|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCN Commercial |
$14.45
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.03
|
| Rate for Payer: UHC Exchange |
$17.03
|
| Rate for Payer: UHC Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$348.04 |
| Max. Negotiated Rate |
$1,044.99 |
| Rate for Payer: Aetna Commercial |
$717.76
|
| Rate for Payer: Aetna Medicare |
$535.64
|
| Rate for Payer: BCBS Complete |
$365.44
|
| Rate for Payer: BCBS MAPPO |
$535.64
|
| Rate for Payer: BCN Commercial |
$906.82
|
| Rate for Payer: BCN Medicare Advantage |
$535.64
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$771.32
|
| Rate for Payer: Cofinity Commercial |
$717.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$535.64
|
| Rate for Payer: Healthscope Commercial |
$642.77
|
| Rate for Payer: Healthscope Whirlpool |
$642.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$562.42
|
| Rate for Payer: Meridian Medicaid |
$365.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$589.20
|
| Rate for Payer: Nomi Health Commercial |
$642.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$792.00
|
| Rate for Payer: PACE SWMI |
$535.64
|
| Rate for Payer: PHP Medicare Advantage |
$535.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$969.37
|
| Rate for Payer: Priority Health Medicare |
$535.64
|
| Rate for Payer: Priority Health Narrow Network |
$969.37
|
| Rate for Payer: Railroad Medicare Medicare |
$535.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,044.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$535.64
|
| Rate for Payer: UHC Exchange |
$1,044.99
|
| Rate for Payer: UHC Medicaid |
$348.04
|
| Rate for Payer: UHCCP DNSP |
$535.64
|
| Rate for Payer: UHCCP Medicaid |
$348.04
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,857.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$638.09 |
| Max. Negotiated Rate |
$1,392.75 |
| Rate for Payer: Aetna Commercial |
$855.04
|
| Rate for Payer: Aetna Medicare |
$638.09
|
| Rate for Payer: BCBS Complete |
$742.80
|
| Rate for Payer: BCBS MAPPO |
$638.09
|
| Rate for Payer: BCN Commercial |
$1,055.72
|
| Rate for Payer: BCN Medicare Advantage |
$638.09
|
| Rate for Payer: Cash Price |
$1,485.60
|
| Rate for Payer: Cash Price |
$1,485.60
|
| Rate for Payer: Cofinity Commercial |
$855.04
|
| Rate for Payer: Cofinity Commercial |
$918.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.09
|
| Rate for Payer: Healthscope Commercial |
$765.71
|
| Rate for Payer: Healthscope Whirlpool |
$765.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$701.90
|
| Rate for Payer: Nomi Health Commercial |
$765.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.75
|
| Rate for Payer: PACE SWMI |
$638.09
|
| Rate for Payer: PHP Medicare Advantage |
$638.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,128.54
|
| Rate for Payer: Priority Health Medicare |
$638.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,128.54
|
| Rate for Payer: Railroad Medicare Medicare |
$638.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,164.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$638.09
|
| Rate for Payer: UHC Exchange |
$1,164.96
|
| Rate for Payer: UHCCP DNSP |
$638.09
|
|
|
PR APPL MLTLAYR CMPRN SYS LEG BELW KNE W/ANKLE&FOOT
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna Medicare |
$22.83
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: BCBS MAPPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$39.34
|
| Rate for Payer: BCN Medicare Advantage |
$22.83
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$32.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Healthscope Whirlpool |
$27.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.97
|
| Rate for Payer: Meridian Medicaid |
$15.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.11
|
| Rate for Payer: Nomi Health Commercial |
$27.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.75
|
| Rate for Payer: PACE SWMI |
$22.83
|
| Rate for Payer: PHP Medicare Advantage |
$22.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.05
|
| Rate for Payer: Priority Health Medicare |
$22.83
|
| Rate for Payer: Priority Health Narrow Network |
$42.05
|
| Rate for Payer: Railroad Medicare Medicare |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.83
|
| Rate for Payer: UHC Exchange |
$49.28
|
| Rate for Payer: UHC Medicaid |
$14.70
|
| Rate for Payer: UHCCP DNSP |
$22.83
|
| Rate for Payer: UHCCP Medicaid |
$14.70
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.75
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.00
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.71
|
| Rate for Payer: UHC Exchange |
