|
HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL SAME FAM
|
Facility
|
IP
|
$991.53
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
36100276
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$694.07 |
| Max. Negotiated Rate |
$991.53 |
| Rate for Payer: Aetna Commercial |
$892.38
|
| Rate for Payer: ASR ASR |
$961.78
|
| Rate for Payer: BCBS Trust/PPO |
$768.73
|
| Rate for Payer: BCN Commercial |
$768.73
|
| Rate for Payer: Cash Price |
$793.22
|
| Rate for Payer: Cofinity Commercial |
$932.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.22
|
| Rate for Payer: Healthscope Commercial |
$991.53
|
| Rate for Payer: Healthscope Whirlpool |
$961.78
|
| Rate for Payer: Mclaren Commercial |
$892.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.55
|
|
|
HC ANGIO ROOM TIME W/FLUORO 1 HOU
|
Facility
|
OP
|
$1,829.05
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,829.05 |
| Rate for Payer: Aetna Commercial |
$1,646.14
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,774.18
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,418.06
|
| Rate for Payer: BCN Commercial |
$1,418.06
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,463.24
|
| Rate for Payer: Cash Price |
$1,463.24
|
| Rate for Payer: Cofinity Commercial |
$1,719.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,463.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,829.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,774.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,646.14
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,554.69
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,280.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,664.44
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,298.63
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,609.56
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC ANGIO ROOM TIME W/FLUORO 1 HOU
|
Facility
|
IP
|
$1,829.05
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,280.34 |
| Max. Negotiated Rate |
$1,829.05 |
| Rate for Payer: Aetna Commercial |
$1,646.14
|
| Rate for Payer: ASR ASR |
$1,774.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,418.06
|
| Rate for Payer: BCN Commercial |
$1,418.06
|
| Rate for Payer: Cash Price |
$1,463.24
|
| Rate for Payer: Cofinity Commercial |
$1,719.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,463.24
|
| Rate for Payer: Healthscope Commercial |
$1,829.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,774.18
|
| Rate for Payer: Mclaren Commercial |
$1,646.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,554.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,280.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,609.56
|
|
|
HC ANGIOTENSIN-1 CONVERTING ENZYME
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Medicare |
$14.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$102.82
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$82.18
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.60
|
| Rate for Payer: Mclaren Commercial |
$95.40
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Medicaid |
$8.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Medicaid |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.28
|
| Rate for Payer: UHC Medicare Advantage |
$15.04
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC ANGIOTENSIN-1 CONVERTING ENZYME
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: ASR ASR |
$102.82
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.80
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.82
|
| Rate for Payer: Mclaren Commercial |
$95.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.28
|
|
|
HC ANGIOTENSIN CONVERTING ENZYME LEVEL
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$42.07 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$14.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.60
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Medicaid |
$8.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Medicaid |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$15.04
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC ANGIOTENSIN CONVERTING ENZYME LEVEL
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC ANGIOTENSIN II
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 82163
|
| Hospital Charge Code |
30100103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: ASR ASR |
$315.25
|
| Rate for Payer: BCBS Trust/PPO |
$251.97
|
| Rate for Payer: BCN Commercial |
$251.97
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$305.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$325.00
|
| Rate for Payer: Healthscope Whirlpool |
$315.25
|
| Rate for Payer: Mclaren Commercial |
$292.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.00
|
|
|
HC ANGIOTENSIN II
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 82163
|
| Hospital Charge Code |
30100103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: Aetna Medicare |
$20.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.65
|
| Rate for Payer: ASR ASR |
$315.25
|
| Rate for Payer: BCBS Complete |
$11.79
|
| Rate for Payer: BCBS MAPPO |
$20.52
|
| Rate for Payer: BCBS Trust/PPO |
$251.97
|
| Rate for Payer: BCN Commercial |
$251.97
|
| Rate for Payer: BCN Medicare Advantage |
$20.52
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$305.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.52
|
| Rate for Payer: Healthscope Commercial |
$325.00
|
| Rate for Payer: Healthscope Whirlpool |
$315.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.52
|
| Rate for Payer: Mclaren Commercial |
$292.50
|
| Rate for Payer: Mclaren Medicaid |
$11.22
|
| Rate for Payer: Mclaren Medicare |
$20.52
|
| Rate for Payer: Meridian Medicaid |
$11.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PACE Medicare |
$19.49
|
| Rate for Payer: PACE SWMI |
$20.52
|
| Rate for Payer: PHP Commercial |
