|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 72100
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$2,071.46 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: BCN Commercial |
$58.65
|
| Rate for Payer: BCN Commercial |
$58.65
|
| Rate for Payer: BCN Commercial |
$58.65
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.46
|
| Rate for Payer: UHC Exchange |
$41.46
|
| Rate for Payer: UHC Exchange |
$41.46
|
| Rate for Payer: UHC Exchange |
$41.46
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$2,111.09 |
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.09
|
| Rate for Payer: BCN Commercial |
$75.26
|
| Rate for Payer: BCN Commercial |
$75.26
|
| Rate for Payer: BCN Commercial |
$75.26
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.82
|
| Rate for Payer: UHC Exchange |
$56.82
|
| Rate for Payer: UHC Exchange |
$56.82
|
| Rate for Payer: UHC Exchange |
$56.82
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72120
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$3,290.25 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,290.25
|
| Rate for Payer: BCN Commercial |
$59.62
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.60
|
| Rate for Payer: UHC Exchange |
$51.60
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$2,773.58 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,773.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,773.58
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.06
|
| Rate for Payer: Priority Health Narrow Network |
$22.06
|
| Rate for Payer: Priority Health Narrow Network |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.27
|
| Rate for Payer: UHC Exchange |
$75.27
|
| Rate for Payer: UHC Exchange |
$75.27
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$165.36 |
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.88
|
| Rate for Payer: Priority Health Narrow Network |
$14.88
|
| Rate for Payer: Priority Health Narrow Network |
$14.88
|
| Rate for Payer: Priority Health Narrow Network |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.17
|
| Rate for Payer: UHC Exchange |
$35.17
|
| Rate for Payer: UHC Exchange |
$35.17
|
| Rate for Payer: UHC Exchange |
$35.17
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$1,922.48 |
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,922.48
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.84
|
| Rate for Payer: UHC Exchange |
$39.84
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$376.68 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$376.68
|
| Rate for Payer: BCN Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.96
|
| Rate for Payer: Priority Health Narrow Network |
$17.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.48
|
| Rate for Payer: UHC Exchange |
$46.48
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$1,847.47 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.40
|
| Rate for Payer: Priority Health Narrow Network |
$15.40
|
| Rate for Payer: Priority Health Narrow Network |
$15.40
|
| Rate for Payer: Priority Health Narrow Network |
$15.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.55
|
| Rate for Payer: UHC Exchange |
$37.55
|
| Rate for Payer: UHC Exchange |
$37.55
|
| Rate for Payer: UHC Exchange |
$37.55
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$5,212.15 |
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.06
|
| Rate for Payer: UHC Exchange |
$39.06
|
| Rate for Payer: UHC Exchange |
$39.06
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$2,498.86 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.86
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.97
|
| Rate for Payer: UHC Exchange |
$33.97
|
| Rate for Payer: UHC Exchange |
$33.97
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 70330
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCN Commercial |
$77.70
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Meridian Medicaid |
$7.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.45
|
| Rate for Payer: Priority Health Narrow Network |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.25
|
| Rate for Payer: UHC Exchange |
$49.25
|
| Rate for Payer: UHCCP Medicaid |
$7.24
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 70328
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$1,498.26 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.26
|
| Rate for Payer: BCN Commercial |
$50.82
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health Narrow Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.59
|
| Rate for Payer: UHC Exchange |
$31.59
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 73660
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$2,915.69 |
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.69
|
| Rate for Payer: BCN Commercial |
$43.00
|
| Rate for Payer: BCN Commercial |
$43.00
|
| Rate for Payer: BCN Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Meridian Medicaid |
$4.25
|
| Rate for Payer: Meridian Medicaid |
$4.25
|
| Rate for Payer: Meridian Medicaid |
$4.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$9.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.17
|
| Rate for Payer: UHC Exchange |
$29.17
|
| Rate for Payer: UHC Exchange |
$29.17
|
| Rate for Payer: UHC Exchange |
$29.17
|
| Rate for Payer: UHCCP Medicaid |
$4.05
|
| Rate for Payer: UHCCP Medicaid |
$4.05
|
| Rate for Payer: UHCCP Medicaid |
$4.05
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73092
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$632.38 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$632.38
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.00
|
| Rate for Payer: UHC Exchange |
$30.00
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 73100
