|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
IP
|
$78.53
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$78.53 |
| Rate for Payer: Aetna Commercial |
$70.68
|
| Rate for Payer: ASR ASR |
$76.17
|
| Rate for Payer: BCBS Trust/PPO |
$64.49
|
| Rate for Payer: BCN Commercial |
$64.49
|
| Rate for Payer: Cash Price |
$62.82
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.82
|
| Rate for Payer: Healthscope Commercial |
$76.17
|
| Rate for Payer: Healthscope Whirlpool |
$78.53
|
| Rate for Payer: Mclaren Commercial |
$70.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.75
|
| Rate for Payer: Nomi Health Commercial |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.11
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
OP
|
$78.53
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$78.53 |
| Rate for Payer: Aetna Commercial |
$70.68
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$76.17
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$64.75
|
| Rate for Payer: BCN Commercial |
$64.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$62.82
|
| Rate for Payer: Cash Price |
$62.82
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$76.17
|
| Rate for Payer: Healthscope Whirlpool |
$78.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$70.68
|
| Rate for Payer: Mclaren Medicaid |
$18.40
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.75
|
| Rate for Payer: Nomi Health Commercial |
$64.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.90
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.81
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$55.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
IP
|
$110.78
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$110.78 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: ASR ASR |
$107.46
|
| Rate for Payer: BCBS Trust/PPO |
$90.97
|
| Rate for Payer: BCN Commercial |
$90.97
|
| Rate for Payer: Cash Price |
$88.62
|
| Rate for Payer: Cofinity Commercial |
$104.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.62
|
| Rate for Payer: Healthscope Commercial |
$107.46
|
| Rate for Payer: Healthscope Whirlpool |
$110.78
|
| Rate for Payer: Mclaren Commercial |
$99.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.16
|
| Rate for Payer: Nomi Health Commercial |
$90.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.49
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
OP
|
$110.78
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$110.78 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.36
|
| Rate for Payer: ASR ASR |
$107.46
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: BCBS Trust/PPO |
$91.34
|
| Rate for Payer: BCN Commercial |
$91.34
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$88.62
|
| Rate for Payer: Cash Price |
$88.62
|
| Rate for Payer: Cofinity Commercial |
$104.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$107.46
|
| Rate for Payer: Healthscope Whirlpool |
$110.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.29
|
| Rate for Payer: Mclaren Commercial |
$99.70
|
| Rate for Payer: Mclaren Medicaid |
$12.29
|
| Rate for Payer: Mclaren Medicare |
$12.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: Meridian Medicaid |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.16
|
| Rate for Payer: Nomi Health Commercial |
$90.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.08
|
| Rate for Payer: PACE Medicare |
$11.68
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.07
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$77.66
|
| Rate for Payer: Railroad Medicare Medicare |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.29
|
| Rate for Payer: UHC Exchange |
$19.05
|
| Rate for Payer: UHC Medicaid |
$6.43
|
| Rate for Payer: UHCCP DNSP |
$12.29
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.29
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$83.13
|
| Rate for Payer: BCN Commercial |
$83.13
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Mclaren Medicaid |
$18.40
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$82.79
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
OP
|
$91.26
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$88.52
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$75.24
|
| Rate for Payer: BCN Commercial |
$75.24
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Commercial |
$85.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Healthscope Whirlpool |
$91.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$82.13
|
| Rate for Payer: Mclaren Medicaid |
$18.40
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$74.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.44 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: ASR ASR |
$88.52
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$74.94
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Commercial |
$85.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Healthscope Whirlpool |
$91.26
|
| Rate for Payer: Mclaren Commercial |
$82.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$74.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.31
|
|
|
HC ACHR MODULATING FLOW CYTOMETRY S
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
30200519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$77.60
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$65.96
|
| Rate for Payer: BCN Commercial |
$65.96
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$75.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$77.60
|
| Rate for Payer: Healthscope Whirlpool |
$80.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$72.00
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.00
|
| Rate for Payer: Nomi Health Commercial |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.00
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$70.10
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$56.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ACHR MODULATING FLOW CYTOMETRY S
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
30200519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: ASR ASR |