$22.57
|
| Rate for Payer: PHP Medicaid |
$11.22
|
| Rate for Payer: PHP Medicare Advantage |
$20.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.75
|
| Rate for Payer: Priority Health Medicare |
$20.52
|
| Rate for Payer: Priority Health Narrow Network |
$230.75
|
| Rate for Payer: Railroad Medicare Medicare |
$20.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.00
|
| Rate for Payer: UHC Medicare Advantage |
$21.14
|
| Rate for Payer: VA VA |
$20.52
|
|
|
HC ANGLE TOLERANCE TEST 60 MINUTES
|
Facility
|
OP
|
$65.48
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$93.38 |
| Rate for Payer: Aetna Commercial |
$58.93
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$63.52
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$50.77
|
| Rate for Payer: BCN Commercial |
$50.77
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Commercial |
$61.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$65.48
|
| Rate for Payer: Healthscope Whirlpool |
$63.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$58.93
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.66
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.38
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$74.70
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.62
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
HC ANGLE TOLERANCE TEST 60 MINUTES
|
Facility
|
IP
|
$65.48
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$65.48 |
| Rate for Payer: Aetna Commercial |
$58.93
|
| Rate for Payer: ASR ASR |
$63.52
|
| Rate for Payer: BCBS Trust/PPO |
$50.77
|
| Rate for Payer: BCN Commercial |
$50.77
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Commercial |
$61.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Healthscope Commercial |
$65.48
|
| Rate for Payer: Healthscope Whirlpool |
$63.52
|
| Rate for Payer: Mclaren Commercial |
$58.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.62
|
|
|
HC ANGLE TOLERANCE TEST EACH ADDL 30 MIN
|
Facility
|
IP
|
$32.75
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
51000088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: ASR ASR |
$31.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.39
|
| Rate for Payer: BCN Commercial |
$25.39
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.20
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Healthscope Whirlpool |
$31.77
|
| Rate for Payer: Mclaren Commercial |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.82
|
|
|
HC ANGLE TOLERANCE TEST EACH ADDL 30 MIN
|
Facility
|
OP
|
$32.75
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
51000088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$93.38 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: ASR ASR |
$31.77
|
| Rate for Payer: BCBS Complete |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$25.39
|
| Rate for Payer: BCN Commercial |
$25.39
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.20
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Healthscope Whirlpool |
$31.77
|
| Rate for Payer: Mclaren Commercial |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.38
|
| Rate for Payer: Priority Health Narrow Network |
$74.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.82
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$485.00
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$387.65
|
| Rate for Payer: BCN Commercial |
$387.65
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$470.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$500.00
|
| Rate for Payer: Healthscope Whirlpool |
$485.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$450.00
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.00
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.00
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$355.00
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.00
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: ASR ASR |
$485.00
|
| Rate for Payer: BCBS Trust/PPO |
$387.65
|
| Rate for Payer: BCN Commercial |
$387.65
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$470.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.00
|
| Rate for Payer: Healthscope Commercial |
$500.00
|
| Rate for Payer: Healthscope Whirlpool |
$485.00
|
| Rate for Payer: Mclaren Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.00
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
IP
|
$1,020.22
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$714.15 |
| Max. Negotiated Rate |
$1,020.22 |
| Rate for Payer: Aetna Commercial |
$918.20
|
| Rate for Payer: ASR ASR |
$989.61
|
| Rate for Payer: BCBS Trust/PPO |
$790.98
|
| Rate for Payer: BCN Commercial |
$790.98
|
| Rate for Payer: Cash Price |
$816.18
|
| Rate for Payer: Cofinity Commercial |
$959.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.18
|
| Rate for Payer: Healthscope Commercial |
$1,020.22
|
| Rate for Payer: Healthscope Whirlpool |
$989.61
|
| Rate for Payer: Mclaren Commercial |
$918.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.79
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
OP
|
$1,020.22
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.09 |
| Max. Negotiated Rate |
$1,020.22 |
| Rate for Payer: Aetna Commercial |
$918.20
|
| Rate for Payer: ASR ASR |
$989.61
|
| Rate for Payer: BCBS Complete |
$408.09
|
| Rate for Payer: BCBS Trust/PPO |
$790.98
|
| Rate for Payer: BCN Commercial |
$790.98
|
| Rate for Payer: Cash Price |
$816.18
|
| Rate for Payer: Cofinity Commercial |
$959.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.18
|
| Rate for Payer: Healthscope Commercial |
$1,020.22
|
| Rate for Payer: Healthscope Whirlpool |
$989.61
|
| Rate for Payer: Mclaren Commercial |
$918.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$928.40
|
| Rate for Payer: Priority Health Narrow Network |
$724.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.79
|
|
|
HC ANOSCOPY
|
