|
PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
10061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.29 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$349.20
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$279.11
|
| Rate for Payer: BCN Commercial |
$279.11
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$338.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Healthscope Whirlpool |
$349.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$324.00
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.00
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.86
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$174.29
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.80
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
10061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: ASR ASR |
$349.20
|
| Rate for Payer: BCBS Trust/PPO |
$279.11
|
| Rate for Payer: BCN Commercial |
$279.11
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$338.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Healthscope Whirlpool |
$349.20
|
| Rate for Payer: Mclaren Commercial |
$324.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.80
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 10060
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$147.64 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Aetna Medicare |
$101.29
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS MAPPO |
$101.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.31
|
| Rate for Payer: BCN Commercial |
$147.64
|
| Rate for Payer: BCN Medicare Advantage |
$101.29
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$145.86
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.29
|
| Rate for Payer: Healthscope Commercial |
$121.55
|
| Rate for Payer: Healthscope Whirlpool |
$121.55
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.35
|
| Rate for Payer: PACE SWMI |
$101.29
|
| Rate for Payer: PHP Medicare Advantage |
$101.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Medicare |
$101.29
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: UHC Medicare Advantage |
$104.33
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
10060
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
10060
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$147.64 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Aetna Medicare |
$101.29
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS MAPPO |
$101.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.31
|
| Rate for Payer: BCN Commercial |
$147.64
|
| Rate for Payer: BCN Medicare Advantage |
$101.29
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$145.86
|
| Rate for Payer: Cofinity Commercial |
$135.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.29
|
| Rate for Payer: Healthscope Commercial |
$121.55
|
| Rate for Payer: Healthscope Whirlpool |
$121.55
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.35
|
| Rate for Payer: PACE SWMI |
$101.29
|
| Rate for Payer: PHP Medicare Advantage |
$101.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Medicare |
$101.29
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: UHC Medicare Advantage |
$104.33
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
10060
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.86
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$174.29
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
PR INCISION&DRAINAGE BURSA FOOT
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 28001
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$795.62 |
| Rate for Payer: Aetna Commercial |
$127.33
|
| Rate for Payer: Aetna Medicare |
$95.02
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS MAPPO |
$95.02
|
| Rate for Payer: BCBS Trust/PPO |
$795.62
|
| Rate for Payer: BCN Commercial |
$249.71
|
| Rate for Payer: BCN Medicare Advantage |
$95.02
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cofinity Commercial |
$136.83
|
| Rate for Payer: Cofinity Commercial |
$127.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.02
|
| Rate for Payer: Healthscope Commercial |
$114.02
|
| Rate for Payer: Healthscope Whirlpool |
$114.02
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.77
|
| Rate for Payer: PACE SWMI |
$95.02
|
| Rate for Payer: PHP Medicare Advantage |
$95.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.54
|
| Rate for Payer: Priority Health Medicare |
$95.02
|
| Rate for Payer: Priority Health Narrow Network |
$145.54
|
| Rate for Payer: UHC Medicare Advantage |
$97.87
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
10180
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$234.02
|
| Rate for Payer: Aetna Medicare |
$174.64
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$174.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$386.55
|
| Rate for Payer: BCN Medicare Advantage |
$174.64
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$251.48
|
| Rate for Payer: Cofinity Commercial |
$234.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.64
|
| Rate for Payer: Healthscope Commercial |
$209.57
|
| Rate for Payer: Healthscope Whirlpool |
$209.57
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$183.37
|
| Rate for Payer: PACE SWMI |
$174.64
|
| Rate for Payer: PHP Medicare Advantage |
$174.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.50
|
| Rate for Payer: Priority Health Medicare |
$174.64
|
| Rate for Payer: Priority Health Narrow Network |
$219.50
|
| Rate for Payer: UHC Medicare Advantage |
$179.88
