|
HC HSV CULTURE, NEONATE
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$19.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.45
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS MAPPO |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$55.38
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.56
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$10.48
|
| Rate for Payer: Mclaren Medicare |
$19.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.54
|
| Rate for Payer: Meridian Medicaid |
$11.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PACE Medicare |
$18.58
|
| Rate for Payer: PACE SWMI |
$19.56
|
| Rate for Payer: PHP Commercial |
$21.52
|
| Rate for Payer: PHP Medicaid |
$10.48
|
| Rate for Payer: PHP Medicare Advantage |
$19.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$19.56
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$19.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.56
|
| Rate for Payer: UHC Exchange |
$30.32
|
| Rate for Payer: UHC Medicare Advantage |
$19.56
|
| Rate for Payer: UHCCP DNSP |
$19.56
|
| Rate for Payer: UHCCP Medicaid |
$10.48
|
| Rate for Payer: VA VA |
$19.56
|
|
|
HC HSV CULTURE, NEONATE CMPT
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC HSV CULTURE, NEONATE CMPT
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$19.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.45
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS MAPPO |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$19.56
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$10.48
|
| Rate for Payer: Mclaren Medicare |
$19.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.54
|
| Rate for Payer: Meridian Medicaid |
$11.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Medicare |
$18.58
|
| Rate for Payer: PACE SWMI |
$19.56
|
| Rate for Payer: PHP Commercial |
$21.52
|
| Rate for Payer: PHP Medicaid |
$10.48
|
| Rate for Payer: PHP Medicare Advantage |
$19.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$19.56
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$19.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.56
|
| Rate for Payer: UHC Exchange |
$30.32
|
| Rate for Payer: UHC Medicare Advantage |
$19.56
|
| Rate for Payer: UHCCP DNSP |
$19.56
|
| Rate for Payer: UHCCP Medicaid |
$10.48
|
| Rate for Payer: VA VA |
$19.56
|
|
|
HC HTLV I II ANTIBODY SCREEN,S
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC HTLV I II ANTIBODY SCREEN,S
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
IP
|
$161.16
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$161.16 |
| Rate for Payer: Aetna Commercial |
$145.04
|
| Rate for Payer: ASR ASR |
$156.33
|
| Rate for Payer: ASR Commercial |
$156.33
|
| Rate for Payer: BCBS Trust/PPO |
$131.33
|
| Rate for Payer: BCN Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$151.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Healthscope Commercial |
$161.16
|
| Rate for Payer: Healthscope Whirlpool |
$156.33
|
| Rate for Payer: Mclaren Commercial |
$145.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.99
|
| Rate for Payer: Nomi Health Commercial |
$132.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.82
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
OP
|
$161.16
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$161.16 |
| Rate for Payer: Aetna Commercial |
$145.04
|
| 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 |
$156.33
|
| Rate for Payer: ASR Commercial |
$156.33
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$131.97
|
| Rate for Payer: BCN Commercial |
$124.95
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$151.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$161.16
|
| Rate for Payer: Healthscope Whirlpool |
$156.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$145.04
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.99
|
| Rate for Payer: Nomi Health Commercial |
$132.15
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.21
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$112.97
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.37
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
OP
|
$379.19
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$379.19 |
| Rate for Payer: Aetna Commercial |
$341.27
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: ASR ASR |
$367.81
|
| Rate for Payer: ASR Commercial |
$367.81
|
| Rate for Payer: BCBS Complete |
$151.68
|
| Rate for Payer: BCBS Trust/PPO |
$310.52
|
| Rate for Payer: BCN Commercial |
$293.99
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Healthscope Commercial |
$379.19
|
| Rate for Payer: Healthscope Whirlpool |
$367.81
|
| Rate for Payer: Mclaren Commercial |
$341.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.25
|
| Rate for Payer: Priority Health Narrow Network |
$265.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.69