Facility
|
IP
|
$159.73
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: ASR ASR |
$154.94
|
| Rate for Payer: BCBS Trust/PPO |
$123.84
|
| Rate for Payer: BCN Commercial |
$123.84
|
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Cofinity Commercial |
$150.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.78
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Healthscope Whirlpool |
$154.94
|
| Rate for Payer: Mclaren Commercial |
$143.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.56
|
|
|
HC ANOSCOPY
|
Facility
|
OP
|
$159.73
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: ASR ASR |
$154.94
|
| Rate for Payer: BCBS Complete |
$63.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.84
|
| Rate for Payer: BCN Commercial |
$123.84
|
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Cofinity Commercial |
$150.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.78
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Healthscope Whirlpool |
$154.94
|
| Rate for Payer: Mclaren Commercial |
$143.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.35
|
| Rate for Payer: Priority Health Narrow Network |
$113.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.56
|
|
|
HC ANOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$147.32
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$147.32 |
| Rate for Payer: Aetna Commercial |
$132.59
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$142.90
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$114.22
|
| Rate for Payer: BCN Commercial |
$114.22
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$138.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$147.32
|
| Rate for Payer: Healthscope Whirlpool |
$142.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$132.59
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.41
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$75.53
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.64
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC ANOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$147.32
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$147.32 |
| Rate for Payer: Aetna Commercial |
$132.59
|
| Rate for Payer: ASR ASR |
$142.90
|
| Rate for Payer: BCBS Trust/PPO |
$114.22
|
| Rate for Payer: BCN Commercial |
$114.22
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$138.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Healthscope Commercial |
$147.32
|
| Rate for Payer: Healthscope Whirlpool |
$142.90
|
| Rate for Payer: Mclaren Commercial |
$132.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.64
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
OP
|
$1,536.46
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$1,536.46 |
| Rate for Payer: Aetna Commercial |
$1,382.81
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,490.37
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.22
|
| Rate for Payer: BCN Commercial |
$1,191.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,229.17
|
| Rate for Payer: Cash Price |
$1,229.17
|
| Rate for Payer: Cofinity Commercial |
$1,444.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,536.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,490.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,382.81
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,305.99
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,398.18
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,090.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
IP
|
$1,536.46
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.52 |
| Max. Negotiated Rate |
$1,536.46 |
| Rate for Payer: Aetna Commercial |
$1,382.81
|
| Rate for Payer: ASR ASR |
$1,490.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.22
|
| Rate for Payer: BCN Commercial |
$1,191.22
|
| Rate for Payer: Cash Price |
$1,229.17
|
| Rate for Payer: Cofinity Commercial |
$1,444.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.17
|
| Rate for Payer: Healthscope Commercial |
$1,536.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,490.37
|
| Rate for Payer: Mclaren Commercial |
$1,382.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,305.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.08
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
OP
|
$2,033.68
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$2,033.68 |
| Rate for Payer: Aetna Commercial |
$1,830.31
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,972.67
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.71
|
| Rate for Payer: BCN Commercial |
$1,576.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,626.94
|
| Rate for Payer: Cash Price |
$1,626.94
|
| Rate for Payer: Cofinity Commercial |
$1,911.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$2,033.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,972.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,830.31
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.63
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,850.65
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,443.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,789.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
IP
|
$2,033.68
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,423.58 |
| Max. Negotiated Rate |
$2,033.68 |
| Rate for Payer: Aetna Commercial |
$1,830.31
|
| Rate for Payer: ASR ASR |
$1,972.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.71
|
| Rate for Payer: BCN Commercial |
$1,576.71
|
| Rate for Payer: Cash Price |
$1,626.94
|
| Rate for Payer: Cofinity Commercial |
$1,911.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.94
|
| Rate for Payer: Healthscope Commercial |
$2,033.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,972.67
|
| Rate for Payer: Mclaren Commercial |
$1,830.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,789.64
|
|