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 10180
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$234.02
|
| Rate for Payer: Aetna Medicare |
$174.64
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$174.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$386.55
|
| Rate for Payer: BCN Medicare Advantage |
$174.64
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$251.48
|
| Rate for Payer: Cofinity Commercial |
$234.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.64
|
| Rate for Payer: Healthscope Commercial |
$209.57
|
| Rate for Payer: Healthscope Whirlpool |
$209.57
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$183.37
|
| Rate for Payer: PACE SWMI |
$174.64
|
| Rate for Payer: PHP Medicare Advantage |
$174.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.50
|
| Rate for Payer: Priority Health Medicare |
$174.64
|
| Rate for Payer: Priority Health Narrow Network |
$219.50
|
| Rate for Payer: UHC Medicare Advantage |
$179.88
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
10180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$3,157.18 |
| Rate for Payer: Aetna Commercial |
$594.00
|
| Rate for Payer: Aetna Medicare |
$2,525.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: ASR ASR |
$640.20
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$511.70
|
| Rate for Payer: BCN Commercial |
$511.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$620.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$660.00
|
| Rate for Payer: Healthscope Whirlpool |
$640.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,525.74
|
| Rate for Payer: Mclaren Commercial |
$594.00
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.00
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$2,778.31
|
| Rate for Payer: PHP Medicaid |
$1,381.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,855.85
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,284.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.80
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
10180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$594.00
|
| Rate for Payer: ASR ASR |
$640.20
|
| Rate for Payer: BCBS Trust/PPO |
$511.70
|
| Rate for Payer: BCN Commercial |
$511.70
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$620.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Healthscope Commercial |
$660.00
|
| Rate for Payer: Healthscope Whirlpool |
$640.20
|
| Rate for Payer: Mclaren Commercial |
$594.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.80
|
|
|
PR INCISION & DRAINAGE FOREARM&/WRIST BURSA
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 25031
|
| Min. Negotiated Rate |
$241.76 |
| Max. Negotiated Rate |
$942.49 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Medicare |
$363.36
|
| Rate for Payer: BCBS Complete |
$253.85
|
| Rate for Payer: BCBS MAPPO |
$363.36
|
| Rate for Payer: BCBS Trust/PPO |
$942.49
|
| Rate for Payer: BCN Commercial |
$547.32
|
| Rate for Payer: BCN Medicare Advantage |
$363.36
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$523.24
|
| Rate for Payer: Cofinity Commercial |
$486.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.36
|
| Rate for Payer: Healthscope Commercial |
$436.03
|
| Rate for Payer: Healthscope Whirlpool |
$436.03
|
| Rate for Payer: Meridian Medicaid |
$253.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$381.53
|
| Rate for Payer: PACE SWMI |
$363.36
|
| Rate for Payer: PHP Medicare Advantage |
$363.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.93
|
| Rate for Payer: Priority Health Medicare |
$363.36
|
| Rate for Payer: Priority Health Narrow Network |
$571.93
|
| Rate for Payer: UHC Medicare Advantage |
$374.26
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,118.00
|
|
|
Service Code
|
HCPCS 27603
|
| Min. Negotiated Rate |
$251.77 |
| Max. Negotiated Rate |
$1,557.43 |
| Rate for Payer: Aetna Commercial |
$515.30
|
| Rate for Payer: Aetna Medicare |
$384.55
|
| Rate for Payer: BCBS Complete |
$264.36
|
| Rate for Payer: BCBS MAPPO |
$384.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.43
|
| Rate for Payer: BCN Commercial |
$777.97
|
| Rate for Payer: BCN Medicare Advantage |
$384.55
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cofinity Commercial |
$515.30
|
| Rate for Payer: Cofinity Commercial |
$553.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.55
|
| Rate for Payer: Healthscope Commercial |
$461.46
|
| Rate for Payer: Healthscope Whirlpool |
$461.46
|
| Rate for Payer: Meridian Medicaid |
$264.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$403.78
|
| Rate for Payer: PACE SWMI |
$384.55
|
| Rate for Payer: PHP Medicare Advantage |
$384.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.03
|
| Rate for Payer: Priority Health Medicare |
$384.55
|
| Rate for Payer: Priority Health Narrow Network |
$601.03
|
| Rate for Payer: UHC Medicare Advantage |
$396.09
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 27604
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$661.18 |
| Rate for Payer: Aetna Commercial |
$423.75
|
| Rate for Payer: Aetna Medicare |
$316.23
|
| Rate for Payer: BCBS Complete |
$219.18
|
| Rate for Payer: BCBS MAPPO |
$316.23
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: BCN Medicare Advantage |
$316.23
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cofinity Commercial |
$423.75
|
| Rate for Payer: Cofinity Commercial |
$455.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.23
|
| Rate for Payer: Healthscope Commercial |
