|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$11,625.42
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$10,510.77 |
| Max. Negotiated Rate |
$11,625.42 |
| Rate for Payer: BCBS Complete |
$11,625.42
|
| Rate for Payer: Mclaren Medicaid |
$11,071.83
|
| Rate for Payer: Meridian Medicaid |
$11,625.42
|
| Rate for Payer: PHP Medicaid |
$10,510.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,071.83
|
| Rate for Payer: UHC Medicaid |
$11,071.83
|
| Rate for Payer: UHCCP Medicaid |
$11,071.83
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$9,621.64
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$8,699.11 |
| Max. Negotiated Rate |
$9,621.64 |
| Rate for Payer: BCBS Complete |
$9,621.64
|
| Rate for Payer: Mclaren Medicaid |
$9,163.46
|
| Rate for Payer: Meridian Medicaid |
$9,621.64
|
| Rate for Payer: PHP Medicaid |
$8,699.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,163.46
|
| Rate for Payer: UHC Medicaid |
$9,163.46
|
| Rate for Payer: UHCCP Medicaid |
$9,163.46
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$7,453.28
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$6,738.66 |
| Max. Negotiated Rate |
$7,453.28 |
| Rate for Payer: BCBS Complete |
$7,453.28
|
| Rate for Payer: Mclaren Medicaid |
$7,098.36
|
| Rate for Payer: Meridian Medicaid |
$7,453.28
|
| Rate for Payer: PHP Medicaid |
$6,738.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,098.36
|
| Rate for Payer: UHC Medicaid |
$7,098.36
|
| Rate for Payer: UHCCP Medicaid |
$7,098.36
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,830.36
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$30,830.36 |
| Rate for Payer: Aetna Commercial |
$27,747.32
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: ASR ASR |
$29,905.45
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$25,419.63
|
| Rate for Payer: BCN Commercial |
$25,419.63
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$24,664.29
|
| Rate for Payer: Cash Price |
$24,664.29
|
| Rate for Payer: Cofinity Commercial |
$28,980.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$29,905.45
|
| Rate for Payer: Healthscope Whirlpool |
$30,830.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.44
|
| Rate for Payer: Mclaren Commercial |
$27,747.32
|
| Rate for Payer: Mclaren Medicaid |
$197.44
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$108.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.77
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Commercial |
$217.18
|
| Rate for Payer: PHP Medicaid |
$105.83
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.03
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health Narrow Network |
$155.22
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,130.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Exchange |
$306.03
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHCCP DNSP |
$197.44
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: VA VA |
$197.44
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,830.36
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23,122.77 |
| Max. Negotiated Rate |
$30,830.36 |
| Rate for Payer: Aetna Commercial |
$27,747.32
|
| Rate for Payer: ASR ASR |
$29,905.45
|
| Rate for Payer: BCBS Trust/PPO |
$25,317.89
|
| Rate for Payer: BCN Commercial |
$25,317.89
|
| Rate for Payer: Cash Price |
$24,664.29
|
| Rate for Payer: Cofinity Commercial |
$28,980.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.29
|
| Rate for Payer: Healthscope Commercial |
$29,905.45
|
| Rate for Payer: Healthscope Whirlpool |
$30,830.36
|
| Rate for Payer: Mclaren Commercial |
$27,747.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,130.72
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,932.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$29,932.37 |
| Rate for Payer: Aetna Commercial |
$26,939.13
|
| Rate for Payer: Aetna Commercial |
$27,747.32
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: ASR ASR |
$29,034.40
|
| Rate for Payer: ASR ASR |
$29,905.45
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$25,419.63
|
| Rate for Payer: BCBS Trust/PPO |
$24,679.24
|
| Rate for Payer: BCN Commercial |
$25,419.63
|
| Rate for Payer: BCN Commercial |
$24,679.24
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$24,664.29
|
| Rate for Payer: Cash Price |
$24,664.29
|
| Rate for Payer: Cofinity Commercial |
$28,136.43
|
| Rate for Payer: Cofinity Commercial |
$28,980.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$29,034.40
|
| Rate for Payer: Healthscope Commercial |
$29,905.45
|
| Rate for Payer: Healthscope Whirlpool |
$29,932.37
|
| Rate for Payer: Healthscope Whirlpool |
$30,830.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.44
|
| Rate for Payer: Mclaren Commercial |
$27,747.32
|
| Rate for Payer: Mclaren Commercial |
$26,939.13
|
| Rate for Payer: Mclaren Medicaid |
$197.44
|
| Rate for Payer: Mclaren Medicaid |
$197.44
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$108.43
|
| Rate for Payer: Meridian Medicaid |
$108.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Nomi Health Commercial |
$24,544.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.77
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Commercial |
$217.18
|
| Rate for Payer: PHP Commercial |
$217.18
|
| Rate for Payer: PHP Medicaid |
$105.83
|
| Rate for Payer: PHP Medicaid |
$105.83
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.03
