicare Advantage |
$157.09
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 43192
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$297.52 |
| Rate for Payer: Aetna Commercial |
$223.67
|
| Rate for Payer: Aetna Medicare |
$166.92
|
| Rate for Payer: BCBS Complete |
$113.84
|
| Rate for Payer: BCBS MAPPO |
$166.92
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$247.27
|
| Rate for Payer: BCN Medicare Advantage |
$166.92
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$223.67
|
| Rate for Payer: Cofinity Commercial |
$240.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.92
|
| Rate for Payer: Healthscope Commercial |
$200.30
|
| Rate for Payer: Healthscope Whirlpool |
$200.30
|
| Rate for Payer: Meridian Medicaid |
$113.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.27
|
| Rate for Payer: PACE SWMI |
$166.92
|
| Rate for Payer: PHP Medicare Advantage |
$166.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.52
|
| Rate for Payer: Priority Health Medicare |
$166.92
|
| Rate for Payer: Priority Health Narrow Network |
$297.52
|
| Rate for Payer: UHC Medicare Advantage |
$171.93
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$364.70 |
| Rate for Payer: Aetna Commercial |
$222.76
|
| Rate for Payer: Aetna Medicare |
$166.24
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS MAPPO |
$166.24
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: BCN Commercial |
$246.29
|
| Rate for Payer: BCN Medicare Advantage |
$166.24
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$239.39
|
| Rate for Payer: Cofinity Commercial |
$222.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.24
|
| Rate for Payer: Healthscope Commercial |
$199.49
|
| Rate for Payer: Healthscope Whirlpool |
$199.49
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.55
|
| Rate for Payer: PACE SWMI |
$166.24
|
| Rate for Payer: PHP Medicare Advantage |
$166.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.34
|
| Rate for Payer: Priority Health Medicare |
$166.24
|
| Rate for Payer: Priority Health Narrow Network |
$296.34
|
| Rate for Payer: UHC Medicare Advantage |
$171.23
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$336.31 |
| Rate for Payer: Aetna Commercial |
$255.15
|
| Rate for Payer: Aetna Medicare |
$190.41
|
| Rate for Payer: BCBS Complete |
$127.03
|
| Rate for Payer: BCBS MAPPO |
$190.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.94
|
| Rate for Payer: BCN Commercial |
$279.53
|
| Rate for Payer: BCN Medicare Advantage |
$190.41
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cofinity Commercial |
$274.19
|
| Rate for Payer: Cofinity Commercial |
$255.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.41
|
| Rate for Payer: Healthscope Commercial |
$228.49
|
| Rate for Payer: Healthscope Whirlpool |
$228.49
|
| Rate for Payer: Meridian Medicaid |
$127.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.93
|
| Rate for Payer: PACE SWMI |
$190.41
|
| Rate for Payer: PHP Medicare Advantage |
$190.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.31
|
| Rate for Payer: Priority Health Medicare |
$190.41
|
| Rate for Payer: Priority Health Narrow Network |
$336.31
|
| Rate for Payer: UHC Medicare Advantage |
$196.12
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$118.85 |
| Max. Negotiated Rate |
$394.10 |
| Rate for Payer: Aetna Commercial |
$248.92
|
| Rate for Payer: Aetna Medicare |
$185.76
|
| Rate for Payer: BCBS Complete |
$124.79
|
| Rate for Payer: BCBS MAPPO |
$185.76
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: BCN Commercial |
$272.68
|
| Rate for Payer: BCN Medicare Advantage |
$185.76
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$248.92
|
| Rate for Payer: Cofinity Commercial |
$267.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.76
|
| Rate for Payer: Healthscope Commercial |
$222.91
|
| Rate for Payer: Healthscope Whirlpool |
$222.91
|
| Rate for Payer: Meridian Medicaid |
$124.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.05
|
| Rate for Payer: PACE SWMI |
$185.76
|
| Rate for Payer: PHP Medicare Advantage |
$185.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.09
|
| Rate for Payer: Priority Health Medicare |
$185.76
|
| Rate for Payer: Priority Health Narrow Network |
$328.09
|
| Rate for Payer: UHC Medicare Advantage |
$191.33
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$962.51 |
| Rate for Payer: Aetna Commercial |
$723.57
|
| Rate for Payer: Aetna Medicare |
$539.98
|
| Rate for Payer: BCBS Complete |
$367.91
|
| Rate for Payer: BCBS MAPPO |
$539.98
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$799.97
|
| Rate for Payer: BCN Medicare Advantage |
$539.98
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$777.57
|
| Rate for Payer: Cofinity Commercial |
$723.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.98
|
| Rate for Payer: Healthscope Commercial |
$647.98
|
| Rate for Payer: Healthscope Whirlpool |
$647.98
|
| Rate for Payer: Meridian Medicaid |
$367.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$566.98
|
| Rate for Payer: PACE SWMI |
$539.98
|
| Rate for Payer: PHP Medicare Advantage |
$539.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$962.51
|
| Rate for Payer: Priority Health Medicare |
$539.98
|
| Rate for Payer: Priority Health Narrow Network |
$962.51
|
| Rate for Payer: UHC Medicare Advantage |
$556.18
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$676.91 |
| Max. Negotiated Rate |
$1,857.41 |
| Rate for Payer: Aetna Commercial |
$1,410.99
|
| Rate for Payer: Aetna Medicare |
$1,052.98
|
| Rate for Payer: BCBS Complete |
$710.76
|
| Rate for Payer: BCBS MAPPO |
$1,052.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.75
|
| Rate for Payer: BCN Commercial |
$1,543.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,052.98
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cofinity Commercial |
$1,410.99
|
| Rate for Payer: Cofinity Commercial |
$1,516.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,052.98
|
| Rate for Payer: Healthscope Commercial |
$1,263.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,263.58
|
| Rate for Payer: Meridian Medicaid |
$710.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,105.63
|
