|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$9.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.40
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS MAPPO |
$9.12
|
| Rate for Payer: BCN Medicare Advantage |
$9.12
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.12
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$4.99
|
| Rate for Payer: Mclaren Medicare |
$9.12
|
| Rate for Payer: Meridian Medicaid |
$5.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$8.67
|
| Rate for Payer: PACE SWMI |
$9.12
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$9.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$9.12
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$9.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.12
|
| Rate for Payer: UHC Medicare Advantage |
$9.40
|
| Rate for Payer: VA VA |
$9.12
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
OP
|
$302.94
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.91
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: BCBS Trust/PPO |
$216.39
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.50
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.06
|
| Rate for Payer: Priority Health SBD |
$190.85
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
IP
|
$302.94
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.85 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.91
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.50
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.06
|
| Rate for Payer: Priority Health SBD |
$190.85
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
OP
|
$21.08
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.92
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.68
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Medicare Advantage |
$6.14
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$14.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.14
|
| Rate for Payer: Healthscope Commercial |
$18.97
|
| Rate for Payer: Mclaren Medicaid |
$3.36
|
| Rate for Payer: Mclaren Medicare |
$6.14
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.92
|
| Rate for Payer: PACE Medicare |
$5.84
|
| Rate for Payer: PACE SWMI |
$6.14
|
| Rate for Payer: PHP Commercial |
$17.92
|
| Rate for Payer: PHP Medicare Advantage |
$6.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health Medicare |
$6.14
|
| Rate for Payer: Priority Health SBD |
$13.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.14
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: VA VA |
$6.14
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
IP
|
$21.08
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$14.76
|
| Rate for Payer: Healthscope Commercial |
$18.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.92
|
| Rate for Payer: PHP Commercial |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health SBD |
$13.28
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
OP
|
$1,366.80
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.02 |
| Max. Negotiated Rate |
$1,230.12 |
| Rate for Payer: Aetna Commercial |
$1,161.78
|
| Rate for Payer: Aetna Medicare |
$517.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$621.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$621.61
|
| Rate for Payer: BCBS Complete |
$285.64
|
| Rate for Payer: BCBS MAPPO |
$497.29
|
| Rate for Payer: BCN Medicare Advantage |
$497.29
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cofinity Commercial |
$1,175.45
|
| Rate for Payer: Cofinity Commercial |
$956.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.29
|
| Rate for Payer: Healthscope Commercial |
$1,230.12
|
| Rate for Payer: Mclaren Medicaid |
$272.02
|
| Rate for Payer: Mclaren Medicare |
$497.29
|
| Rate for Payer: Meridian Medicaid |
$285.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$522.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,161.78
|
| Rate for Payer: PACE Medicare |
$472.42
|
| Rate for Payer: PACE SWMI |
$497.29
|
| Rate for Payer: PHP Commercial |
$1,161.78
|
| Rate for Payer: PHP Medicare Advantage |
$497.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.76
|
| Rate for Payer: Priority Health Medicare |
$497.29
|
| Rate for Payer: Priority Health SBD |
$861.08
|
| Rate for Payer: Railroad Medicare Medicare |
$497.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$497.29
|
| Rate for Payer: UHC Medicare Advantage |
$512.21
|
| Rate for Payer: VA VA |
$497.29
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
IP
|
$1,366.80
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$861.08 |
| Max. Negotiated Rate |
$1,230.12 |
| Rate for Payer: Aetna Commercial |
$1,161.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.42
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cofinity Commercial |
$1,175.45
|
| Rate for Payer: Cofinity Commercial |
$956.76
|
| Rate for Payer: Healthscope Commercial |
$1,230.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,161.78
|
| Rate for Payer: PHP Commercial |
$1,161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.76
|
| Rate for Payer: Priority Health SBD |
$861.08
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: UHC Core |
$41.98
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health SBD |
$61.74
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
OP
|
$9.73
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$8.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.32
|
| Rate for Payer: BCBS Complete |
$3.89
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Cofinity Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.27
|
| Rate for Payer: PHP Commercial |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health SBD |
$6.13
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
IP
|
$9.73
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$8.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.32
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Cofinity Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.27
|
| Rate for Payer: PHP Commercial |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health SBD |