$12.71
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna Medicare |
$14.22
|
| Rate for Payer: BCBS MAPPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: BCN Medicare Advantage |
$14.22
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$17.06
|
| Rate for Payer: Healthscope Whirlpool |
$17.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.64
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$14.22
|
| Rate for Payer: PHP Medicare Advantage |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$14.22
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.22
|
| Rate for Payer: UHC Exchange |
$13.20
|
| Rate for Payer: UHCCP DNSP |
$14.22
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.03
|
| Rate for Payer: Nomi Health Commercial |
$21.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.00
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$18.21
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.21
|
| Rate for Payer: UHC Exchange |
$18.28
|
| Rate for Payer: UHCCP DNSP |
$18.21
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: BCBS MAPPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$14.35
|
| Rate for Payer: BCN Medicare Advantage |
$13.80
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$19.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$16.56
|
| Rate for Payer: Healthscope Whirlpool |
$16.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$16.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PACE SWMI |
$13.80
|
| Rate for Payer: PHP Medicare Advantage |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$13.80
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.80
|
| Rate for Payer: UHC Exchange |
$12.79
|
| Rate for Payer: UHCCP DNSP |
$13.80
|
|
|
PR APPL MULTILAYR CMPRN SYS UPR ARM F/ARM HAND&FNGR
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$17.77
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$23.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.26
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.26
|
| Rate for Payer: Healthscope Commercial |
$15.91
|
| Rate for Payer: Healthscope Whirlpool |
$15.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.92
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Nomi Health Commercial |
$15.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.00
|
| Rate for Payer: PACE SWMI |
$13.26
|
| Rate for Payer: PHP Medicare Advantage |
$13.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.01
|
| Rate for Payer: Priority Health Medicare |
$13.26
|
| Rate for Payer: Priority Health Narrow Network |
$25.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.26
|
| Rate for Payer: UHC Exchange |
$28.92
|
| Rate for Payer: UHC Medicaid |
$8.52
|
| Rate for Payer: UHCCP DNSP |
$13.26
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
|
|
PR APPL SKIN CELL SSP AGRFT T/A/L 1ST 480 SQ CM/<
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15015
|
| Min. Negotiated Rate |
$360.51 |
| Max. Negotiated Rate |
$2,744.01 |
| Rate for Payer: BCBS Complete |
$378.54
|
| Rate for Payer: BCN Commercial |
$1,710.33
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$378.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,744.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,744.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.43
|
| Rate for Payer: UHC Exchange |
$1,338.43
|
| Rate for Payer: UHC Medicaid |
$360.51
|
| Rate for Payer: UHCCP Medicaid |
$360.51
|
|
|
PR APPL SKIN CELL SSP AGRFT T/A/L EA ADDL 480 SQ CM
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15016
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,836.75 |
| Rate for Payer: BCBS Complete |
$61.26
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$61.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.80
|
| Rate for Payer: UHC Exchange |
$227.80
|
| Rate for Payer: UHC Medicaid |
$58.34
|
| Rate for Payer: UHCCP Medicaid |
$58.34
|
|
|
PR APPL SKN CLL SSP AGRFT F/S/N/H/F/G/M/DGT 1ST 480
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15017
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$2,744.01 |
| Rate for Payer: BCBS Complete |
$399.87
|
| Rate for Payer: BCN Commercial |
$1,710.33
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$399.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,744.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,744.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,542.08
|
| Rate for Payer: UHC Exchange |
$1,542.08
|
| Rate for Payer: UHC Medicaid |
$380.83
|
| Rate for Payer: UHCCP Medicaid |
$380.83
|
|
|
PR APPL SKN CLL SSP AGRFT F/S/N/H/F/G/M/DGT EA ADDL
