|
HC HSV CULTURE, NEONATE CMPT
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC HTLV I II ANTIBODY SCREEN,S
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HTLV I II ANTIBODY SCREEN,S
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$7.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$153.26
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$122.50
|
| Rate for Payer: BCN Commercial |
$122.50
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Healthscope Whirlpool |
$153.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$142.20
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.78
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$112.18
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.04
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: ASR ASR |
$153.26
|
| Rate for Payer: BCBS Trust/PPO |
$122.50
|
| Rate for Payer: BCN Commercial |
$122.50
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.40
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Healthscope Whirlpool |
$153.26
|
| Rate for Payer: Mclaren Commercial |
$142.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.04
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
OP
|
$371.75
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.70 |
| Max. Negotiated Rate |
$371.75 |
| Rate for Payer: Aetna Commercial |
$334.58
|
| Rate for Payer: ASR ASR |
$360.60
|
| Rate for Payer: BCBS Complete |
$148.70
|
| Rate for Payer: BCBS Trust/PPO |
$288.22
|
| Rate for Payer: BCN Commercial |
$288.22
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$349.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$371.75
|
| Rate for Payer: Healthscope Whirlpool |
$360.60
|
| Rate for Payer: Mclaren Commercial |
$334.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.29
|
| Rate for Payer: Priority Health Narrow Network |
$263.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.14
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
IP
|
$371.75
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$260.22 |
| Max. Negotiated Rate |
$371.75 |
| Rate for Payer: Aetna Commercial |
$334.58
|
| Rate for Payer: ASR ASR |
$360.60
|
| Rate for Payer: BCBS Trust/PPO |
$288.22
|
| Rate for Payer: BCN Commercial |
$288.22
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$349.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$371.75
|
| Rate for Payer: Healthscope Whirlpool |
$360.60
|
| Rate for Payer: Mclaren Commercial |
$334.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.14
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
OP
|
$97.13
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$97.13 |
| Rate for Payer: Aetna Commercial |
$87.42
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$94.22
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$75.30
|
| Rate for Payer: BCCCP Commercial |
$35.09
|
| Rate for Payer: BCN Commercial |
$75.30
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$91.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$97.13
|
| Rate for Payer: Healthscope Whirlpool |
$94.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$87.42
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.56
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.39
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$68.96
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.47
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
IP
|
$97.13
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.99 |
| Max. Negotiated Rate |
$97.13 |
| Rate for Payer: Aetna Commercial |
$87.42
|
| Rate for Payer: ASR ASR |
$94.22
|
| Rate for Payer: BCBS Trust/PPO |
$75.30
|
| Rate for Payer: BCN Commercial |
$75.30
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$91.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Healthscope Commercial |
$97.13
|
| Rate for Payer: Healthscope Whirlpool |
$94.22
|
| Rate for Payer: Mclaren Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.47
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
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 |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.40
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS MAPPO |
$9.12
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| 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 |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.12
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.12
|
| Rate for Payer: Mclaren 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 |
$10.03
|
| Rate for Payer: PHP Medicaid |
$4.99
|
| 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 HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$9.12
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$9.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$9.40
|
| Rate for Payer: VA VA |
$9.12
|
|
|
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 |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
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 |
$212.06 |
| Max. Negotiated Rate |
$302.94 |
| Rate for Payer: Aetna Commercial |
$272.65
|
| Rate for Payer: ASR ASR |
$293.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.87
|
| Rate for Payer: BCN Commercial |
$234.87
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$284.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$302.94
|
| Rate for Payer: Healthscope Whirlpool |
$293.85
|
| Rate for Payer: Mclaren Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.59
|
|
|
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 |
$302.94 |
| Rate for Payer: Aetna Commercial |
$272.65
|
| Rate for Payer: ASR ASR |
$293.85
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: BCBS Trust/PPO |
$234.87
|
| Rate for Payer: BCN Commercial |
$234.87
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$284.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$302.94
|
| Rate for Payer: Healthscope Whirlpool |
$293.85
|
| Rate for Payer: Mclaren Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.68
|
| Rate for Payer: Priority Health Narrow Network |
$215.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.59
|
|
|
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 |
$14.76 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna Commercial |
$18.97
|
| Rate for Payer: ASR ASR |
$20.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCN Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$21.08
|
| Rate for Payer: Healthscope Whirlpool |
$20.45
|
| Rate for Payer: Mclaren Commercial |
$18.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.55
|
|
|
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 |
$21.08 |
| Rate for Payer: Aetna Commercial |
$18.97
|
| Rate for Payer: Aetna Medicare |
$6.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.68
|
| Rate for Payer: ASR ASR |
$20.45
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCN Commercial |
$16.34
|
| 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 |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.14
|
| Rate for Payer: Healthscope Commercial |
$21.08
|
| Rate for Payer: Healthscope Whirlpool |
$20.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.14
|
| Rate for Payer: Mclaren 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 |
$6.76
|
| Rate for Payer: PHP Medicaid |
$3.36
|
| 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 HMO/PPO/Tiered Network |
$19.18
|
| Rate for Payer: Priority Health Medicare |
$6.14
|
| Rate for Payer: Priority Health Narrow Network |
$14.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: VA VA |
$6.14
|
|
|
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 |
$1,366.80 |
| Rate for Payer: Aetna Commercial |
$1,230.12
|
| Rate for Payer: Aetna Medicare |
$497.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$621.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$621.61
|
| Rate for Payer: ASR ASR |
$1,325.80
|
| Rate for Payer: BCBS Complete |
$285.64
|
| Rate for Payer: BCBS MAPPO |
$497.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.68
|
| Rate for Payer: BCN Commercial |
$1,059.68
|
| 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 |
$1,284.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.29
|
| Rate for Payer: Healthscope Commercial |
$1,366.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,325.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$497.29
|
| Rate for Payer: Mclaren 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 |
$547.02
|
| Rate for Payer: PHP Medicaid |
$272.02
|
| 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 HMO/PPO/Tiered Network |
$1,243.79
|
| Rate for Payer: Priority Health Medicare |
$497.29
|
| Rate for Payer: Priority Health Narrow Network |
$970.43
|
| Rate for Payer: Railroad Medicare Medicare |
$497.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,202.78
|
| 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 |
$956.76 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Aetna Commercial |
$1,230.12
|
| Rate for Payer: ASR ASR |
$1,325.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.68
|
| Rate for Payer: BCN Commercial |
$1,059.68
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cofinity Commercial |
$1,284.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.44
|
| Rate for Payer: Healthscope Commercial |
$1,366.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,325.80
|
| Rate for Payer: Mclaren Commercial |
$1,230.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,202.78
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
|
|
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 |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.18
|
| Rate for Payer: Priority Health Narrow Network |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
IP
|
$9.73
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$9.73 |
| Rate for Payer: Aetna Commercial |
$8.76
|
| Rate for Payer: ASR ASR |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$7.54
|
| Rate for Payer: BCN Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$9.73
|
| Rate for Payer: Healthscope Whirlpool |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.56
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
OP
|
$9.73
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$9.73 |
| Rate for Payer: Aetna Commercial |
$8.76
|
| Rate for Payer: ASR ASR |
$9.44
|
| Rate for Payer: BCBS Complete |
$3.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.54
|
| Rate for Payer: BCN Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$9.73
|
| Rate for Payer: Healthscope Whirlpool |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.85
|
| Rate for Payer: Priority Health Narrow Network |
$6.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.56
|
|
