|
PR EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
24071
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,012.05 |
| Max. Negotiated Rate |
$1,557.00 |
| Rate for Payer: Aetna Commercial |
$1,401.30
|
| Rate for Payer: ASR ASR |
$1,510.29
|
| Rate for Payer: ASR Commercial |
$1,510.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.80
|
| Rate for Payer: BCN Commercial |
$1,207.14
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,463.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Healthscope Commercial |
$1,557.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,510.29
|
| Rate for Payer: Mclaren Commercial |
$1,401.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: Nomi Health Commercial |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,370.16
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 24075
|
| Min. Negotiated Rate |
$318.76 |
| Max. Negotiated Rate |
$843.05 |
| Rate for Payer: Aetna Commercial |
$427.14
|
| Rate for Payer: Aetna Medicare |
$318.76
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$318.76
|
| Rate for Payer: BCN Medicare Advantage |
$318.76
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$459.01
|
| Rate for Payer: Cofinity Commercial |
$427.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.76
|
| Rate for Payer: Healthscope Commercial |
$382.51
|
| Rate for Payer: Healthscope Whirlpool |
$382.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.70
|
| Rate for Payer: Nomi Health Commercial |
$382.51
|
| Rate for Payer: PACE SWMI |
$318.76
|
| Rate for Payer: PHP Medicare Advantage |
$318.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$318.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.76
|
| Rate for Payer: UHC Medicare Advantage |
$318.76
|
| Rate for Payer: UHCCP DNSP |
$318.76
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
24075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$843.05 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,167.30
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$1,258.09
|
| Rate for Payer: ASR Commercial |
$1,258.09
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.11
|
| Rate for Payer: BCN Commercial |
$1,005.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$1,219.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,037.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,297.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,167.30
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,102.45
|
| Rate for Payer: Nomi Health Commercial |
$1,063.54
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.43
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$909.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,141.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
24075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$843.05 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Aetna Commercial |
$1,167.30
|
| Rate for Payer: ASR ASR |
$1,258.09
|
| Rate for Payer: ASR Commercial |
$1,258.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.93
|
| Rate for Payer: BCN Commercial |
$1,005.56
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$1,219.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,037.60
|
| Rate for Payer: Healthscope Commercial |
$1,297.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.09
|
| Rate for Payer: Mclaren Commercial |
$1,167.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,102.45
|
| Rate for Payer: Nomi Health Commercial |
$1,063.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,141.36
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
24075
|
| Min. Negotiated Rate |
$318.76 |
| Max. Negotiated Rate |
$843.05 |
| Rate for Payer: Aetna Commercial |
$427.14
|
| Rate for Payer: Aetna Medicare |
$318.76
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$318.76
|
| Rate for Payer: BCN Medicare Advantage |
$318.76
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$459.01
|
| Rate for Payer: Cofinity Commercial |
$427.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.76
|
| Rate for Payer: Healthscope Commercial |
$382.51
|
| Rate for Payer: Healthscope Whirlpool |
$382.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.70
|
| Rate for Payer: Nomi Health Commercial |
$382.51
|
| Rate for Payer: PACE SWMI |
$318.76
|
| Rate for Payer: PHP Medicare Advantage |
$318.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$318.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.76
|
| Rate for Payer: UHC Medicare Advantage |
$318.76
|
| Rate for Payer: UHCCP DNSP |
$318.76
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
24073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,100.45 |
| Max. Negotiated Rate |
$1,693.00 |
| Rate for Payer: Aetna Commercial |
$1,523.70
|
| Rate for Payer: ASR ASR |
$1,642.21
|
| Rate for Payer: ASR Commercial |
$1,642.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.63
|
| Rate for Payer: BCN Commercial |
$1,312.58
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$1,591.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.40
|
| Rate for Payer: Healthscope Commercial |
$1,693.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,642.21
|
| Rate for Payer: Mclaren Commercial |
$1,523.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.05
|
| Rate for Payer: Nomi Health Commercial |
$1,388.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,489.84