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15018
|
| Min. Negotiated Rate |
$80.77 |
| Max. Negotiated Rate |
$1,836.75 |
| Rate for Payer: BCBS Complete |
$84.81
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$84.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.23
|
| Rate for Payer: UHC Exchange |
$314.23
|
| Rate for Payer: UHC Medicaid |
$80.77
|
| Rate for Payer: UHCCP Medicaid |
$80.77
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$4,012.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$1,744.53 |
| Max. Negotiated Rate |
$3,321.82 |
| Rate for Payer: Aetna Commercial |
$2,337.67
|
| Rate for Payer: Aetna Medicare |
$1,744.53
|
| Rate for Payer: BCBS MAPPO |
$1,744.53
|
| Rate for Payer: BCN Commercial |
$2,527.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,744.53
|
| Rate for Payer: Cash Price |
$3,209.60
|
| Rate for Payer: Cash Price |
$3,209.60
|
| Rate for Payer: Cofinity Commercial |
$2,337.67
|
| Rate for Payer: Cofinity Commercial |
$2,512.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,744.53
|
| Rate for Payer: Healthscope Commercial |
$2,093.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,093.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,831.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,918.98
|
| Rate for Payer: Nomi Health Commercial |
$2,093.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,009.00
|
| Rate for Payer: PACE SWMI |
$1,744.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,744.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,702.10
|
| Rate for Payer: Priority Health Medicare |
$1,744.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,702.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,744.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,744.53
|
| Rate for Payer: UHC Exchange |
$3,321.82
|
| Rate for Payer: UHCCP DNSP |
$1,744.53
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Aetna Commercial |
$52.49
|
| Rate for Payer: Aetna Medicare |
$39.17
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS MAPPO |
$39.17
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: BCN Medicare Advantage |
$39.17
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$52.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$47.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.13
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.09
|
| Rate for Payer: Nomi Health Commercial |
$47.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.75
|
| Rate for Payer: PACE SWMI |
$39.17
|
| Rate for Payer: PHP Medicare Advantage |
$39.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.70
|
| Rate for Payer: Priority Health Medicare |
$39.17
|
| Rate for Payer: Priority Health Narrow Network |
$59.70
|
| Rate for Payer: Railroad Medicare Medicare |
$39.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.17
|
| Rate for Payer: UHC Exchange |
$80.96
|
| Rate for Payer: UHC Medicaid |
$24.92
|
| Rate for Payer: UHCCP DNSP |
$39.17
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Aetna Commercial |
$229.31
|
| Rate for Payer: Aetna Medicare |
$171.13
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS MAPPO |
$171.13
|
| Rate for Payer: BCN Commercial |
$288.34
|
| Rate for Payer: BCN Medicare Advantage |
$171.13
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$246.43
|
| Rate for Payer: Cofinity Commercial |
$229.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.13
|
| Rate for Payer: Healthscope Commercial |
$205.36
|
| Rate for Payer: Healthscope Whirlpool |
$205.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.69
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.24
|
| Rate for Payer: Nomi Health Commercial |
$205.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.50
|
| Rate for Payer: PACE SWMI |
$171.13
|
| Rate for Payer: PHP Medicare Advantage |
$171.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$263.90
|
| Rate for Payer: Priority Health Medicare |
$171.13
|
| Rate for Payer: Priority Health Narrow Network |
$263.90
|
| Rate for Payer: Railroad Medicare Medicare |
$171.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$171.13
|
| Rate for Payer: UHC Exchange |
$356.40
|
| Rate for Payer: UHC Medicaid |
$109.48
|
| Rate for Payer: UHCCP DNSP |
$171.13
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$47.93 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$99.66
|
| Rate for Payer: Aetna Medicare |
$74.37
|
| Rate for Payer: BCBS Complete |
$50.33
|
| Rate for Payer: BCBS MAPPO |
$74.37
|
| Rate for Payer: BCN Commercial |
$125.50
|
| Rate for Payer: BCN Medicare Advantage |
$74.37
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$99.66
