|
HC AMMONIA LEVEL
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.83
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
|
|
HC AMMONIA LEVEL
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$42.00
|
| Rate for Payer: BCN Commercial |
$42.00
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$14.57
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicaid |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.15
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$106.52
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC AMNIOCENTESIS
|
Facility
|
OP
|
$832.87
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$832.87 |
| Rate for Payer: Aetna Commercial |
$749.58
|
| Rate for Payer: Aetna Medicare |
$303.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$807.88
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$686.70
|
| Rate for Payer: BCN Commercial |
$686.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cofinity Commercial |
$782.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$807.88
|
| Rate for Payer: Healthscope Whirlpool |
$832.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.63
|
| Rate for Payer: Mclaren Commercial |
$749.58
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$166.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.94
|
| Rate for Payer: Nomi Health Commercial |
$682.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.65
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$333.99
|
| Rate for Payer: PHP Medicaid |
$162.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$729.76
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Narrow Network |
$583.84
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$470.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP DNSP |
$303.63
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC AMNIOCENTESIS
|
Facility
|
IP
|
$832.87
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.65 |
| Max. Negotiated Rate |
$832.87 |
| Rate for Payer: Aetna Commercial |
$749.58
|
| Rate for Payer: ASR ASR |
$807.88
|
| Rate for Payer: BCBS Trust/PPO |
$683.95
|
| Rate for Payer: BCN Commercial |
$683.95
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cofinity Commercial |
$782.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.30
|
| Rate for Payer: Healthscope Commercial |
$807.88
|
| Rate for Payer: Healthscope Whirlpool |
$832.87
|
| Rate for Payer: Mclaren Commercial |
$749.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.94
|
| Rate for Payer: Nomi Health Commercial |
$682.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.93
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$446.38
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.79 |
| Max. Negotiated Rate |
$446.38 |
| Rate for Payer: Aetna Commercial |
$401.74
|
| Rate for Payer: ASR ASR |
$432.99
|
| Rate for Payer: BCBS Trust/PPO |
$366.57
|
| Rate for Payer: BCN Commercial |
$366.57
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Commercial |
$419.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$432.99
|
| Rate for Payer: Healthscope Whirlpool |
$446.38
|
| Rate for Payer: Mclaren Commercial |
$401.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Nomi Health Commercial |
$366.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.81
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$446.38
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.79 |
| Max. Negotiated Rate |
$1,422.50 |
| Rate for Payer: Aetna Commercial |
$401.74
|
| Rate for Payer: Aetna Medicare |
$917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,147.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,147.17
|
| Rate for Payer: ASR ASR |
$432.99
|
| Rate for Payer: BCBS Complete |
$504.02
|
| Rate for Payer: BCBS MAPPO |
$917.74
|
| Rate for Payer: BCBS Trust/PPO |
$368.04
|
| Rate for Payer: BCN Commercial |
$368.04
|
| Rate for Payer: BCN Medicare Advantage |
$917.74
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Commercial |
$419.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.74
|
| Rate for Payer: Healthscope Commercial |
$432.99
|
| Rate for Payer: Healthscope Whirlpool |
$446.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$917.74
|
| Rate for Payer: Mclaren Commercial |
$401.74
|
| Rate for Payer: Mclaren Medicaid |
$917.74
|
| Rate for Payer: Mclaren Medicare |
$917.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.63
|
| Rate for Payer: Meridian Medicaid |
$504.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,009.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Nomi Health Commercial |
$366.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PACE Medicare |
$871.85
|
| Rate for Payer: PACE SWMI |
$917.74
|
| Rate for Payer: PHP Commercial |
$1,009.51
|
| Rate for Payer: PHP Medicaid |
$491.91
|
| Rate for Payer: PHP Medicare Advantage |
$917.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$543.53
|
| Rate for Payer: Priority Health Medicare |
$917.74
|
| Rate for Payer: Priority Health Narrow Network |
$434.83
|
| Rate for Payer: Railroad Medicare Medicare |
$917.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$917.74
|
| Rate for Payer: UHC Exchange |
$1,422.50
|
| Rate for Payer: UHC Medicaid |
$479.98
|
| Rate for Payer: UHCCP DNSP |
$917.74
|
| Rate for Payer: UHCCP Medicaid |
$479.98
|
| Rate for Payer: VA VA |
$917.74
|
|
|
HC AMNIOINFUSION
|
Facility
|
IP
|
$586.12
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.59 |