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 24073
|
| Min. Negotiated Rate |
$672.27 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Commercial |
$900.84
|
| Rate for Payer: Aetna Medicare |
$672.27
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: BCBS MAPPO |
$672.27
|
| Rate for Payer: BCN Medicare Advantage |
$672.27
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$968.07
|
| Rate for Payer: Cofinity Commercial |
$900.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.27
|
| Rate for Payer: Healthscope Commercial |
$806.72
|
| Rate for Payer: Healthscope Whirlpool |
$806.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.88
|
| Rate for Payer: Nomi Health Commercial |
$806.72
|
| Rate for Payer: PACE SWMI |
$672.27
|
| Rate for Payer: PHP Medicare Advantage |
$672.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health Medicare |
$672.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.27
|
| Rate for Payer: UHC Medicare Advantage |
$672.27
|
| Rate for Payer: UHCCP DNSP |
$672.27
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
24073
|
| Min. Negotiated Rate |
$672.27 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Commercial |
$900.84
|
| Rate for Payer: Aetna Medicare |
$672.27
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: BCBS MAPPO |
$672.27
|
| Rate for Payer: BCN Medicare Advantage |
$672.27
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$968.07
|
| Rate for Payer: Cofinity Commercial |
$900.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.27
|
| Rate for Payer: Healthscope Commercial |
$806.72
|
| Rate for Payer: Healthscope Whirlpool |
$806.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.88
|
| Rate for Payer: Nomi Health Commercial |
$806.72
|
| Rate for Payer: PACE SWMI |
$672.27
|
| Rate for Payer: PHP Medicare Advantage |
$672.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health Medicare |
$672.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.27
|
| Rate for Payer: UHC Medicare Advantage |
$672.27
|
| Rate for Payer: UHCCP DNSP |
$672.27
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
24073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,100.45 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$1,523.70
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$1,642.21
|
| Rate for Payer: ASR Commercial |
$1,642.21
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,386.40
|
| Rate for Payer: BCN Commercial |
$1,312.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$1,591.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,693.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,642.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$1,523.70
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.05
|
| Rate for Payer: Nomi Health Commercial |
$1,388.26
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,483.41
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,186.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,489.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$762.39 |
| Rate for Payer: Aetna Commercial |
$709.45
|
| Rate for Payer: Aetna Medicare |
$529.44
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$529.44
|
| Rate for Payer: BCN Medicare Advantage |
$529.44
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$762.39
|
| Rate for Payer: Cofinity Commercial |
$709.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.44
|
| Rate for Payer: Healthscope Commercial |
$635.33
|
| Rate for Payer: Healthscope Whirlpool |
$635.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.91
|
| Rate for Payer: Nomi Health Commercial |
$635.33
|
| Rate for Payer: PACE SWMI |
$529.44
|
| Rate for Payer: PHP Medicare Advantage |
$529.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.44
|
| Rate for Payer: UHC Medicare Advantage |
$529.44
|
| Rate for Payer: UHCCP DNSP |
$529.44
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
24076
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$762.39 |
| Rate for Payer: Aetna Commercial |
$709.45
|
| Rate for Payer: Aetna Medicare |
$529.44
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$529.44
|
| Rate for Payer: BCN Medicare Advantage |
$529.44
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$762.39
|
| Rate for Payer: Cofinity Commercial |
$709.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.44
|
| Rate for Payer: Healthscope Commercial |
$635.33
|
| Rate for Payer: Healthscope Whirlpool |
$635.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.91
|
| Rate for Payer: Nomi Health Commercial |
$635.33
|
| Rate for Payer: PACE SWMI |
$529.44
|
| Rate for Payer: PHP Medicare Advantage |
$529.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.44
|
| Rate for Payer: UHC Medicare Advantage |
$529.44
|
| Rate for Payer: UHCCP DNSP |
$529.44
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$750.75 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: ASR ASR |
$1,120.35
|
| Rate for Payer: ASR Commercial |
$1,120.35
|
| Rate for Payer: BCBS Trust/PPO |
$941.21
|
| Rate for Payer: BCN Commercial |
$895.47
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Healthscope Commercial |
$1,155.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.35
|
| Rate for Payer: Mclaren Commercial |
$1,039.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: Nomi Health Commercial |