|
| Rate for Payer: Cofinity Commercial |
$107.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.37
|
| Rate for Payer: Healthscope Commercial |
$89.24
|
| Rate for Payer: Healthscope Whirlpool |
$89.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.09
|
| Rate for Payer: Meridian Medicaid |
$50.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.81
|
| Rate for Payer: Nomi Health Commercial |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE SWMI |
$74.37
|
| Rate for Payer: PHP Medicare Advantage |
$74.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.85
|
| Rate for Payer: Priority Health Medicare |
$74.37
|
| Rate for Payer: Priority Health Narrow Network |
$114.85
|
| Rate for Payer: Railroad Medicare Medicare |
$74.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.37
|
| Rate for Payer: UHC Exchange |
$149.99
|
| Rate for Payer: UHC Medicaid |
$47.93
|
| Rate for Payer: UHCCP DNSP |
$74.37
|
| Rate for Payer: UHCCP Medicaid |
$47.93
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCN Commercial |
$24.90
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$21.18
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Whirlpool |
$17.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.78
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow Network |
$22.78
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.71
|
| Rate for Payer: UHC Exchange |
$31.39
|
| Rate for Payer: UHC Medicaid |
$9.37
|
| Rate for Payer: UHCCP DNSP |
$14.71
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$400.01 |
| Max. Negotiated Rate |
$1,311.75 |
| Rate for Payer: Aetna Commercial |
$819.21
|
| Rate for Payer: Aetna Medicare |
$611.35
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS MAPPO |
$611.35
|
| Rate for Payer: BCN Commercial |
$1,015.38
|
| Rate for Payer: BCN Medicare Advantage |
$611.35
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$880.34
|
| Rate for Payer: Cofinity Commercial |
$819.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.35
|
| Rate for Payer: Healthscope Commercial |
$733.62
|
| Rate for Payer: Healthscope Whirlpool |
$733.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$641.92
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$672.49
|
| Rate for Payer: Nomi Health Commercial |
$733.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,311.75
|
| Rate for Payer: PACE SWMI |
$611.35
|
| Rate for Payer: PHP Medicare Advantage |
$611.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,085.42
|
| Rate for Payer: Priority Health Medicare |
$611.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,085.42
|
| Rate for Payer: Railroad Medicare Medicare |
$611.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,155.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$611.35
|
| Rate for Payer: UHC Exchange |
$1,155.60
|
| Rate for Payer: UHC Medicaid |
$400.01
|
| Rate for Payer: UHCCP DNSP |
$611.35
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$1,568.00
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$572.35
|
| Rate for Payer: Aetna Medicare |
$427.13
|
| Rate for Payer: BCBS Complete |
$295.89
|
| Rate for Payer: BCBS MAPPO |
$427.13
|
| Rate for Payer: BCN Commercial |
$700.66
|
| Rate for Payer: BCN Medicare Advantage |
$427.13
|
| Rate for Payer: Cash Price |
$1,254.40
|
| Rate for Payer: Cash Price |
$1,254.40
|
| Rate for Payer: Cofinity Commercial |
$615.07
|
| Rate for Payer: Cofinity Commercial |
$572.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.13
|
| Rate for Payer: Healthscope Commercial |
$512.56
|
| Rate for Payer: Healthscope Whirlpool |
$512.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$448.49
|
| Rate for Payer: Meridian Medicaid |
$295.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$469.84
|
| Rate for Payer: Nomi Health Commercial |
$512.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,176.00
|
| Rate for Payer: PACE SWMI |
$427.13
|
| Rate for Payer: PHP Medicare Advantage |
$427.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$748.99
|
| Rate for Payer: Priority Health Medicare |
$427.13
|
| Rate for Payer: Priority Health Narrow Network |
$748.99
|
| Rate for Payer: Railroad Medicare Medicare |
$427.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$427.13
|
| Rate for Payer: UHC Exchange |
$780.08
|
| Rate for Payer: UHC Medicaid |
$281.80
|
| Rate for Payer: UHCCP DNSP |
$427.13
|
| Rate for Payer: UHCCP Medicaid |
$281.80
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$1,473.00
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$357.84 |
| Max. Negotiated Rate |
$1,104.75 |