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health Narrow Network |
$155.22
|
| Rate for Payer: Priority Health Narrow Network |
$155.22
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,130.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,340.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Exchange |
$306.03
|
| Rate for Payer: UHC Exchange |
$306.03
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHCCP DNSP |
$197.44
|
| Rate for Payer: UHCCP DNSP |
$197.44
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: VA VA |
$197.44
|
| Rate for Payer: VA VA |
$197.44
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,932.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,449.28 |
| Max. Negotiated Rate |
$29,932.37 |
| Rate for Payer: Aetna Commercial |
$26,939.13
|
| Rate for Payer: Aetna Commercial |
$27,747.32
|
| Rate for Payer: ASR ASR |
$29,034.40
|
| Rate for Payer: ASR ASR |
$29,905.45
|
| Rate for Payer: BCBS Trust/PPO |
$24,580.46
|
| Rate for Payer: BCBS Trust/PPO |
$25,317.89
|
| Rate for Payer: BCN Commercial |
$24,580.46
|
| Rate for Payer: BCN Commercial |
$25,317.89
|
| Rate for Payer: Cash Price |
$24,664.29
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$28,980.54
|
| Rate for Payer: Cofinity Commercial |
$28,136.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.29
|
| Rate for Payer: Healthscope Commercial |
$29,034.40
|
| Rate for Payer: Healthscope Commercial |
$29,905.45
|
| Rate for Payer: Healthscope Whirlpool |
$30,830.36
|
| Rate for Payer: Healthscope Whirlpool |
$29,932.37
|
| Rate for Payer: Mclaren Commercial |
$27,747.32
|
| Rate for Payer: Mclaren Commercial |
$26,939.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Nomi Health Commercial |
$24,544.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,130.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,340.49
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$17.26
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: ASR ASR |
$23.32
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: ASR ASR |
$20.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.74
|
| Rate for Payer: BCBS Trust/PPO |
$14.17
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Commercial |
$14.17
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$20.04
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.05
|
| Rate for Payer: Healthscope Commercial |
$20.68
|
| Rate for Payer: Healthscope Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Healthscope Whirlpool |
$21.32
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$17.25
|
| Rate for Payer: Mclaren Commercial |
$19.18
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$17.48
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.18
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$17.26
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$7.89
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: ASR ASR |
$23.32
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: ASR ASR |
$20.68
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCBS Trust/PPO |
$17.57
|
| Rate for Payer: BCBS Trust/PPO |
$19.82
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Commercial |
$17.57
|
| Rate for Payer: BCN Commercial |
$19.82
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$20.04
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.05
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$20.68
|
| Rate for Payer: Healthscope Whirlpool |
$21.32
|
| Rate for Payer: Healthscope Whirlpool |
$17.25
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.18
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Nomi Health Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$17.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: Priority Health Narrow Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.18
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$28,628.91
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$15,922.40 |
| Max. Negotiated Rate |
$28,628.91 |
| Rate for Payer: Aetna Medicare |
$16,760.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,950.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,950.53
|
| Rate for Payer: BCBS MAPPO |
$16,760.42
|
| Rate for Payer: BCN Medicare Advantage |
$16,760.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,760.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,760.42
|
| Rate for Payer: Mclaren Medicare |
$16,760.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,598.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,274.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,436.46
|
| Rate for Payer: PACE Medicare |
$15,922.40
|
| Rate for Payer: PACE SWMI |
$16,760.42
|
| Rate for Payer: PHP Commercial |
$18,436.46
|
| Rate for Payer: PHP Medicare Advantage |
$16,760.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,628.91
|
| Rate for Payer: Priority Health Medicare |
$16,760.42
|
| Rate for Payer: Priority Health Narrow Network |
$22,903.13
|
| Rate for Payer: Railroad Medicare Medicare |
$16,760.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,760.42
|
| Rate for Payer: UHC Exchange |
$25,978.65
|
| Rate for Payer: UHCCP DNSP |
$16,760.42
|
| Rate for Payer: VA VA |
$16,760.42
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,108.56
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$9,189.98 |
| Max. Negotiated Rate |
$15,108.56 |
| Rate for Payer: Aetna Medicare |
