|
HC ALPHA FETOPROTEIN TUMOR MARKER
|
Facility
|
IP
|
$65.79
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.34 |
| Max. Negotiated Rate |
$65.79 |
| Rate for Payer: Aetna Commercial |
$59.21
|
| Rate for Payer: ASR ASR |
$63.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$54.03
|
| Rate for Payer: Cash Price |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.63
|
| Rate for Payer: Healthscope Commercial |
$63.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.79
|
| Rate for Payer: Mclaren Commercial |
$59.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.92
|
| Rate for Payer: Nomi Health Commercial |
$53.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.90
|
|
|
HC ALPHA-GLOBIN GENE ANALYSIS
|
Facility
|
IP
|
$430.04
|
|
|
Service Code
|
CPT 81269
|
| Hospital Charge Code |
31000088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$322.53 |
| Max. Negotiated Rate |
$430.04 |
| Rate for Payer: Aetna Commercial |
$387.04
|
| Rate for Payer: ASR ASR |
$417.14
|
| Rate for Payer: BCBS Trust/PPO |
$353.15
|
| Rate for Payer: BCN Commercial |
$353.15
|
| Rate for Payer: Cash Price |
$344.03
|
| Rate for Payer: Cofinity Commercial |
$404.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.03
|
| Rate for Payer: Healthscope Commercial |
$417.14
|
| Rate for Payer: Healthscope Whirlpool |
$430.04
|
| Rate for Payer: Mclaren Commercial |
$387.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.53
|
| Rate for Payer: Nomi Health Commercial |
$352.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.44
|
|
|
HC ALPHA-GLOBIN GENE ANALYSIS
|
Facility
|
OP
|
$430.04
|
|
|
Service Code
|
CPT 81269
|
| Hospital Charge Code |
31000088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$430.04 |
| Rate for Payer: Aetna Commercial |
$387.04
|
| Rate for Payer: Aetna Medicare |
$202.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$253.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$253.00
|
| Rate for Payer: ASR ASR |
$417.14
|
| Rate for Payer: BCBS Complete |
$111.16
|
| Rate for Payer: BCBS MAPPO |
$202.40
|
| Rate for Payer: BCBS Trust/PPO |
$354.57
|
| Rate for Payer: BCN Commercial |
$354.57
|
| Rate for Payer: BCN Medicare Advantage |
$202.40
|
| Rate for Payer: Cash Price |
$344.03
|
| Rate for Payer: Cash Price |
$344.03
|
| Rate for Payer: Cofinity Commercial |
$404.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.40
|
| Rate for Payer: Healthscope Commercial |
$417.14
|
| Rate for Payer: Healthscope Whirlpool |
$430.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$202.40
|
| Rate for Payer: Mclaren Commercial |
$387.04
|
| Rate for Payer: Mclaren Medicaid |
$202.40
|
| Rate for Payer: Mclaren Medicare |
$202.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.52
|
| Rate for Payer: Meridian Medicaid |
$111.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.53
|
| Rate for Payer: Nomi Health Commercial |
$352.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.53
|
| Rate for Payer: PACE Medicare |
$192.28
|
| Rate for Payer: PACE SWMI |
$202.40
|
| Rate for Payer: PHP Commercial |
$222.64
|
| Rate for Payer: PHP Medicaid |
$108.49
|
| Rate for Payer: PHP Medicare Advantage |
$202.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.00
|
| Rate for Payer: Priority Health Medicare |
$202.40
|
| Rate for Payer: Priority Health Narrow Network |
$193.60
|
| Rate for Payer: Railroad Medicare Medicare |
$202.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$202.40
|
| Rate for Payer: UHC Exchange |
$313.72
|
| Rate for Payer: UHC Medicaid |
$105.86
|
| Rate for Payer: UHCCP DNSP |
$202.40
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
| Rate for Payer: VA VA |
$202.40
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
OP
|
$90.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$147.39 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: ASR ASR |
$87.49
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$74.37
|
| Rate for Payer: BCN Commercial |
$74.37
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$84.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$87.49
|
| Rate for Payer: Healthscope Whirlpool |
$90.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.09
|
| Rate for Payer: Mclaren Commercial |
$81.18
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.67
|
| Rate for Payer: Nomi Health Commercial |
$73.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.65
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$104.60
|
| Rate for Payer: PHP Medicaid |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.37
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Narrow Network |
$77.90
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$147.39
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: VA VA |
$95.09
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
IP
|
$90.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$90.20 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: ASR ASR |
$87.49
|
| Rate for Payer: BCBS Trust/PPO |
$74.07
|
| Rate for Payer: BCN Commercial |
$74.07
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cofinity Commercial |
$84.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.16
|
| Rate for Payer: Healthscope Commercial |
$87.49
|
| Rate for Payer: Healthscope Whirlpool |
$90.20
|
| Rate for Payer: Mclaren Commercial |
$81.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.67
|
| Rate for Payer: Nomi Health Commercial |
$73.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.38
|
|
|
HC ALTERNARIA IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ALTERNARIA IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC ALUMINUM
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$51.57
|
| Rate for Payer: ASR ASR |
$55.58
|
| Rate for Payer: BCBS Trust/PPO |
$47.05
|
| Rate for Payer: BCN Commercial |
$47.05
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$55.58
|
| Rate for Payer: Healthscope Whirlpool |
$57.30
|
| Rate for Payer: Mclaren Commercial |
$51.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.42