$77.60
|
| Rate for Payer: BCBS Trust/PPO |
$65.70
|
| Rate for Payer: BCN Commercial |
$65.70
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$75.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$77.60
|
| Rate for Payer: Healthscope Whirlpool |
$80.00
|
| Rate for Payer: Mclaren Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.00
|
| Rate for Payer: Nomi Health Commercial |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.40
|
|
|
HC ACOUSTIC IMMITANCE TESTING
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$198.73 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: Aetna Medicare |
$128.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: ASR ASR |
$147.34
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$125.24
|
| Rate for Payer: BCN Commercial |
$125.24
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$142.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$147.34
|
| Rate for Payer: Healthscope Whirlpool |
$151.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$136.71
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$70.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$141.03
|
| Rate for Payer: PHP Medicaid |
$68.72
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.09
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$106.48
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$198.73
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP DNSP |
$128.21
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC ACOUSTIC IMMITANCE TESTING
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: ASR ASR |
$147.34
|
| Rate for Payer: BCBS Trust/PPO |
$124.74
|
| Rate for Payer: BCN Commercial |
$124.74
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$142.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Healthscope Commercial |
$147.34
|
| Rate for Payer: Healthscope Whirlpool |
$151.90
|
| Rate for Payer: Mclaren Commercial |
$136.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.67
|
|
|
HC ACTIGRAPHY
|
Facility
|
OP
|
$281.07
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$281.07 |
| Rate for Payer: Aetna Commercial |
$252.96
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$272.64
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$231.74
|
| Rate for Payer: BCN Commercial |
$231.74
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$224.86
|
| Rate for Payer: Cash Price |
$224.86
|
| Rate for Payer: Cofinity Commercial |
$264.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$272.64
|
| Rate for Payer: Healthscope Whirlpool |
$281.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$252.96
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.91
|
| Rate for Payer: Nomi Health Commercial |
$230.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.80
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$246.27
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$197.03
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC ACTIGRAPHY
|
Facility
|
IP
|
$281.07
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$281.07 |
| Rate for Payer: Aetna Commercial |
$252.96
|
| Rate for Payer: ASR ASR |
$272.64
|
| Rate for Payer: BCBS Trust/PPO |
$230.81
|
| Rate for Payer: BCN Commercial |
$230.81
|
| Rate for Payer: Cash Price |
$224.86
|
| Rate for Payer: Cofinity Commercial |
$264.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.86
|
| Rate for Payer: Healthscope Commercial |
$272.64
|
| Rate for Payer: Healthscope Whirlpool |
$281.07
|
| Rate for Payer: Mclaren Commercial |
$252.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.91
|
| Rate for Payer: Nomi Health Commercial |
$230.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.34
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
IP
|
$94.45
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$94.45 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: ASR ASR |
$91.62
|
| Rate for Payer: BCBS Trust/PPO |
$77.56
|
| Rate for Payer: BCN Commercial |
$77.56
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Commercial |
$88.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Healthscope Commercial |
$91.62
|
| Rate for Payer: Healthscope Whirlpool |
$94.45
|
| Rate for Payer: Mclaren Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Nomi Health Commercial |
$77.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.12
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$94.45
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$94.45 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$91.62
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$77.87
|
| Rate for Payer: BCN Commercial |
$77.87
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Commercial |
$88.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$91.62
|
| Rate for Payer: Healthscope Whirlpool |
$94.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$85.00
|
| Rate for Payer: Mclaren Medicaid |
$15.32
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Nomi Health Commercial |
$77.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.76
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$66.21
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.32
|
| Rate for Payer: UHC Exchange |
$23.75
|
| Rate for Payer: UHC Medicaid |
$8.01
|
| Rate for Payer: UHCCP DNSP |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.01
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE.
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$56.00
|
| Rate for Payer: BCN Commercial |
$56.00
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$65.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Mclaren Medicaid |
$15.32
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.51
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$47.61
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.32
|
| Rate for Payer: UHC Exchange |
$23.75
|
| Rate for Payer: UHC Medicaid |
$8.01
|
| Rate for Payer: UHCCP DNSP |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.01
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE.
