|
Thyroid, Parathyroid And Thyroglossal Procedures
|
Facility
|
IP
|
$9,064.19
|
|
|
Service Code
|
APR-DRG 4042
|
| Hospital Charge Code |
APRDRG4042
|
| Min. Negotiated Rate |
$9,064.19 |
| Max. Negotiated Rate |
$9,064.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,064.19
|
| Rate for Payer: Mercy Care Medicaid |
$9,064.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,064.19
|
|
|
Thyroid, Parathyroid And Thyroglossal Procedures
|
Facility
|
IP
|
$16,795.72
|
|
|
Service Code
|
APR-DRG 4043
|
| Hospital Charge Code |
APRDRG4041
|
| Min. Negotiated Rate |
$16,795.72 |
| Max. Negotiated Rate |
$16,795.72 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,795.72
|
| Rate for Payer: Mercy Care Medicaid |
$16,795.72
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,795.72
|
|
|
Thyroid, Parathyroid And Thyroglossal Procedures
|
Facility
|
IP
|
$31,813.40
|
|
|
Service Code
|
APR-DRG 4044
|
| Hospital Charge Code |
APRDRG4041
|
| Min. Negotiated Rate |
$31,813.40 |
| Max. Negotiated Rate |
$31,813.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$31,813.40
|
| Rate for Payer: Mercy Care Medicaid |
$31,813.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$31,813.40
|
|
|
Thyroid, Parathyroid And Thyroglossal Procedures
|
Facility
|
IP
|
$9,064.19
|
|
|
Service Code
|
APR-DRG 4042
|
| Hospital Charge Code |
APRDRG4041
|
| Min. Negotiated Rate |
$9,064.19 |
| Max. Negotiated Rate |
$9,064.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,064.19
|
| Rate for Payer: Mercy Care Medicaid |
$9,064.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,064.19
|
|
|
Thyroid, Parathyroid And Thyroglossal Procedures
|
Facility
|
IP
|
$31,813.40
|
|
|
Service Code
|
APR-DRG 4044
|
| Hospital Charge Code |
APRDRG4043
|
| Min. Negotiated Rate |
$31,813.40 |
| Max. Negotiated Rate |
$31,813.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$31,813.40
|
| Rate for Payer: Mercy Care Medicaid |
$31,813.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$31,813.40
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$19,378.45
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$19,378.45 |
| Max. Negotiated Rate |
$19,378.45 |
| Rate for Payer: Seven Corners Travel Insurance |
$19,378.45
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,032.17
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$39,032.17 |
| Max. Negotiated Rate |
$39,032.17 |
| Rate for Payer: Seven Corners Travel Insurance |
$39,032.17
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,186.57
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$17,186.57 |
| Max. Negotiated Rate |
$17,186.57 |
| Rate for Payer: Seven Corners Travel Insurance |
$17,186.57
|
|
|
THYROID PEROX
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
22481507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna of AZ Commercial |
$219.60
|
| Rate for Payer: Cash Price |
$195.20
|
|
|
THYROID PEROX
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
22481507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna of AZ Commercial |
$219.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$39.04
|
| Rate for Payer: Banner UC Health Medicare |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$165.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$39.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$39.04
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cigna of AZ Commercial |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$43.92
|
| Rate for Payer: Humana of AZ Medicare |
$39.04
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$165.92
|
| Rate for Payer: TriWest Medicare |
$39.04
|
| Rate for Payer: United Healthcare Commercial |
$139.57
|
| Rate for Payer: United Healthcare Medicare |
$39.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$38.65
|
|
|
.Thyroid Peroxidase (TPO) Ab LC
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
22531070
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna of AZ Commercial |
$219.60
|
| Rate for Payer: Cash Price |
$195.20
|
|
|
.Thyroid Peroxidase (TPO) Ab LC
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
22531070
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna of AZ Commercial |
$219.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$39.04
|
| Rate for Payer: Banner UC Health Medicare |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$165.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$39.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$39.04
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cigna of AZ Commercial |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$43.92
|
| Rate for Payer: Humana of AZ Medicare |
$39.04
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$165.92
|
| Rate for Payer: TriWest Medicare |
$39.04
|
| Rate for Payer: United Healthcare Commercial |
$139.57
|
| Rate for Payer: United Healthcare Medicare |
$39.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$38.65
|
|
|
Thyroid Peroxidase (TPO) Ab LC
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
1285786
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna of AZ Commercial |
$208.80
|
| Rate for Payer: Aetna of AZ Commercial |
$280.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$49.92
|
| Rate for Payer: Arizona Complete Health Allwell |
$37.12
|
| Rate for Payer: Banner UC Health Medicare |
$49.92
|
| Rate for Payer: Banner UC Health Medicare |
$37.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$157.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$37.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$49.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$37.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$49.92
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna of AZ Commercial |
$202.80
|
| Rate for Payer: Cigna of AZ Commercial |
$150.80
|
| Rate for Payer: Devoted Health Medicare |
$56.16
|
| Rate for Payer: Devoted Health Medicare |
$41.76
|
| Rate for Payer: Humana of AZ Medicare |
$37.12
|
| Rate for Payer: Humana of AZ Medicare |
$49.92
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.10
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$212.16
|
| Rate for Payer: Southwest Service Administrators UFCW |
$157.76
|
| Rate for Payer: TriWest Medicare |
$37.12
|
| Rate for Payer: TriWest Medicare |
$49.92
|
| Rate for Payer: United Healthcare Commercial |
$132.70
|
| Rate for Payer: United Healthcare Commercial |
$178.46
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: United Healthcare Medicare |
$49.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$49.42
|
| Rate for Payer: Veterans Affairs TRICARE |
$36.75
|
|
|
Thyroid Peroxidase (TPO) Ab LC
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
1285786
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna of AZ Commercial |
$280.80
|
| Rate for Payer: Aetna of AZ Commercial |
$208.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$185.60
