|
HC URINE PRESUMPTIVE ID
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.66 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: BCBS Trust/PPO |
$49.46
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
|
|
HC URINE PRESUMPTIVE ID
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.11
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS MAPPO |
$8.09
|
| Rate for Payer: BCBS Trust/PPO |
$49.46
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: BCN Medicare Advantage |
$8.09
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.09
|
| Rate for Payer: Healthscope Commercial |
$63.80
|
| Rate for Payer: Healthscope Whirlpool |
$61.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.09
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: Mclaren Medicaid |
$4.43
|
| Rate for Payer: Mclaren Medicare |
$8.09
|
| Rate for Payer: Meridian Medicaid |
$4.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PACE Medicare |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.09
|
| Rate for Payer: PHP Commercial |
$8.90
|
| Rate for Payer: PHP Medicaid |
$4.43
|
| Rate for Payer: PHP Medicare Advantage |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.60
|
| Rate for Payer: Priority Health Medicare |
$8.09
|
| Rate for Payer: Priority Health Narrow Network |
$18.88
|
| Rate for Payer: Railroad Medicare Medicare |
$8.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
| Rate for Payer: UHC Medicare Advantage |
$8.33
|
| Rate for Payer: VA VA |
$8.09
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$37.90 |
| Rate for Payer: Aetna Commercial |
$34.11
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$36.76
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$35.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$37.90
|
| Rate for Payer: Healthscope Whirlpool |
$36.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.49
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$26.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.35
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$37.90 |
| Rate for Payer: Aetna Commercial |
$34.11
|
| Rate for Payer: ASR ASR |
$36.76
|
| Rate for Payer: BCBS Trust/PPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$35.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.32
|
| Rate for Payer: Healthscope Commercial |
$37.90
|
| Rate for Payer: Healthscope Whirlpool |
$36.76
|
| Rate for Payer: Mclaren Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.35
|
|
|
HC URIN MDMA
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| 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 |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.34
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$65.80
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URIN MDMA
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
|
|
HC URN COTININE.
|
Facility
|
OP
|
$99.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$99.95 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$96.95
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$77.49
|
| Rate for Payer: BCN Commercial |
$77.49
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$99.95
|
| Rate for Payer: Healthscope Whirlpool |
$96.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.96
|
| 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 |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.95
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$70.96
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URN COTININE.
|
Facility
|
IP
|
$99.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$99.95 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.95
|
| Rate for Payer: BCBS Trust/PPO |
$77.49
|
| Rate for Payer: BCN Commercial |
$77.49
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.96
|
| Rate for Payer: Healthscope Commercial |
$99.95
|
| Rate for Payer: Healthscope Whirlpool |
$96.95
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC URN MDMA
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$32.64
|
| 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: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN MDMA
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| 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 URN TRICYCLIC
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$36.30
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.61
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN TRICYCLIC
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$36.30
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
IP
|
$1,925.25
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.68 |
| Max. Negotiated Rate |
$1,925.25 |
| Rate for Payer: Aetna Commercial |
$1,732.72
|
| Rate for Payer: ASR ASR |
$1,867.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.65
|
| Rate for Payer: BCN Commercial |
$1,492.65
|
| Rate for Payer: Cash Price |
$1,540.20
|
| Rate for Payer: Cofinity Commercial |
$1,809.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.20
|
| Rate for Payer: Healthscope Commercial |
$1,925.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,867.49
|
| Rate for Payer: Mclaren Commercial |
$1,732.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,636.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.22
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
OP
|
$1,925.25
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.10 |
| Max. Negotiated Rate |
$1,925.25 |
| Rate for Payer: Aetna Commercial |
$1,732.72
|
| Rate for Payer: ASR ASR |
$1,867.49
|
| Rate for Payer: BCBS Complete |
$770.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.65
|
| Rate for Payer: BCN Commercial |
$1,492.65
|
| Rate for Payer: Cash Price |
$1,540.20
|
| Rate for Payer: Cofinity Commercial |
$1,809.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.20
|
| Rate for Payer: Healthscope Commercial |
$1,925.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,867.49
|
| Rate for Payer: Mclaren Commercial |
$1,732.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,636.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,751.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,366.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.22
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
OP
|
$16.05
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.61
|
| Rate for Payer: Priority Health Narrow Network |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
IP
|
$16.05
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
HC US AAA SCREENING
|
Facility
|
IP
|
$359.82
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.87 |
| Max. Negotiated Rate |
$359.82 |
| Rate for Payer: Aetna Commercial |