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Trust/PPO |
$55.78
|
| Rate for Payer: BCN Commercial |
$55.78
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$65.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.92
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
|
|
HC ACUNAV CATHETER
|
Facility
|
IP
|
$5,836.64
|
|
|
Service Code
|
HCPCS C1759
|
| Hospital Charge Code |
27200010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,377.48 |
| Max. Negotiated Rate |
$5,836.64 |
| Rate for Payer: Aetna Commercial |
$5,252.98
|
| Rate for Payer: ASR ASR |
$5,661.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,793.05
|
| Rate for Payer: BCN Commercial |
$4,793.05
|
| Rate for Payer: Cash Price |
$4,669.31
|
| Rate for Payer: Cofinity Commercial |
$5,486.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,669.31
|
| Rate for Payer: Healthscope Commercial |
$5,661.54
|
| Rate for Payer: Healthscope Whirlpool |
$5,836.64
|
| Rate for Payer: Mclaren Commercial |
$5,252.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,961.14
|
| Rate for Payer: Nomi Health Commercial |
$4,786.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,377.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,136.24
|
|
|
HC ACUNAV CATHETER
|
Facility
|
OP
|
$5,836.64
|
|
|
Service Code
|
HCPCS C1759
|
| Hospital Charge Code |
27200010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.56 |
| Max. Negotiated Rate |
$5,836.64 |
| Rate for Payer: Aetna Commercial |
$5,252.98
|
| Rate for Payer: Aetna Medicare |
$2,159.56
|
| Rate for Payer: ASR ASR |
$5,661.54
|
| Rate for Payer: BCBS Complete |
$2,334.66
|
| Rate for Payer: BCBS Trust/PPO |
$4,812.31
|
| Rate for Payer: BCN Commercial |
$4,812.31
|
| Rate for Payer: Cash Price |
$4,669.31
|
| Rate for Payer: Cofinity Commercial |
$5,486.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,669.31
|
| Rate for Payer: Healthscope Commercial |
$5,661.54
|
| Rate for Payer: Healthscope Whirlpool |
$5,836.64
|
| Rate for Payer: Mclaren Commercial |
$5,252.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,669.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,961.14
|
| Rate for Payer: Nomi Health Commercial |
$4,786.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,377.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,114.06
|
| Rate for Payer: Priority Health Narrow Network |
$4,091.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,136.24
|
|
|
HC ACU OBSERVATION PER HOUR
|
Facility
|
OP
|
$147.98
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$133.18
|
| Rate for Payer: Aetna Medicare |
$54.75
|
| Rate for Payer: ASR ASR |
$143.54
|
| Rate for Payer: BCBS Complete |
$59.19
|
| Rate for Payer: BCBS Trust/PPO |
$122.01
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: Cash Price |
$118.38
|
| Rate for Payer: Cash Price |
$118.38
|
| Rate for Payer: Cash Price |
$118.38
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.38
|
| Rate for Payer: Healthscope Commercial |
$143.54
|
| Rate for Payer: Healthscope Whirlpool |
$147.98
|
| Rate for Payer: Mclaren Commercial |
$133.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.78
|
| Rate for Payer: Nomi Health Commercial |
$121.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.22
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC ACU OBSERVATION PER HOUR
|
Facility
|
IP
|
$147.98
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$110.98 |
| Max. Negotiated Rate |
$147.98 |
| Rate for Payer: Aetna Commercial |
$133.18
|
| Rate for Payer: ASR ASR |
$143.54
|
| Rate for Payer: BCBS Trust/PPO |
$121.52
|
| Rate for Payer: BCN Commercial |
$121.52
|
| Rate for Payer: Cash Price |
$118.38
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.38
|
| Rate for Payer: Healthscope Commercial |
$143.54
|
| Rate for Payer: Healthscope Whirlpool |
$147.98
|
| Rate for Payer: Mclaren Commercial |
$133.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.78
|
| Rate for Payer: Nomi Health Commercial |
$121.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.22
|
|
|
HC ACU OBS OVERFLOW PER HOUR
|
Facility
|
OP
|
$139.76
|
|
| Hospital Charge Code |
76900001
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$139.76 |
| Rate for Payer: Aetna Commercial |
$125.78
|
| Rate for Payer: Aetna Medicare |
$51.71
|
| Rate for Payer: ASR ASR |
$135.57
|
| Rate for Payer: BCBS Complete |
$55.90
|
| Rate for Payer: BCBS Trust/PPO |
$115.23
|
| Rate for Payer: BCN Commercial |
$115.23
|
| Rate for Payer: Cash Price |
$111.81
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.81
|
| Rate for Payer: Healthscope Commercial |
$135.57
|
| Rate for Payer: Healthscope Whirlpool |
$139.76
|
| Rate for Payer: Mclaren Commercial |
$125.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.80
|
| Rate for Payer: Nomi Health Commercial |
$114.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$122.46
|
| Rate for Payer: Priority Health Narrow Network |
$97.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.99
|
|
|
HC ACU OBS OVERFLOW PER HOUR
|
Facility
|
IP
|
$139.76
|
|
| Hospital Charge Code |
76900001
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$104.82 |
| Max. Negotiated Rate |
$139.76 |
| Rate for Payer: Aetna Commercial |
$125.78
|
| Rate for Payer: ASR ASR |
$135.57
|
| Rate for Payer: BCBS Trust/PPO |
$114.77
|
| Rate for Payer: BCN Commercial |
$114.77
|
| Rate for Payer: Cash Price |
$111.81
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.81
|
| Rate for Payer: Healthscope Commercial |
$135.57
|
| Rate for Payer: Healthscope Whirlpool |
$139.76
|
| Rate for Payer: Mclaren Commercial |
$125.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.80
|
| Rate for Payer: Nomi Health Commercial |
$114.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.99
|
|