$9,673.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,092.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,092.08
|
| Rate for Payer: BCBS MAPPO |
$9,673.66
|
| Rate for Payer: BCN Medicare Advantage |
$9,673.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,673.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,673.66
|
| Rate for Payer: Mclaren Medicare |
$9,673.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,157.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,124.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,641.03
|
| Rate for Payer: PACE Medicare |
$9,189.98
|
| Rate for Payer: PACE SWMI |
$9,673.66
|
| Rate for Payer: PHP Commercial |
$10,641.03
|
| Rate for Payer: PHP Medicare Advantage |
$9,673.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,108.56
|
| Rate for Payer: Priority Health Medicare |
$9,673.66
|
| Rate for Payer: Priority Health Narrow Network |
$12,086.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9,673.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,673.66
|
| Rate for Payer: UHC Exchange |
$14,994.17
|
| Rate for Payer: UHCCP DNSP |
$9,673.66
|
| Rate for Payer: VA VA |
$9,673.66
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Commercial |
$578.25
|
| Rate for Payer: Aetna Commercial |
$99.54
|
| Rate for Payer: Aetna Commercial |
$91.75
|
| Rate for Payer: ASR ASR |
$35.55
|
| Rate for Payer: ASR ASR |
$98.89
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: ASR ASR |
$107.28
|
| Rate for Payer: ASR ASR |
$623.23
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCBS Trust/PPO |
$90.82
|
| Rate for Payer: BCBS Trust/PPO |
$83.72
|
| Rate for Payer: BCBS Trust/PPO |
$527.62
|
| Rate for Payer: BCBS Trust/PPO |
$30.10
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: BCN Commercial |
$527.62
|
| Rate for Payer: BCN Commercial |
$53.46
|
| Rate for Payer: BCN Commercial |
$83.72
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$103.96
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Cofinity Commercial |
$95.83
|
| Rate for Payer: Cofinity Commercial |
$34.45
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$107.28
|
| Rate for Payer: Healthscope Commercial |
$623.23
|
| Rate for Payer: Healthscope Commercial |
$98.89
|
| Rate for Payer: Healthscope Commercial |
$63.15
|
| Rate for Payer: Healthscope Whirlpool |
$642.50
|
| Rate for Payer: Healthscope Whirlpool |
$65.10
|
| Rate for Payer: Healthscope Whirlpool |
$101.95
|
| Rate for Payer: Healthscope Whirlpool |
$110.60
|
| Rate for Payer: Healthscope Whirlpool |
$36.65
|
| Rate for Payer: Mclaren Commercial |
$99.54
|
| Rate for Payer: Mclaren Commercial |
$578.25
|
| Rate for Payer: Mclaren Commercial |
$91.75
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Mclaren Commercial |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Nomi Health Commercial |
$526.85
|
| Rate for Payer: Nomi Health Commercial |
$30.05
|
| Rate for Payer: Nomi Health Commercial |
$90.69
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: Nomi Health Commercial |
$53.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$36.65
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: Aetna Commercial |
$99.54
|
| Rate for Payer: Aetna Commercial |
$91.75
|
| Rate for Payer: Aetna Commercial |
$578.25
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna Medicare |
$40.92
|
| Rate for Payer: ASR ASR |
$35.55
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: ASR ASR |
$623.23
|
| Rate for Payer: ASR ASR |
$107.28
|
| Rate for Payer: ASR ASR |
$98.89
|
| Rate for Payer: BCBS Complete |
$257.00
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: BCBS Complete |
$26.04
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$44.24
|
| Rate for Payer: BCBS Trust/PPO |
$84.06
|
| Rate for Payer: BCBS Trust/PPO |
$91.19
|
| Rate for Payer: BCBS Trust/PPO |
$529.74
|
| Rate for Payer: BCBS Trust/PPO |
$53.67
|
| Rate for Payer: BCBS Trust/PPO |
$30.22
|
| Rate for Payer: BCN Commercial |
$529.74
|
| Rate for Payer: BCN Commercial |
$91.19
|
| Rate for Payer: BCN Commercial |
$84.06
|
| Rate for Payer: BCN Commercial |
$53.67
|
| Rate for Payer: BCN Commercial |
$30.22
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$95.83
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Cofinity Commercial |
$103.96
|
| Rate for Payer: Cofinity Commercial |
$34.45
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$98.89
|
| Rate for Payer: Healthscope Commercial |
$107.28
|
| Rate for Payer: Healthscope Commercial |
$63.15
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$623.23
|
| Rate for Payer: Healthscope Whirlpool |
$36.65
|
| Rate for Payer: Healthscope Whirlpool |
$101.95
|
| Rate for Payer: Healthscope Whirlpool |
$110.60
|
| Rate for Payer: Healthscope Whirlpool |
$65.10
|
| Rate for Payer: Healthscope Whirlpool |
$642.50
|
| Rate for Payer: Mclaren Commercial |
$99.54
|
| Rate for Payer: Mclaren Commercial |
$91.75
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Mclaren Commercial |
$578.25
|
| Rate for Payer: Mclaren Commercial |
$32.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Nomi Health Commercial |
$90.69
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: Nomi Health Commercial |
$53.38
|
| Rate for Payer: Nomi Health Commercial |
$526.85
|
| Rate for Payer: Nomi Health Commercial |
$30.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.25
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,694.94
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,271.21 |