$379.48
|
| Rate for Payer: Healthscope Whirlpool |
$379.48
|
| Rate for Payer: Meridian Medicaid |
$219.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.04
|
| Rate for Payer: PACE SWMI |
$316.23
|
| Rate for Payer: PHP Medicare Advantage |
$316.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$493.80
|
| Rate for Payer: Priority Health Medicare |
$316.23
|
| Rate for Payer: Priority Health Narrow Network |
$493.80
|
| Rate for Payer: UHC Medicare Advantage |
$325.72
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 10081
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$406.41 |
| Rate for Payer: Aetna Commercial |
$224.37
|
| Rate for Payer: Aetna Medicare |
$167.44
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS MAPPO |
$167.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$406.41
|
| Rate for Payer: BCN Medicare Advantage |
$167.44
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$224.37
|
| Rate for Payer: Cofinity Commercial |
$241.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$200.93
|
| Rate for Payer: Healthscope Whirlpool |
$200.93
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.81
|
| Rate for Payer: PACE SWMI |
$167.44
|
| Rate for Payer: PHP Medicare Advantage |
$167.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.62
|
| Rate for Payer: Priority Health Medicare |
$167.44
|
| Rate for Payer: Priority Health Narrow Network |
$209.62
|
| Rate for Payer: UHC Medicare Advantage |
$172.46
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 10080
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$297.64 |
| Rate for Payer: Aetna Commercial |
$135.42
|
| Rate for Payer: Aetna Medicare |
$101.06
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS MAPPO |
$101.06
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$297.64
|
| Rate for Payer: BCN Medicare Advantage |
$101.06
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cofinity Commercial |
$145.53
|
| Rate for Payer: Cofinity Commercial |
$135.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.06
|
| Rate for Payer: Healthscope Commercial |
$121.27
|
| Rate for Payer: Healthscope Whirlpool |
$121.27
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.11
|
| Rate for Payer: PACE SWMI |
$101.06
|
| Rate for Payer: PHP Medicare Advantage |
$101.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.25
|
| Rate for Payer: Priority Health Medicare |
$101.06
|
| Rate for Payer: Priority Health Narrow Network |
$128.25
|
| Rate for Payer: UHC Medicare Advantage |
$104.09
|
|
|
PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 23931
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$508.90 |
| Rate for Payer: Aetna Commercial |
$211.10
|
| Rate for Payer: Aetna Medicare |
$157.54
|
| Rate for Payer: BCBS Complete |
$110.04
|
| Rate for Payer: BCBS MAPPO |
$157.54
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$448.61
|
| Rate for Payer: BCN Medicare Advantage |
$157.54
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$211.10
|
| Rate for Payer: Cofinity Commercial |
$226.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.54
|
| Rate for Payer: Healthscope Commercial |
$189.05
|
| Rate for Payer: Healthscope Whirlpool |
$189.05
|
| Rate for Payer: Meridian Medicaid |
$110.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.42
|
| Rate for Payer: PACE SWMI |
$157.54
|
| Rate for Payer: PHP Medicare Advantage |
$157.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.17
|
| Rate for Payer: Priority Health Medicare |
$157.54
|
| Rate for Payer: Priority Health Narrow Network |
$248.17
|
| Rate for Payer: UHC Medicare Advantage |
$162.27
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$173.81 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$454.89
|
| Rate for Payer: Aetna Medicare |
$339.47
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: BCBS MAPPO |
$339.47
|
| Rate for Payer: BCBS Trust/PPO |
$173.81
|
| Rate for Payer: BCN Commercial |
$514.58
|
| Rate for Payer: BCN Medicare Advantage |
$339.47
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cofinity Commercial |
$488.84
|
| Rate for Payer: Cofinity Commercial |
$454.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.47
|
| Rate for Payer: Healthscope Commercial |
$407.36
|
| Rate for Payer: Healthscope Whirlpool |
$407.36
|
| Rate for Payer: Meridian Medicaid |
$238.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.44
|
| Rate for Payer: PACE SWMI |
$339.47
|
| Rate for Payer: PHP Medicare Advantage |
$339.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.71
|
| Rate for Payer: Priority Health Medicare |
$339.47
|
| Rate for Payer: Priority Health Narrow Network |
$537.71
|
| Rate for Payer: UHC Medicare Advantage |
$349.65
|
|
|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$1,124.75 |
| Rate for Payer: Aetna Commercial |
$456.50
|
| Rate for Payer: Aetna Medicare |
$340.67
|
| Rate for Payer: BCBS Complete |
$239.98
|
| Rate for Payer: BCBS MAPPO |
$340.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.75
|
| Rate for Payer: BCN Commercial |
$515.07
|
| Rate for Payer: BCN Medicare Advantage |
$340.67
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cofinity Commercial |
$490.56
|
| Rate for Payer: Cofinity Commercial |
$456.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.67
|
| Rate for Payer: Healthscope Commercial |
$408.80
|
| Rate for Payer: Healthscope Whirlpool |
$408.80
|
| Rate for Payer: Meridian Medicaid |
$239.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$357.70
|