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
IP
|
$379.19
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$379.19 |
| Rate for Payer: Aetna Commercial |
$341.27
|
| Rate for Payer: ASR ASR |
$367.81
|
| Rate for Payer: ASR Commercial |
$367.81
|
| Rate for Payer: BCBS Trust/PPO |
$309.00
|
| Rate for Payer: BCN Commercial |
$293.99
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Healthscope Commercial |
$379.19
|
| Rate for Payer: Healthscope Whirlpool |
$367.81
|
| Rate for Payer: Mclaren Commercial |
$341.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.69
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
IP
|
$99.07
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$99.07 |
| Rate for Payer: Aetna Commercial |
$89.16
|
| Rate for Payer: ASR ASR |
$96.10
|
| Rate for Payer: ASR Commercial |
$96.10
|
| Rate for Payer: BCBS Trust/PPO |
$80.73
|
| Rate for Payer: BCN Commercial |
$76.81
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$93.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.26
|
| Rate for Payer: Healthscope Commercial |
$99.07
|
| Rate for Payer: Healthscope Whirlpool |
$96.10
|
| Rate for Payer: Mclaren Commercial |
$89.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$81.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.18
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
OP
|
$99.07
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$99.07 |
| Rate for Payer: Aetna Commercial |
$89.16
|
| 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 |
$96.10
|
| Rate for Payer: ASR Commercial |
$96.10
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$81.13
|
| Rate for Payer: BCN Commercial |
$76.81
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$93.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$99.07
|
| Rate for Payer: Healthscope Whirlpool |
$96.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$89.16
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$81.24
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$69.45
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.94
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$7.95
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.95
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Mclaren Medicare |
$7.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.35
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$7.55
|
| Rate for Payer: PACE SWMI |
$7.95
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Medicaid |
$4.26
|
| Rate for Payer: PHP Medicare Advantage |
$7.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$7.95
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.95
|
| Rate for Payer: UHC Exchange |
$12.32
|
| Rate for Payer: UHC Medicare Advantage |
$7.95
|
| Rate for Payer: UHCCP DNSP |
$7.95
|
| Rate for Payer: UHCCP Medicaid |
$4.26
|
| Rate for Payer: VA VA |
$7.95
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.85 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: ASR ASR |
$299.73
|
| Rate for Payer: ASR Commercial |
$299.73
|
| Rate for Payer: BCBS Trust/PPO |
$251.80
|
| Rate for Payer: BCN Commercial |
$239.57
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$290.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.20
|
| Rate for Payer: Healthscope Commercial |
$309.00
|
| Rate for Payer: Healthscope Whirlpool |
$299.73
|
| Rate for Payer: Mclaren Commercial |
$278.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.65
|
| Rate for Payer: Nomi Health Commercial |
$253.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.92
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: Aetna Medicare |
$154.50
|
| Rate for Payer: ASR ASR |
$299.73
|
| Rate for Payer: ASR Commercial |
$299.73
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS Trust/PPO |
$253.04
|
| Rate for Payer: BCN Commercial |
$239.57
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$290.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.20
|
| Rate for Payer: Healthscope Commercial |
$309.00
|
| Rate for Payer: Healthscope Whirlpool |
$299.73
|
| Rate for Payer: Mclaren Commercial |
$278.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.65
|
| Rate for Payer: Nomi Health Commercial |
$253.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.75
|
| Rate for Payer: Priority Health Narrow Network |
$216.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.92
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: ASR ASR |
$20.86
|
| Rate for Payer: ASR Commercial |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.52
|
| Rate for Payer: BCN Commercial |
$16.67
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$21.50
|
| Rate for Payer: Healthscope Whirlpool |
$20.86
|
| Rate for Payer: Mclaren Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.92
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.46