$323.84
|
| Rate for Payer: ASR ASR |
$349.03
|
| Rate for Payer: BCBS Trust/PPO |
$278.97
|
| Rate for Payer: BCN Commercial |
$278.97
|
| Rate for Payer: Cash Price |
$287.86
|
| Rate for Payer: Cofinity Commercial |
$338.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.86
|
| Rate for Payer: Healthscope Commercial |
$359.82
|
| Rate for Payer: Healthscope Whirlpool |
$349.03
|
| Rate for Payer: Mclaren Commercial |
$323.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.64
|
|
|
HC US AAA SCREENING
|
Facility
|
OP
|
$359.82
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$359.82 |
| Rate for Payer: Aetna Commercial |
$323.84
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$349.03
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$278.97
|
| Rate for Payer: BCN Commercial |
$278.97
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$287.86
|
| Rate for Payer: Cash Price |
$287.86
|
| Rate for Payer: Cofinity Commercial |
$338.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$359.82
|
| Rate for Payer: Healthscope Whirlpool |
$349.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$323.84
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.85
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.44
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$255.47
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.64
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
IP
|
$932.27
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$652.59 |
| Max. Negotiated Rate |
$932.27 |
| Rate for Payer: Aetna Commercial |
$839.04
|
| Rate for Payer: ASR ASR |
$904.30
|
| Rate for Payer: BCBS Trust/PPO |
$722.79
|
| Rate for Payer: BCN Commercial |
$722.79
|
| Rate for Payer: Cash Price |
$745.82
|
| Rate for Payer: Cofinity Commercial |
$876.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.82
|
| Rate for Payer: Healthscope Commercial |
$932.27
|
| Rate for Payer: Healthscope Whirlpool |
$904.30
|
| Rate for Payer: Mclaren Commercial |
$839.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$792.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.40
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
OP
|
$932.27
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$932.27 |
| Rate for Payer: Aetna Commercial |
$839.04
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$904.30
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$722.79
|
| Rate for Payer: BCN Commercial |
$722.79
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$745.82
|
| Rate for Payer: Cash Price |
$745.82
|
| Rate for Payer: Cofinity Commercial |
$876.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$932.27
|
| Rate for Payer: Healthscope Whirlpool |
$904.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$839.04
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$792.43
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.26
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$478.61
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.40
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
OP
|
$800.65
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$800.65 |
| Rate for Payer: Aetna Commercial |
$720.58
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$776.63
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$620.74
|
| Rate for Payer: BCN Commercial |
$620.74
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cofinity Commercial |
$752.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$800.65
|
| Rate for Payer: Healthscope Whirlpool |
$776.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$720.58
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.55
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.73
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$258.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.57
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
IP
|
$800.65
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$560.46 |
| Max. Negotiated Rate |
$800.65 |
| Rate for Payer: Aetna Commercial |
$720.58
|
| Rate for Payer: ASR ASR |
$776.63
|
| Rate for Payer: BCBS Trust/PPO |
$620.74
|
| Rate for Payer: BCN Commercial |
$620.74
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cofinity Commercial |
$752.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.52
|
| Rate for Payer: Healthscope Commercial |
$800.65
|
| Rate for Payer: Healthscope Whirlpool |
$776.63
|
| Rate for Payer: Mclaren Commercial |
$720.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.57
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
OP
|
$590.39
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$590.39 |
| Rate for Payer: Aetna Commercial |
$531.35
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$572.68
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$457.73
|
| Rate for Payer: BCCCP Commercial |
$105.89
|
| Rate for Payer: BCN Commercial |
$457.73
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$554.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$590.39
|
| Rate for Payer: Healthscope Whirlpool |
$572.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$531.35
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.25
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$419.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.54
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
IP
|
$590.39
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$413.27 |
| Max. Negotiated Rate |
$590.39 |
| Rate for Payer: Aetna Commercial |
$531.35
|
| Rate for Payer: ASR ASR |
$572.68
|
| Rate for Payer: BCBS Trust/PPO |
$457.73
|
| Rate for Payer: BCN Commercial |
$457.73
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$554.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.31
|
| Rate for Payer: Healthscope Commercial |
$590.39
|
| Rate for Payer: Healthscope Whirlpool |
$572.68
|
| Rate for Payer: Mclaren Commercial |
$531.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.54
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
IP
|
$551.42
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$385.99 |
| Max. Negotiated Rate |
$551.42 |
| Rate for Payer: Aetna Commercial |
$496.28
|
| Rate for Payer: ASR ASR |
$534.88
|
| Rate for Payer: BCBS Trust/PPO |
$427.52
|
| Rate for Payer: BCN Commercial |
$427.52
|
| Rate for Payer: Cash Price |
$441.14
|
| Rate for Payer: Cofinity Commercial |
$518.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.14
|
| Rate for Payer: Healthscope Commercial |
$551.42
|
| Rate for Payer: Healthscope Whirlpool |
$534.88
|
| Rate for Payer: Mclaren Commercial |
$496.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.25
|
|
