|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$86.48
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$86.90
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.98
|
| Rate for Payer: Priority Health Narrow Network |
$74.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: ASR Commercial |
$53.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.88
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Aetna Medicare |
$27.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: ASR Commercial |
$53.43
|
| Rate for Payer: BCBS Complete |
$15.72
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$45.11
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicaid |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.26
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$38.61
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Exchange |
$43.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.94
|
| Rate for Payer: UHCCP DNSP |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$14.98
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$27.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$15.72
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicaid |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Exchange |
$43.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.94
|
| Rate for Payer: UHCCP DNSP |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$14.98
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$41.75
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.18
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicaid |
$12.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.67
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow Network |
$35.74
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.18
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicare Advantage |
$24.18
|
| Rate for Payer: UHCCP DNSP |
$24.18
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: VA VA |
$24.18
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Aetna Commercial |
$106.37
|
| Rate for Payer: ASR ASR |
$114.64
|
| Rate for Payer: ASR Commercial |
$114.64
|
| Rate for Payer: BCBS Trust/PPO |
$96.31
|
| Rate for Payer: BCN Commercial |
$91.63
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Healthscope Commercial |
$118.19
|
| Rate for Payer: Healthscope Whirlpool |
$114.64
|
| Rate for Payer: Mclaren Commercial |
$106.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: Nomi Health Commercial |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.01
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$136.21 |
| Rate for Payer: Aetna Commercial |
$106.37
|
| Rate for Payer: Aetna Medicare |
$87.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.85
|
| Rate for Payer: ASR ASR |
$114.64
|
| Rate for Payer: ASR Commercial |
$114.64
|
| Rate for Payer: BCBS Complete |
$49.46
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCBS Trust/PPO |
$96.79
|
| Rate for Payer: BCN Commercial |
$91.63
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$118.19
|
| Rate for Payer: Healthscope Whirlpool |
$114.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$87.88
|
| Rate for Payer: Mclaren Commercial |
$106.37
|
| Rate for Payer: Mclaren Medicaid |
$47.10
|
| Rate for Payer: Mclaren Medicare |
$87.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: Meridian Medicaid |
$49.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: Nomi Health Commercial |
$96.92
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$96.67
|
| Rate for Payer: PHP Medicaid |
$47.10
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.56
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health Narrow Network |
$82.85
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.88
|
| Rate for Payer: UHC Exchange |
$136.21
|
| Rate for Payer: UHC Medicare Advantage |
$87.88
|
| Rate for Payer: UHCCP DNSP |
$87.88
|
| Rate for Payer: UHCCP Medicaid |
$47.10
|
| Rate for Payer: VA VA |
$87.88
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$119.02 |
| Rate for Payer: Aetna Commercial |
$107.12
|
| Rate for Payer: ASR ASR |
$115.45
|
| Rate for Payer: ASR Commercial |
$115.45
|
| Rate for Payer: BCBS Trust/PPO |
$96.99
|
| Rate for Payer: BCN Commercial |
$92.28
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$111.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Healthscope Commercial |
$119.02
|
| Rate for Payer: Healthscope Whirlpool |
$115.45
|
| Rate for Payer: Mclaren Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.74
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$119.02 |
| Rate for Payer: Aetna Commercial |
$107.12
|
| Rate for Payer: Aetna Medicare |
$64.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.10
|
| Rate for Payer: ASR ASR |
$115.45
|
| Rate for Payer: ASR Commercial |
$115.45
|
| Rate for Payer: BCBS Complete |
$36.51
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCBS Trust/PPO |
$97.47
|
| Rate for Payer: BCN Commercial |
$92.28
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$111.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$119.02
|
| Rate for Payer: Healthscope Whirlpool |
$115.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.88
|
| Rate for Payer: Mclaren Commercial |
$107.12
|
| Rate for Payer: Mclaren Medicaid |
$34.78
|
| Rate for Payer: Mclaren Medicare |
$64.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.12
|
| Rate for Payer: Meridian Medicaid |
$36.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$71.37
|
| Rate for Payer: PHP Medicaid |
$34.78
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.29
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health Narrow Network |
$83.43
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.88
|
| Rate for Payer: UHC Exchange |
$100.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.88
|
| Rate for Payer: UHCCP DNSP |
$64.88
|
| Rate for Payer: UHCCP Medicaid |
$34.78
|
| Rate for Payer: VA VA |
$64.88
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: ASR Commercial |
$64.59
|
| Rate for Payer: BCBS Trust/PPO |
$54.26
|
| Rate for Payer: BCN Commercial |
$51.63
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$66.59
|
| Rate for Payer: Healthscope Whirlpool |
$64.59
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: ASR Commercial |
$64.59
|
| Rate for Payer: BCBS Complete |
$14.04
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$54.53
|
| Rate for Payer: BCN Commercial |
$51.63
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$66.59
|