| Rate for Payer: Aetna Commercial |
$731.32
|
| Rate for Payer: Aetna Medicare |
$545.76
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS MAPPO |
$545.76
|
| Rate for Payer: BCN Commercial |
$902.84
|
| Rate for Payer: BCN Medicare Advantage |
$545.76
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cofinity Commercial |
$785.89
|
| Rate for Payer: Cofinity Commercial |
$731.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$545.76
|
| Rate for Payer: Healthscope Commercial |
$654.91
|
| Rate for Payer: Healthscope Whirlpool |
$654.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.05
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$600.34
|
| Rate for Payer: Nomi Health Commercial |
$654.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.75
|
| Rate for Payer: PACE SWMI |
$545.76
|
| Rate for Payer: PHP Medicare Advantage |
$545.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$965.11
|
| Rate for Payer: Priority Health Medicare |
$545.76
|
| Rate for Payer: Priority Health Narrow Network |
$965.11
|
| Rate for Payer: Railroad Medicare Medicare |
$545.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,021.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$545.76
|
| Rate for Payer: UHC Exchange |
$1,021.88
|
| Rate for Payer: UHC Medicaid |
$357.84
|
| Rate for Payer: UHCCP DNSP |
$545.76
|
| Rate for Payer: UHCCP Medicaid |
$357.84
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$3,046.00
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$396.82 |
| Max. Negotiated Rate |
$2,284.50 |
| Rate for Payer: Aetna Commercial |
$812.50
|
| Rate for Payer: Aetna Medicare |
$606.34
|
| Rate for Payer: BCBS Complete |
$416.66
|
| Rate for Payer: BCBS MAPPO |
$606.34
|
| Rate for Payer: BCN Commercial |
$1,007.91
|
| Rate for Payer: BCN Medicare Advantage |
$606.34
|
| Rate for Payer: Cash Price |
$2,436.80
|
| Rate for Payer: Cash Price |
$2,436.80
|
| Rate for Payer: Cofinity Commercial |
$873.13
|
| Rate for Payer: Cofinity Commercial |
$812.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.34
|
| Rate for Payer: Healthscope Commercial |
$727.61
|
| Rate for Payer: Healthscope Whirlpool |
$727.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.66
|
| Rate for Payer: Meridian Medicaid |
$416.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$666.97
|
| Rate for Payer: Nomi Health Commercial |
$727.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,284.50
|
| Rate for Payer: PACE SWMI |
$606.34
|
| Rate for Payer: PHP Medicare Advantage |
$606.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,077.43
|
| Rate for Payer: Priority Health Medicare |
$606.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.43
|
| Rate for Payer: Railroad Medicare Medicare |
$606.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,145.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$606.34
|
| Rate for Payer: UHC Exchange |
$1,145.15
|
| Rate for Payer: UHC Medicaid |
$396.82
|
| Rate for Payer: UHCCP DNSP |
$606.34
|
| Rate for Payer: UHCCP Medicaid |
$396.82
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$1,394.00
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$465.83 |
| Max. Negotiated Rate |
$1,357.18 |
| Rate for Payer: Aetna Commercial |
$955.29
|
| Rate for Payer: Aetna Medicare |
$712.90
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS MAPPO |
$712.90
|
| Rate for Payer: BCN Commercial |
$1,187.19
|
| Rate for Payer: BCN Medicare Advantage |
$712.90
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Cash Price |
$1,115.20
|
| Rate for Payer: Cofinity Commercial |
$955.29
|
| Rate for Payer: Cofinity Commercial |
$1,026.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.90
|
| Rate for Payer: Healthscope Commercial |
$855.48
|
| Rate for Payer: Healthscope Whirlpool |
$855.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$748.54
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$784.19
|
| Rate for Payer: Nomi Health Commercial |
$855.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.50
|
| Rate for Payer: PACE SWMI |
$712.90
|
| Rate for Payer: PHP Medicare Advantage |
$712.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,269.07
|
| Rate for Payer: Priority Health Medicare |
$712.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.07
|
| Rate for Payer: Railroad Medicare Medicare |
$712.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,357.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$712.90
|
| Rate for Payer: UHC Exchange |
$1,357.18
|
| Rate for Payer: UHC Medicaid |
$465.83
|
| Rate for Payer: UHCCP DNSP |
$712.90
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
|
