|
HC FECAL FAT QUANTITATIVE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
30100200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$9.46
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$9.00
|
| Rate for Payer: Mclaren Medicare |
$16.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$9.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$25.20
|
| Rate for Payer: PACE Medicare |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.80
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health Narrow Network |
$13.44
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHCCP Medicaid |
$9.46
|
| Rate for Payer: VA VA |
$16.80
|
|
|
HC FECAL LEUKOCYTE ASSESSMENT
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health SBD |
$33.93
|
|
|
HC FECAL LEUKOCYTE ASSESSMENT
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$3.52
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
IP
|
$1,307.32
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$823.61 |
| Max. Negotiated Rate |
$1,176.59 |
| Rate for Payer: Aetna Commercial |
$1,111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.76
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cofinity Commercial |
$1,124.30
|
| Rate for Payer: Cofinity Commercial |
$915.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.86
|
| Rate for Payer: Healthscope Commercial |
$1,176.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.22
|
| Rate for Payer: PHP Commercial |
$1,111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.76
|
| Rate for Payer: Priority Health SBD |
$823.61
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
OP
|
$1,307.32
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Commercial |
$1,111.22
|
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$375.10
|
| Rate for Payer: BCN Commercial |
$375.10
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cofinity Commercial |
$1,124.30
|
| Rate for Payer: Cofinity Commercial |
$915.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$1,176.59
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.22
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,111.22
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Priority Health SBD |
$823.61
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,585.77
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$517.17
|
| Rate for Payer: VA VA |
$918.60
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$171.16 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$14.09
|
| Rate for Payer: BCN Commercial |
$14.09
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| Rate for Payer: Mclaren Medicare |
$15.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: Meridian Medicaid |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$23.88
|
| Rate for Payer: PACE Medicare |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.37
|
| Rate for Payer: Priority Health Medicare |
$15.92
|
| Rate for Payer: Priority Health Narrow Network |
$13.10
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC Core |
$171.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.92
|
| Rate for Payer: UHC Exchange |
$171.16
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UHCCP Medicaid |
$8.96
|
| Rate for Payer: VA VA |
$15.92
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$66.65 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Mclaren Medicare |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$13.14
|
| Rate for Payer: PACE Medicare |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health Narrow Network |
$3.50
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.26
|
| Rate for Payer: UHC Core |
$66.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$66.65
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHCCP Medicaid |
$2.47
|
| Rate for Payer: VA VA |
$4.38
|
|
|
HC FECAL PH
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health SBD |
$15.08
|
|
|
HC FECAL PH
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$1.92
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$5.37
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$2.86
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$2.02
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.87
|
| Rate for Payer: BCN Commercial |
$4.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$8.25
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.66
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health Narrow Network |
$4.53
|
| Rate for Payer: Priority Health SBD |
$32.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.50
|
| Rate for Payer: UHCCP Medicaid |
$3.10
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health SBD |
$32.33
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
OP
|
$75.33
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Aetna Commercial |
$64.03
|
| Rate for Payer: Aetna Medicare |
$20.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$64.78
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$67.80
|
| Rate for Payer: Mclaren Medicaid |
$10.56
|
| Rate for Payer: Mclaren Medicare |
$19.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: Meridian Medicaid |
$11.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.03
|
| Rate for Payer: Nomi Health Commercial |
$29.55
|
| Rate for Payer: PACE Medicare |
$18.72
|
| Rate for Payer: PACE SWMI |
$19.70
|
| Rate for Payer: PHP Commercial |
$64.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.70
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow Network |
$15.76
|
| Rate for Payer: Priority Health SBD |
$47.46
|
| Rate for Payer: Railroad Medicare Medicare |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.70
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: UHCCP Medicaid |
$11.09
|
| Rate for Payer: VA VA |
$19.70
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
IP
|
$75.33
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Aetna Commercial |
$64.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.96
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Cofinity Commercial |
$64.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Healthscope Commercial |
$67.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.03
|
| Rate for Payer: PHP Commercial |
$64.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.96
|
| Rate for Payer: Priority Health SBD |
$47.46
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.50
|
| Rate for Payer: BCN Commercial |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$10.49
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.92 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna Commercial |
$407.84
|
| Rate for Payer: Aetna Medicare |
$239.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.88
|
| Rate for Payer: BCBS Complete |
$191.92
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$335.87
|
| Rate for Payer: Cofinity Commercial |
$412.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$431.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: PHP Commercial |
$407.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health SBD |
$302.28
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$302.28 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna Commercial |
$407.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.88
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$335.87
|
| Rate for Payer: Cofinity Commercial |
$412.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$431.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: PHP Commercial |
$407.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health SBD |
$302.28
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$40.24
|
| Rate for Payer: BCN Commercial |
$40.24
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Priority Health SBD |
$224.60
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$263.81
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$48.57
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.60 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health SBD |
$224.60
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.60 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health SBD |
$224.60
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$50.92
|
| Rate for Payer: BCN Commercial |
$50.92
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Priority Health SBD |
$224.60
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$263.81
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$48.57
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna Medicare |
$101.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health SBD |
$127.88
|
| Rate for Payer: UHC Core |
$30.28
|
| Rate for Payer: UHC Exchange |
$30.28
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.88 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health SBD |
$127.88
|
|