| Rate for Payer: PACE SWMI |
$340.67
|
| Rate for Payer: PHP Medicare Advantage |
$340.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.22
|
| Rate for Payer: Priority Health Medicare |
$340.67
|
| Rate for Payer: Priority Health Narrow Network |
$538.22
|
| Rate for Payer: UHC Medicare Advantage |
$350.89
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$393.58 |
| Rate for Payer: Aetna Commercial |
$37.13
|
| Rate for Payer: Aetna Medicare |
$27.71
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$27.71
|
| Rate for Payer: BCBS Trust/PPO |
$393.58
|
| Rate for Payer: BCN Commercial |
$146.11
|
| Rate for Payer: BCN Medicare Advantage |
$27.71
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.71
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Healthscope Whirlpool |
$33.25
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.10
|
| Rate for Payer: PACE SWMI |
$27.71
|
| Rate for Payer: PHP Medicare Advantage |
$27.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.56
|
| Rate for Payer: Priority Health Medicare |
$27.71
|
| Rate for Payer: Priority Health Narrow Network |
$50.56
|
| Rate for Payer: UHC Medicare Advantage |
$28.54
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$386.81 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna Commercial |
$787.46
|
| Rate for Payer: Aetna Medicare |
$587.66
|
| Rate for Payer: BCBS Complete |
$406.15
|
| Rate for Payer: BCBS MAPPO |
$587.66
|
| Rate for Payer: BCBS Trust/PPO |
$864.83
|
| Rate for Payer: BCN Commercial |
$876.69
|
| Rate for Payer: BCN Medicare Advantage |
$587.66
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cofinity Commercial |
$846.23
|
| Rate for Payer: Cofinity Commercial |
$787.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.66
|
| Rate for Payer: Healthscope Commercial |
$705.19
|
| Rate for Payer: Healthscope Whirlpool |
$705.19
|
| Rate for Payer: Meridian Medicaid |
$406.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$617.04
|
| Rate for Payer: PACE SWMI |
$587.66
|
| Rate for Payer: PHP Medicare Advantage |
$587.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.11
|
| Rate for Payer: Priority Health Medicare |
$587.66
|
| Rate for Payer: Priority Health Narrow Network |
$916.11
|
| Rate for Payer: UHC Medicare Advantage |
$605.29
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$971.54 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Medicare |
$106.79
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS MAPPO |
$106.79
|
| Rate for Payer: BCBS Trust/PPO |
$971.54
|
| Rate for Payer: BCN Commercial |
$322.04
|
| Rate for Payer: BCN Medicare Advantage |
$106.79
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$153.78
|
| Rate for Payer: Cofinity Commercial |
$143.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.79
|
| Rate for Payer: Healthscope Commercial |
$128.15
|
| Rate for Payer: Healthscope Whirlpool |
$128.15
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.13
|
| Rate for Payer: PACE SWMI |
$106.79
|
| Rate for Payer: PHP Medicare Advantage |
$106.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.21
|
| Rate for Payer: Priority Health Medicare |
$106.79
|
| Rate for Payer: Priority Health Narrow Network |
$195.21
|
| Rate for Payer: UHC Medicare Advantage |
$109.99
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$387.52 |
| Rate for Payer: Aetna Commercial |
$240.20
|
| Rate for Payer: Aetna Medicare |
$179.25
|
| Rate for Payer: BCBS Complete |
$123.46
|
| Rate for Payer: BCBS MAPPO |
$179.25
|
| Rate for Payer: BCBS Trust/PPO |
$234.52
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Medicare Advantage |
$179.25
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Commercial |
$258.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.25
|
| Rate for Payer: Healthscope Commercial |
$215.10
|
| Rate for Payer: Healthscope Whirlpool |
$215.10
|
| Rate for Payer: Meridian Medicaid |
$123.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$188.21
|
| Rate for Payer: PACE SWMI |
$179.25
|
| Rate for Payer: PHP Medicare Advantage |
$179.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.83
|
| Rate for Payer: Priority Health Medicare |
$179.25
|
| Rate for Payer: Priority Health Narrow Network |
$224.83
|
| Rate for Payer: UHC Medicare Advantage |
$184.63
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$238.62
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$190.72
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$231.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$246.00
|
| Rate for Payer: Healthscope Whirlpool |
$238.62
|
| Rate for Payer: Mclaren Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.48
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$221.86 |
| Rate for Payer: Aetna Commercial |
$136.10
|
| Rate for Payer: Aetna Medicare |
$101.57
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.57
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$221.86
|
| Rate for Payer: BCN Medicare Advantage |
$101.57
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$146.26
|
| Rate for Payer: Cofinity Commercial |
$136.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.57
|
| Rate for Payer: Healthscope Commercial |
$121.88
|
| Rate for Payer: Healthscope Whirlpool |
$121.88
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.65
|
| Rate for Payer: PACE SWMI |
$101.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Medicare |
$101.57
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: UHC Medicare Advantage |
$104.62
|
|