| Rate for Payer: PACE SWMI |
$1,052.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,052.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,639.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,857.41
|
| Rate for Payer: Priority Health Medicare |
$1,052.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,857.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,084.57
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,468.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$836.45 |
| Max. Negotiated Rate |
$2,427.60 |
| Rate for Payer: Aetna Commercial |
$1,741.66
|
| Rate for Payer: Aetna Medicare |
$1,299.75
|
| Rate for Payer: BCBS Complete |
$878.27
|
| Rate for Payer: BCBS MAPPO |
$1,299.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.94
|
| Rate for Payer: BCN Commercial |
$1,905.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.75
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cofinity Commercial |
$1,741.66
|
| Rate for Payer: Cofinity Commercial |
$1,871.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.75
|
| Rate for Payer: Healthscope Commercial |
$1,559.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,559.70
|
| Rate for Payer: Meridian Medicaid |
$878.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,364.74
|
| Rate for Payer: PACE SWMI |
$1,299.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,427.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,292.50
|
| Rate for Payer: Priority Health Medicare |
$1,299.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,292.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,338.74
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,212.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$272.07 |
| Max. Negotiated Rate |
$2,266.63 |
| Rate for Payer: Aetna Commercial |
$1,722.62
|
| Rate for Payer: Aetna Medicare |
$1,285.54
|
| Rate for Payer: BCBS Complete |
$867.76
|
| Rate for Payer: BCBS MAPPO |
$1,285.54
|
| Rate for Payer: BCBS Trust/PPO |
$272.07
|
| Rate for Payer: BCN Commercial |
$1,883.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,285.54
|
| Rate for Payer: Cash Price |
$2,569.60
|
| Rate for Payer: Cash Price |
$2,569.60
|
| Rate for Payer: Cofinity Commercial |
$1,851.18
|
| Rate for Payer: Cofinity Commercial |
$1,722.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,285.54
|
| Rate for Payer: Healthscope Commercial |
$1,542.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,542.65
|
| Rate for Payer: Meridian Medicaid |
$867.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,349.82
|
| Rate for Payer: PACE SWMI |
$1,285.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,285.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,248.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,266.63
|
| Rate for Payer: Priority Health Medicare |
$1,285.54
|
| Rate for Payer: Priority Health Narrow Network |
$2,266.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,324.11
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$932.98 |
| Rate for Payer: Aetna Commercial |
$512.05
|
| Rate for Payer: Aetna Commercial |
$512.05
|
| Rate for Payer: Aetna Medicare |
$382.13
|
| Rate for Payer: Aetna Medicare |
$382.13
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Complete |
$321.20
|
| Rate for Payer: BCBS MAPPO |
$382.13
|
| Rate for Payer: BCBS MAPPO |
$382.13
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Medicare Advantage |
$382.13
|
| Rate for Payer: BCN Medicare Advantage |
$382.13
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$512.05
|
| Rate for Payer: Cofinity Commercial |
$512.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.13
|
| Rate for Payer: Healthscope Commercial |
$458.56
|
| Rate for Payer: Healthscope Commercial |
$458.56
|
| Rate for Payer: Healthscope Whirlpool |
$458.56
|
| Rate for Payer: Healthscope Whirlpool |
$458.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$401.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$401.24
|
| Rate for Payer: PACE SWMI |
$382.13
|
| Rate for Payer: PACE SWMI |
$382.13
|
| Rate for Payer: PHP Medicare Advantage |
$382.13
|
| Rate for Payer: PHP Medicare Advantage |
$382.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.65
|
| Rate for Payer: Priority Health Medicare |
$382.13
|
| Rate for Payer: Priority Health Medicare |
$382.13
|
| Rate for Payer: Priority Health Narrow Network |
$550.65
|
| Rate for Payer: Priority Health Narrow Network |
$550.65
|
| Rate for Payer: UHC Medicare Advantage |
$393.59
|
| Rate for Payer: UHC Medicare Advantage |
$393.59
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$802.90 |
| Rate for Payer: Aetna Commercial |
$173.06
|
| Rate for Payer: Aetna Medicare |
$129.15
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$129.15
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: BCN Commercial |
$603.52
|
| Rate for Payer: BCN Medicare Advantage |
$129.15
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cofinity Commercial |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$173.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.15
|
| Rate for Payer: Healthscope Commercial |
$154.98
|
| Rate for Payer: Healthscope Whirlpool |
$154.98
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.61
|
| Rate for Payer: PACE SWMI |
$129.15
|
| Rate for Payer: PHP Medicare Advantage |
$129.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.90
|
| Rate for Payer: Priority Health Medicare |
$129.15
|
| Rate for Payer: Priority Health Narrow Network |
$229.90
|
| Rate for Payer: UHC Medicare Advantage |
$133.02
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$757.40 |
| Rate for Payer: Aetna Commercial |
$182.74
|
| Rate for Payer: Aetna Medicare |
$136.37
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$278.94
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$182.74
|
| Rate for Payer: Cofinity Commercial |
$196.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$163.64
|
| Rate for Payer: Healthscope Whirlpool |
$163.64
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.83
|
| Rate for Payer: Priority Health Medicare |
$136.37
|
| Rate for Payer: Priority Health Narrow Network |
$242.83
|
| Rate for Payer: UHC Medicare Advantage |
$140.46
|
|