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$88.75 |
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: BCN Commercial |
$49.85
|
| Rate for Payer: BCN Commercial |
$49.85
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.22
|
| Rate for Payer: UHC Exchange |
$31.22
|
| Rate for Payer: UHC Exchange |
$31.22
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 73110
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$115.70 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.65
|
| Rate for Payer: UHC Exchange |
$36.65
|
| Rate for Payer: UHC Exchange |
$36.65
|
| Rate for Payer: UHC Exchange |
$36.65
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
CHG RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 77431
|
| Min. Negotiated Rate |
$69.86 |
| Max. Negotiated Rate |
$2,159.16 |
| Rate for Payer: Aetna Commercial |
$125.01
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$73.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.16
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$73.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.45
|
| Rate for Payer: Priority Health Narrow Network |
$126.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.76
|
| Rate for Payer: UHC Exchange |
$134.76
|
| Rate for Payer: UHCCP Medicaid |
$69.86
|
|
|
CHG RADIATION TREATMENT DELIVERY >=1 MEV COMPLEX
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 77412
|
| Min. Negotiated Rate |
$187.96 |
| Max. Negotiated Rate |
$696.30 |
| Rate for Payer: Aetna Commercial |
$290.34
|
| Rate for Payer: Aetna Medicare |
$276.50
|
| Rate for Payer: BCBS Complete |
$221.20
|
| Rate for Payer: BCBS Trust/PPO |
$696.30
|
| Rate for Payer: BCN Commercial |
$187.96
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.63
|
| Rate for Payer: Priority Health Narrow Network |
$353.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.29
|
| Rate for Payer: UHC Exchange |
$278.29
|
|
|
CHG RADIATION TREATMENT DELIVERY >=1 MEV SIMPLE
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 77402
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$158.33
|
| Rate for Payer: Aetna Medicare |
$181.00
|
| Rate for Payer: BCBS Complete |
$144.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$106.71
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.53
|
| Rate for Payer: Priority Health Narrow Network |
$194.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.12
|
| Rate for Payer: UHC Exchange |
$180.12
|
|
|
CHG RADIATION TREATMENT MANAGEMENT 5 TREATMENTS
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 77427
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$2,101.58 |
| Rate for Payer: Aetna Commercial |
$223.07
|
| Rate for Payer: Aetna Medicare |
$180.00
|
| Rate for Payer: BCBS Complete |
$129.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,101.58
|
| Rate for Payer: BCN Commercial |
$278.06
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Meridian Medicaid |
$129.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.56
|
| Rate for Payer: Priority Health Narrow Network |
$292.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.44
|
| Rate for Payer: UHC Exchange |
$266.44
|
| Rate for Payer: UHCCP Medicaid |
$123.75
|
|
|
CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTAGE
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 77401
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$2,336.14 |
| Rate for Payer: Aetna Commercial |
$48.09
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,336.14
|
| Rate for Payer: BCN Commercial |
$60.11
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.16
|
| Rate for Payer: Priority Health Narrow Network |
$64.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.53
|
| Rate for Payer: UHC Exchange |
$34.53
|
|
|
CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 70110
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$63.53 |
| Rate for Payer: Aetna Commercial |
$49.43
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCN Commercial |
$63.53
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Meridian Medicaid |
$8.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.96
|
| Rate for Payer: Priority Health Narrow Network |
$17.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.45
|
| Rate for Payer: UHC Exchange |
$41.45
|
| Rate for Payer: UHCCP Medicaid |
$7.67
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 75989
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$3,322.48 |
| Rate for Payer: Aetna Commercial |
$145.39
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: BCBS Complete |
$36.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,322.48
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Meridian Medicaid |
$36.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.66
|
| Rate for Payer: Priority Health Narrow Network |
$83.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.84
|
| Rate for Payer: UHC Exchange |
$146.84
|
| Rate for Payer: UHCCP Medicaid |
$34.93
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 74018
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$2,936.82 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,936.82
|
| Rate for Payer: BCN Commercial |
$43.98
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health Narrow Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.42
|
| Rate for Payer: UHC Exchange |
$30.42
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 74019
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$54.24 |
| Rate for Payer: Aetna Commercial |
$42.11
|
| Rate for Payer: Aetna Commercial |
$42.11
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.13
|
| Rate for Payer: UHC Exchange |
$37.13
|
| Rate for Payer: UHC Exchange |
$37.13
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
|