|
| Rate for Payer: ASR ASR |
$20.86
|
| Rate for Payer: ASR Commercial |
$20.86
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$6.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$16.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.77
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.77
|
| Rate for Payer: Healthscope Commercial |
$21.50
|
| Rate for Payer: Healthscope Whirlpool |
$20.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.77
|
| Rate for Payer: Mclaren Commercial |
$19.35
|
| Rate for Payer: Mclaren Medicaid |
$3.63
|
| Rate for Payer: Mclaren Medicare |
$6.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.11
|
| Rate for Payer: Meridian Medicaid |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: PACE Medicare |
$6.43
|
| Rate for Payer: PACE SWMI |
$6.77
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: PHP Medicaid |
$3.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.84
|
| Rate for Payer: Priority Health Medicare |
$6.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.07
|
| Rate for Payer: Railroad Medicare Medicare |
$6.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.77
|
| Rate for Payer: UHC Exchange |
$10.49
|
| Rate for Payer: UHC Medicare Advantage |
$6.77
|
| Rate for Payer: UHCCP DNSP |
$6.77
|
| Rate for Payer: UHCCP Medicaid |
$3.63
|
| Rate for Payer: VA VA |
$6.77
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
OP
|
$1,394.14
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$283.68 |
| Max. Negotiated Rate |
$1,394.14 |
| Rate for Payer: Aetna Commercial |
$1,254.73
|
| Rate for Payer: Aetna Medicare |
$529.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$661.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$661.58
|
| Rate for Payer: ASR ASR |
$1,352.32
|
| Rate for Payer: ASR Commercial |
$1,352.32
|
| Rate for Payer: BCBS Complete |
$297.87
|
| Rate for Payer: BCBS MAPPO |
$529.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.66
|
| Rate for Payer: BCN Commercial |
$1,080.88
|
| Rate for Payer: BCN Medicare Advantage |
$529.26
|
| Rate for Payer: Cash Price |
$1,115.31
|
| Rate for Payer: Cash Price |
$1,115.31
|
| Rate for Payer: Cofinity Commercial |
$1,310.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.26
|
| Rate for Payer: Healthscope Commercial |
$1,394.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,352.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$529.26
|
| Rate for Payer: Mclaren Commercial |
$1,254.73
|
| Rate for Payer: Mclaren Medicaid |
$283.68
|
| Rate for Payer: Mclaren Medicare |
$529.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.72
|
| Rate for Payer: Meridian Medicaid |
$297.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$608.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.02
|
| Rate for Payer: Nomi Health Commercial |
$1,143.19
|
| Rate for Payer: PACE Medicare |
$502.80
|
| Rate for Payer: PACE SWMI |
$529.26
|
| Rate for Payer: PHP Commercial |
$582.19
|
| Rate for Payer: PHP Medicaid |
$283.68
|
| Rate for Payer: PHP Medicare Advantage |
$529.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,221.55
|
| Rate for Payer: Priority Health Medicare |
$529.26
|
| Rate for Payer: Priority Health Narrow Network |
$977.29
|
| Rate for Payer: Railroad Medicare Medicare |
$529.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,226.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.26
|
| Rate for Payer: UHC Exchange |
$820.35
|
| Rate for Payer: UHC Medicare Advantage |
$529.26
|
| Rate for Payer: UHCCP DNSP |
$529.26
|
| Rate for Payer: UHCCP Medicaid |
$283.68
|
| Rate for Payer: VA VA |
$529.26
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
IP
|
$1,394.14
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$906.19 |
| Max. Negotiated Rate |
$1,394.14 |
| Rate for Payer: Aetna Commercial |
$1,254.73
|
| Rate for Payer: ASR ASR |
$1,352.32
|
| Rate for Payer: ASR Commercial |
$1,352.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,136.08
|
| Rate for Payer: BCN Commercial |
$1,080.88
|
| Rate for Payer: Cash Price |
$1,115.31
|
| Rate for Payer: Cofinity Commercial |
$1,310.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.31
|
| Rate for Payer: Healthscope Commercial |
$1,394.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,352.32
|
| Rate for Payer: Mclaren Commercial |
$1,254.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.02
|
| Rate for Payer: Nomi Health Commercial |
$1,143.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,226.84
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Trust/PPO |
$81.46
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: Aetna Medicare |
$49.98
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$81.86
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Narrow Network |
$70.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