|
|
|
HC ALUMINUM
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$51.57
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.85
|
| Rate for Payer: ASR ASR |
$55.58
|
| Rate for Payer: BCBS Complete |
$13.99
|
| Rate for Payer: BCBS MAPPO |
$25.48
|
| Rate for Payer: BCBS Trust/PPO |
$47.24
|
| Rate for Payer: BCN Commercial |
$47.24
|
| Rate for Payer: BCN Medicare Advantage |
$25.48
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.48
|
| Rate for Payer: Healthscope Commercial |
$55.58
|
| Rate for Payer: Healthscope Whirlpool |
$57.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.48
|
| Rate for Payer: Mclaren Commercial |
$51.57
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicare |
$25.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.75
|
| Rate for Payer: Meridian Medicaid |
$13.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PACE Medicare |
$24.21
|
| Rate for Payer: PACE SWMI |
$25.48
|
| Rate for Payer: PHP Commercial |
$28.03
|
| Rate for Payer: PHP Medicaid |
$13.66
|
| Rate for Payer: PHP Medicare Advantage |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.21
|
| Rate for Payer: Priority Health Medicare |
$25.48
|
| Rate for Payer: Priority Health Narrow Network |
$40.17
|
| Rate for Payer: Railroad Medicare Medicare |
$25.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.48
|
| Rate for Payer: UHC Exchange |
$39.49
|
| Rate for Payer: UHC Medicaid |
$13.33
|
| Rate for Payer: UHCCP DNSP |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$13.33
|
| Rate for Payer: VA VA |
$25.48
|
|
|
HC AMBIT PUMP
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.09 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Aetna Medicare |
$243.09
|
| Rate for Payer: ASR ASR |
$637.29
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS Trust/PPO |
$541.70
|
| Rate for Payer: BCN Commercial |
$541.70
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$617.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$637.29
|
| Rate for Payer: Healthscope Whirlpool |
$657.00
|
| Rate for Payer: Mclaren Commercial |
$591.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$538.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$575.66
|
| Rate for Payer: Priority Health Narrow Network |
$460.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.16
|
|
|
HC AMBIT PUMP
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.75 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: ASR ASR |
$637.29
|
| Rate for Payer: BCBS Trust/PPO |
$539.53
|
| Rate for Payer: BCN Commercial |
$539.53
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$617.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$637.29
|
| Rate for Payer: Healthscope Whirlpool |
$657.00
|
| Rate for Payer: Mclaren Commercial |
$591.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$538.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.16
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
IP
|
$80.02
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$80.02 |
| Rate for Payer: Aetna Commercial |
$72.02
|
| Rate for Payer: ASR ASR |
$77.62
|
| Rate for Payer: BCBS Trust/PPO |
$65.71
|
| Rate for Payer: BCN Commercial |
$65.71
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.02
|
| Rate for Payer: Mclaren Commercial |
$72.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Nomi Health Commercial |
$65.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.42
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
OP
|
$80.02
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$80.02 |
| Rate for Payer: Aetna Commercial |
$72.02
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: ASR ASR |
$77.62
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$65.98
|
| Rate for Payer: BCN Commercial |
$65.98
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$72.02
|
| Rate for Payer: Mclaren Medicaid |
$15.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Nomi Health Commercial |
$65.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Medicaid |
$8.08
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$70.11
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$56.09
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.08
|
| Rate for Payer: UHC Exchange |
$23.37
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHCCP DNSP |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
OP
|
$161.30
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$161.30 |
| Rate for Payer: Aetna Commercial |
$145.17
|
| Rate for Payer: Aetna Medicare |
$16.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: ASR ASR |
$156.46
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$132.99
|
| Rate for Payer: BCN Commercial |
$132.99
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$129.04
|
| Rate for Payer: Cash Price |
$129.04
|
| Rate for Payer: Cofinity Commercial |
$151.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$156.46
|
| Rate for Payer: Healthscope Whirlpool |
$161.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$145.17
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.10
|
| Rate for Payer: Nomi Health Commercial |
$132.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.97
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141.33
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$113.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
IP
|
$161.30
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.97 |
| Max. Negotiated Rate |
$161.30 |
| Rate for Payer: Aetna Commercial |
$145.17
|
| Rate for Payer: ASR ASR |
$156.46
|
| Rate for Payer: BCBS Trust/PPO |
$132.46
|
| Rate for Payer: BCN Commercial |
$132.46
|
| Rate for Payer: Cash Price |
$129.04
|
| Rate for Payer: Cofinity Commercial |
$151.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.04
|
| Rate for Payer: Healthscope Commercial |
$156.46
|
| Rate for Payer: Healthscope Whirlpool |
$161.30
|
| Rate for Payer: Mclaren Commercial |
$145.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.10
|
| Rate for Payer: Nomi Health Commercial |