|
|
|
Thyroid Stim Immunoglobulin LC
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
6780901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of AZ Commercial |
$540.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$96.00
|
| Rate for Payer: Banner UC Health Medicare |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$96.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$96.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna of AZ Commercial |
$390.00
|
| Rate for Payer: Devoted Health Medicare |
$108.00
|
| Rate for Payer: Humana of AZ Medicare |
$96.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$73.75
|
| Rate for Payer: Southwest Service Administrators UFCW |
$408.00
|
| Rate for Payer: TriWest Medicare |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$343.20
|
| Rate for Payer: United Healthcare Medicare |
$96.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$95.04
|
|
|
Thyroid Stim Immunoglobulin LC
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
6780901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of AZ Commercial |
$540.00
|
| Rate for Payer: Cash Price |
$480.00
|
|
|
Thyroid Stimulating Hormone
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna of AZ Commercial |
$290.70
|
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$36.96
|
| Rate for Payer: Arizona Complete Health Allwell |
$51.68
|
| Rate for Payer: Banner UC Health Medicare |
$36.96
|
| Rate for Payer: Banner UC Health Medicare |
$51.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$219.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$51.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$36.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$51.68
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna of AZ Commercial |
$209.95
|
| Rate for Payer: Cigna of AZ Commercial |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$58.14
|
| Rate for Payer: Devoted Health Medicare |
$41.58
|
| Rate for Payer: Humana of AZ Medicare |
$36.96
|
| Rate for Payer: Humana of AZ Medicare |
$51.68
|
| Rate for Payer: Seven Corners Travel Insurance |
$24.36
|
| Rate for Payer: Seven Corners Travel Insurance |
$24.36
|
| Rate for Payer: Southwest Service Administrators UFCW |
$157.08
|
| Rate for Payer: Southwest Service Administrators UFCW |
$219.64
|
| Rate for Payer: TriWest Medicare |
$36.96
|
| Rate for Payer: TriWest Medicare |
$51.68
|
| Rate for Payer: United Healthcare Commercial |
$184.76
|
| Rate for Payer: United Healthcare Commercial |
$132.13
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
| Rate for Payer: United Healthcare Medicare |
$51.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$51.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$36.59
|
|
|
Thyroid Stimulating Hormone
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of AZ Commercial |
$207.90
|
| Rate for Payer: Aetna of AZ Commercial |
$290.70
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$258.40
|
|
|
THYROID STIMULATING IMMUNE GLOBULIN (TSI)
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
22491211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$578.70 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Aetna of AZ Commercial |
$578.70
|
| Rate for Payer: Cash Price |
$514.40
|
|
|
THYROID STIMULATING IMMUNE GLOBULIN (TSI)
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
22491211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Aetna of AZ Commercial |
$578.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$102.88
|
| Rate for Payer: Banner UC Health Medicare |
$102.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$437.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$102.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$102.88
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cigna of AZ Commercial |
$417.95
|
| Rate for Payer: Devoted Health Medicare |
$115.74
|
| Rate for Payer: Humana of AZ Medicare |
$102.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$73.75
|
| Rate for Payer: Southwest Service Administrators UFCW |
$437.24
|
| Rate for Payer: TriWest Medicare |
$102.88
|
| Rate for Payer: United Healthcare Commercial |
$367.80
|
| Rate for Payer: United Healthcare Medicare |
$102.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$101.85
|
|
|
Thyrotropin Receptor Ab, Serum LC
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2087655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna of AZ Commercial |
$334.80
|
| Rate for Payer: Cash Price |
$297.60
|
|
|
Thyrotropin Receptor Ab, Serum LC
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2087655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna of AZ Commercial |
$334.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$59.52
|
| Rate for Payer: Banner UC Health Medicare |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$252.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$59.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$59.52
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna of AZ Commercial |
$241.80
|
| Rate for Payer: Devoted Health Medicare |
$66.96
|
| Rate for Payer: Humana of AZ Medicare |
$59.52
|
| Rate for Payer: Seven Corners Travel Insurance |
$26.68
|
| Rate for Payer: Southwest Service Administrators UFCW |
$252.96
|
| Rate for Payer: TriWest Medicare |
$59.52
|
| Rate for Payer: United Healthcare Commercial |
$212.78
|
| Rate for Payer: United Healthcare Medicare |
$59.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$58.92
|
|
|
Thyroxine Binding Globulin LC
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6738642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
|
|
Thyroxine Binding Globulin LC
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6738642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.00
|
| Rate for Payer: Banner UC Health Medicare |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of AZ Commercial |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.00
|
| Rate for Payer: Humana of AZ Medicare |
$16.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$68.00
|
| Rate for Payer: TriWest Medicare |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$15.84
|
|
|
THYROXINE BINDING GLOBULIN (TBG)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
22949892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of AZ Commercial |
$90.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.00
|
| Rate for Payer: Banner UC Health Medicare |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of AZ Commercial |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$18.00
|
| Rate for Payer: Humana of AZ Medicare |
$16.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.43
|
| Rate for Payer: Southwest Service Administrators UFCW |
$68.00
|
| Rate for Payer: TriWest Medicare |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$57.20
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$15.84
|
|