$947.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.40
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$750.75 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$1,120.35
|
| Rate for Payer: ASR Commercial |
$1,120.35
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$945.83
|
| Rate for Payer: BCN Commercial |
$895.47
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,155.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$1,039.50
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: Nomi Health Commercial |
$947.10
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.01
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$809.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
26115
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Aetna Commercial |
$431.57
|
| Rate for Payer: Aetna Medicare |
$322.07
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$322.07
|
| Rate for Payer: BCN Medicare Advantage |
$322.07
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$463.78
|
| Rate for Payer: Cofinity Commercial |
$431.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.07
|
| Rate for Payer: Healthscope Commercial |
$386.48
|
| Rate for Payer: Healthscope Whirlpool |
$386.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.17
|
| Rate for Payer: Nomi Health Commercial |
$386.48
|
| Rate for Payer: PACE SWMI |
$322.07
|
| Rate for Payer: PHP Medicare Advantage |
$322.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$322.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.07
|
| Rate for Payer: UHC Medicare Advantage |
$322.07
|
| Rate for Payer: UHCCP DNSP |
$322.07
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: ASR ASR |
$1,056.33
|
| Rate for Payer: ASR Commercial |
$1,056.33
|
| Rate for Payer: BCBS Trust/PPO |
$887.43
|
| Rate for Payer: BCN Commercial |
$844.30
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,023.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.33
|
| Rate for Payer: Mclaren Commercial |
$980.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.32
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$1,056.33
|
| Rate for Payer: ASR Commercial |
$1,056.33
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$891.78
|
| Rate for Payer: BCN Commercial |
$844.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,023.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$980.10
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$954.18
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$763.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Aetna Commercial |
$431.57
|
| Rate for Payer: Aetna Medicare |
$322.07
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$322.07
|
| Rate for Payer: BCN Medicare Advantage |
$322.07
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$463.78
|
| Rate for Payer: Cofinity Commercial |
$431.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.07
|
| Rate for Payer: Healthscope Commercial |
$386.48
|
| Rate for Payer: Healthscope Whirlpool |
$386.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.17
|
| Rate for Payer: Nomi Health Commercial |
$386.48
|
| Rate for Payer: PACE SWMI |
$322.07
|
| Rate for Payer: PHP Medicare Advantage |
$322.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$322.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.07
|
| Rate for Payer: UHC Medicare Advantage |
$322.07
|
| Rate for Payer: UHCCP DNSP |
$322.07
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$681.97
|
| Rate for Payer: Aetna Medicare |
$508.93
|
| Rate for Payer: BCBS Complete |
$672.00
|
| Rate for Payer: BCBS MAPPO |
$508.93
|
| Rate for Payer: BCN Medicare Advantage |
$508.93
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$732.86
|
| Rate for Payer: Cofinity Commercial |
$681.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.93
|
| Rate for Payer: Healthscope Commercial |
$610.72
|
| Rate for Payer: Healthscope Whirlpool |
$610.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.38
|
| Rate for Payer: Nomi Health Commercial |
$610.72
|
| Rate for Payer: PACE SWMI |
$508.93
|
| Rate for Payer: PHP Medicare Advantage |
$508.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health Medicare |
$508.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.93
|
| Rate for Payer: UHC Medicare Advantage |
$508.93
|
| Rate for Payer: UHCCP DNSP |
$508.93
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$5,537.00
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$610.21 |
| Max. Negotiated Rate |
$3,599.05 |
| Rate for Payer: Aetna Commercial |
$817.68
|
| Rate for Payer: Aetna Medicare |
$610.21
|
| Rate for Payer: BCBS Complete |
$2,214.80
|
| Rate for Payer: BCBS MAPPO |
$610.21
|
| Rate for Payer: BCN Medicare Advantage |
$610.21
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cofinity Commercial |
$878.70
|
| Rate for Payer: Cofinity Commercial |
$817.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$610.21
|
| Rate for Payer: Healthscope Commercial |
$732.25
|
| Rate for Payer: Healthscope Whirlpool |
$732.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$640.72
|
| Rate for Payer: Nomi Health Commercial |
$732.25
|
| Rate for Payer: PACE SWMI |
$610.21
|
| Rate for Payer: PHP Medicare Advantage |
$610.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,599.05
|
| Rate for Payer: Priority Health Medicare |
$610.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$610.21