$132.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.94
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
IP
|
$238.77
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$214.89
|
| Rate for Payer: ASR ASR |
$231.61
|
| Rate for Payer: BCBS Trust/PPO |
$196.08
|
| Rate for Payer: BCN Commercial |
$196.08
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$231.61
|
| Rate for Payer: Healthscope Whirlpool |
$238.77
|
| Rate for Payer: Mclaren Commercial |
$214.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Nomi Health Commercial |
$195.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.12
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
OP
|
$238.77
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$214.89
|
| Rate for Payer: Aetna Medicare |
$16.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: ASR ASR |
$231.61
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$196.87
|
| Rate for Payer: BCN Commercial |
$196.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$231.61
|
| Rate for Payer: Healthscope Whirlpool |
$238.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$214.89
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Nomi Health Commercial |
$195.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.21
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$167.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna Commercial |
$195.79
|
| Rate for Payer: Aetna Medicare |
$16.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: ASR ASR |
$211.02
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$179.37
|
| Rate for Payer: BCN Commercial |
$179.37
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$204.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$211.02
|
| Rate for Payer: Healthscope Whirlpool |
$217.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$195.79
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.62
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$152.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$163.16 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna Commercial |
$195.79
|
| Rate for Payer: ASR ASR |
$211.02
|
| Rate for Payer: BCBS Trust/PPO |
$178.65
|
| Rate for Payer: BCN Commercial |
$178.65
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$204.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$211.02
|
| Rate for Payer: Healthscope Whirlpool |
$217.55
|
| Rate for Payer: Mclaren Commercial |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.44
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$80.52
|
| Rate for Payer: ASR ASR |
$86.79
|
| Rate for Payer: BCBS Trust/PPO |
$73.47
|
| Rate for Payer: BCN Commercial |
$73.47
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$86.79
|
| Rate for Payer: Healthscope Whirlpool |
$89.47
|
| Rate for Payer: Mclaren Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.73
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$80.52
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: ASR ASR |
$86.79
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$73.77
|
| Rate for Payer: BCN Commercial |
$73.77
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$86.79
|
| Rate for Payer: Healthscope Whirlpool |
$89.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.45
|
| Rate for Payer: Mclaren Commercial |
$80.52
|
| Rate for Payer: Mclaren Medicaid |
$16.45
|
| Rate for Payer: Mclaren Medicare |
$16.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.10
|
| Rate for Payer: PACE Medicare |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$18.09
|
| Rate for Payer: PHP Medicaid |
$8.82
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.39
|
| Rate for Payer: Priority Health Medicare |
$16.45
|
| Rate for Payer: Priority Health Narrow Network |
$62.72
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.45
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicaid |
$8.60
|
| Rate for Payer: UHCCP DNSP |
$16.45
|
| Rate for Payer: UHCCP Medicaid |
$8.60
|
| Rate for Payer: VA VA |
$16.45
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
OP
|
$43.13
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$41.84
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$35.56
|
| Rate for Payer: BCN Commercial |
$35.56
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cofinity Commercial |
$40.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$41.84
|
| Rate for Payer: Healthscope Whirlpool |
$43.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$38.82
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.66
|
| Rate for Payer: Nomi Health Commercial |
$35.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.35
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.79
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$30.23
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: ASR ASR |
$41.84
|
| Rate for Payer: BCBS Trust/PPO |
$35.42
|
| Rate for Payer: BCN Commercial |
$35.42
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cofinity Commercial |
$40.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.50
|
| Rate for Payer: Healthscope Commercial |
$41.84
|
| Rate for Payer: Healthscope Whirlpool |
$43.13
|
| Rate for Payer: Mclaren Commercial |
$38.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.66
|
| Rate for Payer: Nomi Health Commercial |
$35.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.95
|
|
|
HC AMITRIPTYLINE
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: BCBS Complete |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$36.89
|
| Rate for Payer: BCN Commercial |
$36.89
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$43.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.74
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
HC AMITRIPTYLINE
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: BCBS Trust/PPO |
$36.74
|
| Rate for Payer: BCN Commercial |
$36.74
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$43.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.74
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