| Max. Negotiated Rate |
$1,694.94 |
| Rate for Payer: Aetna Commercial |
$1,525.45
|
| Rate for Payer: ASR ASR |
$1,644.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,391.89
|
| Rate for Payer: BCN Commercial |
$1,391.89
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Commercial |
$1,593.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Healthscope Commercial |
$1,644.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,694.94
|
| Rate for Payer: Mclaren Commercial |
$1,525.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.70
|
| Rate for Payer: Nomi Health Commercial |
$1,389.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,491.55
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,694.94
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$1,694.94 |
| Rate for Payer: Aetna Commercial |
$1,525.45
|
| Rate for Payer: Aetna Medicare |
$558.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.65
|
| Rate for Payer: ASR ASR |
$1,644.10
|
| Rate for Payer: BCBS Complete |
$306.52
|
| Rate for Payer: BCBS MAPPO |
$558.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,397.48
|
| Rate for Payer: BCN Commercial |
$1,397.48
|
| Rate for Payer: BCN Medicare Advantage |
$558.12
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Commercial |
$1,593.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.12
|
| Rate for Payer: Healthscope Commercial |
$1,644.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,694.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.12
|
| Rate for Payer: Mclaren Commercial |
$1,525.45
|
| Rate for Payer: Mclaren Medicaid |
$558.12
|
| Rate for Payer: Mclaren Medicare |
$558.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.03
|
| Rate for Payer: Meridian Medicaid |
$306.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$613.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.70
|
| Rate for Payer: Nomi Health Commercial |
$1,389.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PACE Medicare |
$530.21
|
| Rate for Payer: PACE SWMI |
$558.12
|
| Rate for Payer: PHP Commercial |
$613.93
|
| Rate for Payer: PHP Medicaid |
$299.15
|
| Rate for Payer: PHP Medicare Advantage |
$558.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$610.75
|
| Rate for Payer: Priority Health Medicare |
$558.12
|
| Rate for Payer: Priority Health Narrow Network |
$488.60
|
| Rate for Payer: Railroad Medicare Medicare |
$558.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,491.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$558.12
|
| Rate for Payer: UHC Exchange |
$865.09
|
| Rate for Payer: UHC Medicaid |
$291.90
|
| Rate for Payer: UHCCP DNSP |
$558.12
|
| Rate for Payer: UHCCP Medicaid |
$291.90
|
| Rate for Payer: VA VA |
$558.12
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
IP
|
$43.06
|
|
|
Service Code
|
NDC 65074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$38.76
|
| Rate for Payer: ASR ASR |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$35.36
|
| Rate for Payer: BCN Commercial |
$35.36
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cofinity Commercial |
$40.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.45
|
| Rate for Payer: Healthscope Commercial |
$41.77
|
| Rate for Payer: Healthscope Whirlpool |
$43.06
|
| Rate for Payer: Mclaren Commercial |
$38.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.60
|
| Rate for Payer: Nomi Health Commercial |
$35.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.90
|
|
|
TETRACAINE HCL (PF) 0.5 % EYE DROPS
|
Facility
|
OP
|
$43.06
|
|
|
Service Code
|
NDC 65074114
|
| Hospital Charge Code |
151946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$38.76
|
| Rate for Payer: Aetna Medicare |
$15.93
|
| Rate for Payer: ASR ASR |
$41.77
|
| Rate for Payer: BCBS Complete |
$17.23
|
| Rate for Payer: BCBS Trust/PPO |
$35.51
|
| Rate for Payer: BCN Commercial |
$35.51
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cofinity Commercial |
$40.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.45
|
| Rate for Payer: Healthscope Commercial |
$41.77
|
| Rate for Payer: Healthscope Whirlpool |
$43.06
|
| Rate for Payer: Mclaren Commercial |
$38.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.60
|
| Rate for Payer: Nomi Health Commercial |
$35.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$30.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.90
|
|
|
THERMAGE
|
Professional
|
Both
|
$1,051.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
|
|
THERMAGE ABDOMEN - ENTIRE
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
|
|
THERMAGE ABDOMEN - LOWER
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
|
|
THERMAGE ARMS - 1 ARM
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE ARMS - BILATERAL
|
Professional
|
Both
|
$2,206.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,654.50 |
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,654.50
|
|
|
THERMAGE EYES
|
Professional
|
Both
|
$998.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$748.50 |
| Rate for Payer: BCBS Complete |
$399.20
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$748.50
|
|
|
THERMAGE FACE
|
Professional
|
Both
|
$2,101.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
|
|
THERMAGE FACE & EYES
|
Professional
|
Both
|
$2,837.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,134.80 |
| Max. Negotiated Rate |
$2,127.75 |
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.75
|
|