|
| Rate for Payer: UHC Medicare Advantage |
$610.21
|
| Rate for Payer: UHCCP DNSP |
$610.21
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,149.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$841.38 |
| Rate for Payer: Aetna Commercial |
$782.95
|
| Rate for Payer: Aetna Medicare |
$584.29
|
| Rate for Payer: BCBS Complete |
$459.60
|
| Rate for Payer: BCBS MAPPO |
$584.29
|
| Rate for Payer: BCN Medicare Advantage |
$584.29
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cofinity Commercial |
$841.38
|
| Rate for Payer: Cofinity Commercial |
$782.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$584.29
|
| Rate for Payer: Healthscope Commercial |
$701.15
|
| Rate for Payer: Healthscope Whirlpool |
$701.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$613.50
|
| Rate for Payer: Nomi Health Commercial |
$701.15
|
| Rate for Payer: PACE SWMI |
$584.29
|
| Rate for Payer: PHP Medicare Advantage |
$584.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.85
|
| Rate for Payer: Priority Health Medicare |
$584.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$584.29
|
| Rate for Payer: UHC Medicare Advantage |
$584.29
|
| Rate for Payer: UHCCP DNSP |
$584.29
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$411.95 |
| Max. Negotiated Rate |
$1,392.95 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna Medicare |
$411.95
|
| Rate for Payer: BCBS Complete |
$857.20
|
| Rate for Payer: BCBS MAPPO |
$411.95
|
| Rate for Payer: BCN Medicare Advantage |
$411.95
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cofinity Commercial |
$593.21
|
| Rate for Payer: Cofinity Commercial |
$552.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.95
|
| Rate for Payer: Healthscope Commercial |
$494.34
|
| Rate for Payer: Healthscope Whirlpool |
$494.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.55
|
| Rate for Payer: Nomi Health Commercial |
$494.34
|
| Rate for Payer: PACE SWMI |
$411.95
|
| Rate for Payer: PHP Medicare Advantage |
$411.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health Medicare |
$411.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.95
|
| Rate for Payer: UHC Medicare Advantage |
$411.95
|
| Rate for Payer: UHCCP DNSP |
$411.95
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$485.70 |
| Rate for Payer: Aetna Commercial |
$451.97
|
| Rate for Payer: Aetna Medicare |
$337.29
|
| Rate for Payer: BCBS Complete |
$262.00
|
| Rate for Payer: BCBS MAPPO |
$337.29
|
| Rate for Payer: BCN Medicare Advantage |
$337.29
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cofinity Commercial |
$485.70
|
| Rate for Payer: Cofinity Commercial |
$451.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.29
|
| Rate for Payer: Healthscope Commercial |
$404.75
|
| Rate for Payer: Healthscope Whirlpool |
$404.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.15
|
| Rate for Payer: Nomi Health Commercial |
$404.75
|
| Rate for Payer: PACE SWMI |
$337.29
|
| Rate for Payer: PHP Medicare Advantage |
$337.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.75
|
| Rate for Payer: Priority Health Medicare |
$337.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.29
|
| Rate for Payer: UHC Medicare Advantage |
$337.29
|
| Rate for Payer: UHCCP DNSP |
$337.29
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$778.38 |
| Rate for Payer: Aetna Commercial |
$724.32
|
| Rate for Payer: Aetna Medicare |
$540.54
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCBS MAPPO |
$540.54
|
| Rate for Payer: BCN Medicare Advantage |
$540.54
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$778.38
|
| Rate for Payer: Cofinity Commercial |
$724.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.54
|
| Rate for Payer: Healthscope Commercial |
$648.65
|
| Rate for Payer: Healthscope Whirlpool |
$648.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.57
|
| Rate for Payer: Nomi Health Commercial |
$648.65
|
| Rate for Payer: PACE SWMI |
$540.54
|
| Rate for Payer: PHP Medicare Advantage |
$540.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health Medicare |
$540.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.54
|
| Rate for Payer: UHC Medicare Advantage |
$540.54
|
| Rate for Payer: UHCCP DNSP |
$540.54
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$743.10 |
| Rate for Payer: Aetna Commercial |
$691.49
|
| Rate for Payer: Aetna Medicare |
$516.04
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS MAPPO |
$516.04
|
| Rate for Payer: BCN Medicare Advantage |
$516.04
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cofinity Commercial |
$743.10
|
| Rate for Payer: Cofinity Commercial |
$691.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.04
|
| Rate for Payer: Healthscope Commercial |
$619.25
|
| Rate for Payer: Healthscope Whirlpool |
$619.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.84
|
| Rate for Payer: Nomi Health Commercial |
$619.25
|
| Rate for Payer: PACE SWMI |
$516.04
|
| Rate for Payer: PHP Medicare Advantage |
$516.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Medicare |
$516.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.04
|
| Rate for Payer: UHC Medicare Advantage |
$516.04
|
| Rate for Payer: UHCCP DNSP |
$516.04
|
|
|
PR EXERCISE EQUIPMENT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A9300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