| Rate for Payer: Healthscope Whirlpool |
$64.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.95
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$13.37
|
| Rate for Payer: Mclaren Medicare |
$24.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: Meridian Medicaid |
$14.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: PHP Medicaid |
$13.37
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health Narrow Network |
$46.68
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.95
|
| Rate for Payer: UHC Exchange |
$38.67
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: UHCCP DNSP |
$24.95
|
| Rate for Payer: UHCCP Medicaid |
$13.37
|
| Rate for Payer: VA VA |
$24.95
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Trust/PPO |
$46.55
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$46.78
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicaid |
$8.76
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$40.04
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$25.33
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP DNSP |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna Commercial |
$147.80
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$159.29
|
| Rate for Payer: ASR Commercial |
$159.29
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$134.48
|
| Rate for Payer: BCN Commercial |
$127.32
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$154.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$164.22
|
| Rate for Payer: Healthscope Whirlpool |
$159.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.90
|
| Rate for Payer: Mclaren Commercial |
$147.80
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| Rate for Payer: Mclaren Medicare |
$14.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: Meridian Medicaid |
$8.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: Nomi Health Commercial |
$134.66
|
| Rate for Payer: PACE Medicare |
$14.15
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$16.39
|
| Rate for Payer: PHP Medicaid |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.89
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health Narrow Network |
$115.12
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.90
|
| Rate for Payer: UHC Exchange |
$23.09
|
| Rate for Payer: UHC Medicare Advantage |
$14.90
|
| Rate for Payer: UHCCP DNSP |
$14.90
|
| Rate for Payer: UHCCP Medicaid |
$7.99
|
| Rate for Payer: VA VA |
$14.90
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna Commercial |
$147.80
|
| Rate for Payer: ASR ASR |
$159.29
|
| Rate for Payer: ASR Commercial |
$159.29
|
| Rate for Payer: BCBS Trust/PPO |
$133.82
|
| Rate for Payer: BCN Commercial |
$127.32
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$154.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Healthscope Commercial |
$164.22
|
| Rate for Payer: Healthscope Whirlpool |
$159.29
|
| Rate for Payer: Mclaren Commercial |
$147.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: Nomi Health Commercial |
$134.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.51
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$128.42 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: ASR ASR |
$124.57
|
| Rate for Payer: ASR Commercial |
$124.57
|
| Rate for Payer: BCBS Trust/PPO |
$104.65
|
| Rate for Payer: BCN Commercial |
$99.56
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$120.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Healthscope Commercial |
$128.42
|
| Rate for Payer: Healthscope Whirlpool |
$124.57
|
| Rate for Payer: Mclaren Commercial |
$115.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.01
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$128.42 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$124.57
|
| Rate for Payer: ASR Commercial |
$124.57
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$105.16
|
| Rate for Payer: BCN Commercial |
$99.56
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$120.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$128.42
|
| Rate for Payer: Healthscope Whirlpool |
$124.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$115.58
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.52
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$90.02
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$618.56 |
| Max. Negotiated Rate |
$1,546.41 |
| Rate for Payer: Aetna Commercial |
$1,391.77
|
| Rate for Payer: Aetna Medicare |
$773.21
|
| Rate for Payer: ASR ASR |
$1,500.02
|
| Rate for Payer: ASR Commercial |
$1,500.02
|
| Rate for Payer: BCBS Complete |
$618.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,266.36
|
| Rate for Payer: BCN Commercial |
$1,198.93
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,453.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,546.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,500.02
|
| Rate for Payer: Mclaren Commercial |
$1,391.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: Nomi Health Commercial |
$1,268.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,354.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,084.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,360.84
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,005.17 |
| Max. Negotiated Rate |
$1,546.41 |
| Rate for Payer: Aetna Commercial |
$1,391.77
|
| Rate for Payer: ASR ASR |
$1,500.02
|
| Rate for Payer: ASR Commercial |
$1,500.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.17
|
| Rate for Payer: BCN Commercial |
$1,198.93
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,453.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,546.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,500.02
|
| Rate for Payer: Mclaren Commercial |
$1,391.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: Nomi Health Commercial |
$1,268.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,360.84
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.64 |
| Max. Negotiated Rate |
$300.99 |
| Rate for Payer: Aetna Commercial |
$270.89
|
| Rate for Payer: ASR ASR |
$291.96
|
| Rate for Payer: ASR Commercial |
$291.96
|
| Rate for Payer: BCBS Trust/PPO |
$245.28
|
| Rate for Payer: BCN Commercial |
$233.36
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$282.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$300.99
|
| Rate for Payer: Healthscope Whirlpool |
$291.96
|
| Rate for Payer: Mclaren Commercial |
$270.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$246.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.87
|
|