$6.13
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna Medicare |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: BCBS Complete |
$13.10
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS Trust/PPO |
$17.86
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Cofinity Commercial |
$60.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Mclaren Medicaid |
$12.48
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Meridian Medicaid |
$13.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health SBD |
$54.81
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.37
|
| Rate for Payer: UHC Core |
$38.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.81
|
| Rate for Payer: UHC Exchange |
$22.81
|
| Rate for Payer: UHC Medicare Advantage |
$23.49
|
| Rate for Payer: VA VA |
$22.81
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.55
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health SBD |
$54.81
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$38.34
|
| Rate for Payer: Aetna Medicare |
$28.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.96
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS MAPPO |
$27.17
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Medicare Advantage |
$27.17
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Cofinity Commercial |
$31.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$40.59
|
| Rate for Payer: Mclaren Medicaid |
$14.86
|
| Rate for Payer: Mclaren Medicare |
$27.17
|
| Rate for Payer: Meridian Medicaid |
$15.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.34
|
| Rate for Payer: PACE Medicare |
$25.81
|
| Rate for Payer: PACE SWMI |
$27.17
|
| Rate for Payer: PHP Commercial |
$38.34
|
| Rate for Payer: PHP Medicare Advantage |
$27.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.57
|
| Rate for Payer: Priority Health Medicare |
$27.17
|
| Rate for Payer: Priority Health SBD |
$28.41
|
| Rate for Payer: Railroad Medicare Medicare |
$27.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.60
|
| Rate for Payer: UHC Core |
$46.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.17
|
| Rate for Payer: UHC Exchange |
$27.17
|
| Rate for Payer: UHC Medicare Advantage |
$27.99
|
| Rate for Payer: VA VA |
$27.17
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna Commercial |
$38.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$31.57
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Healthscope Commercial |
$40.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.34
|
| Rate for Payer: PHP Commercial |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.57
|
| Rate for Payer: Priority Health SBD |
$28.41
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
OP
|
$27.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: BCBS Complete |
$7.04
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Mclaren Medicaid |
$6.70
|
| Rate for Payer: Mclaren Medicare |
$12.25
|
| Rate for Payer: Meridian Medicaid |
$7.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PACE Medicare |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health SBD |
$17.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.70
|
| Rate for Payer: UHC Core |
$20.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.25
|
| Rate for Payer: UHC Exchange |
$12.25
|
| Rate for Payer: UHC Medicare Advantage |
$12.62
|
| Rate for Payer: VA VA |
$12.25
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health SBD |
$17.35
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health SBD |
$17.99
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.06
|
| Rate for Payer: UHC Core |
$25.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$6.13
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$15.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.96
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health SBD |
$14.05
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.38
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.05
|
| Rate for Payer: VA VA |
$7.82
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.96
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health SBD |
$14.05
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,013.52
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$3,612.17 |
| Rate for Payer: Aetna Commercial |
$3,411.49
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,608.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$939.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cofinity Commercial |
$2,809.46
|
| Rate for Payer: Cofinity Commercial |
$3,451.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$3,612.17
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,411.49
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$3,411.49
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.46
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health SBD |
$2,528.52
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$148.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,013.52
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,528.52 |
| Max. Negotiated Rate |
$3,612.17 |
| Rate for Payer: Aetna Commercial |
$3,411.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,608.79
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cofinity Commercial |
$2,809.46
|
| Rate for Payer: Cofinity Commercial |
$3,451.63
|
| Rate for Payer: Healthscope Commercial |
$3,612.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,411.49
|
| Rate for Payer: PHP Commercial |
$3,411.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.46
|
| Rate for Payer: Priority Health SBD |
$2,528.52
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,091.70
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,247.77 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,509.60
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cofinity Commercial |
$11,258.86
|
| Rate for Payer: Cofinity Commercial |
$9,164.19
|
| Rate for Payer: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,164.19
|
| Rate for Payer: Priority Health SBD |
$8,247.77
|
|