| Max. Negotiated Rate |
$586.12 |
| Rate for Payer: Aetna Commercial |
$527.51
|
| Rate for Payer: ASR ASR |
$568.54
|
| Rate for Payer: BCBS Trust/PPO |
$481.32
|
| Rate for Payer: BCN Commercial |
$481.32
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cofinity Commercial |
$550.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.90
|
| Rate for Payer: Healthscope Commercial |
$568.54
|
| Rate for Payer: Healthscope Whirlpool |
$586.12
|
| Rate for Payer: Mclaren Commercial |
$527.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.20
|
| Rate for Payer: Nomi Health Commercial |
$480.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.79
|
|
|
HC AMNIOINFUSION
|
Facility
|
OP
|
$586.12
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$586.12 |
| Rate for Payer: Aetna Commercial |
$527.51
|
| Rate for Payer: Aetna Medicare |
$303.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$568.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$483.26
|
| Rate for Payer: BCN Commercial |
$483.26
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cofinity Commercial |
$550.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$568.54
|
| Rate for Payer: Healthscope Whirlpool |
$586.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.63
|
| Rate for Payer: Mclaren Commercial |
$527.51
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$166.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.20
|
| Rate for Payer: Nomi Health Commercial |
$480.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.59
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$333.99
|
| Rate for Payer: PHP Medicaid |
$162.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$513.56
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Narrow Network |
$410.87
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$470.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP DNSP |
$303.63
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC AMNIOTIC FLUID DELTA OD
|
Facility
|
IP
|
$71.89
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
30100095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$71.89 |
| Rate for Payer: Aetna Commercial |
$64.70
|
| Rate for Payer: ASR ASR |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$59.04
|
| Rate for Payer: BCN Commercial |
$59.04
|
| Rate for Payer: Cash Price |
$57.51
|
| Rate for Payer: Cofinity Commercial |
$67.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.51
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Whirlpool |
$71.89
|
| Rate for Payer: Mclaren Commercial |
$64.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.11
|
| Rate for Payer: Nomi Health Commercial |
$58.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.26
|
|
|
HC AMNIOTIC FLUID DELTA OD
|
Facility
|
OP
|
$71.89
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
30100095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$71.89 |
| Rate for Payer: Aetna Commercial |
$64.70
|
| Rate for Payer: Aetna Medicare |
$9.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: ASR ASR |
$69.73
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$59.27
|
| Rate for Payer: BCN Commercial |
$59.27
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$57.51
|
| Rate for Payer: Cash Price |
$57.51
|
| Rate for Payer: Cofinity Commercial |
$67.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Whirlpool |
$71.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.35
|
| Rate for Payer: Mclaren Commercial |
$64.70
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Mclaren Medicare |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.11
|
| Rate for Payer: Nomi Health Commercial |
$58.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.92
|
| Rate for Payer: PACE Medicare |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Medicaid |
$5.01
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.99
|
| Rate for Payer: Priority Health Medicare |
$9.35
|
| Rate for Payer: Priority Health Narrow Network |
$50.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.35
|
| Rate for Payer: UHC Exchange |
$14.49
|
| Rate for Payer: UHC Medicaid |
$4.89
|
| Rate for Payer: UHCCP DNSP |
$9.35
|
| Rate for Payer: UHCCP Medicaid |
$4.89
|
| Rate for Payer: VA VA |
$9.35
|
|
|
HC AMNISURE ROM
|
Facility
|
OP
|
$211.71
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$251.79 |
| Rate for Payer: Aetna Commercial |
$190.54
|
| Rate for Payer: Aetna Medicare |
$98.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.64
|
| Rate for Payer: ASR ASR |
$205.36
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS MAPPO |
$98.11
|
| Rate for Payer: BCBS Trust/PPO |
$174.55
|
| Rate for Payer: BCN Commercial |
$174.55
|
| Rate for Payer: BCN Medicare Advantage |
$98.11
|
| Rate for Payer: Cash Price |
$169.37
|
| Rate for Payer: Cash Price |
$169.37
|
| Rate for Payer: Cofinity Commercial |
$199.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.11
|
| Rate for Payer: Healthscope Commercial |
$205.36
|
| Rate for Payer: Healthscope Whirlpool |
$211.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$98.11
|
| Rate for Payer: Mclaren Commercial |
$190.54
|
| Rate for Payer: Mclaren Medicaid |
$98.11
|
| Rate for Payer: Mclaren Medicare |
$98.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.02
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$173.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.78
|
| Rate for Payer: PACE Medicare |
$93.20
|
| Rate for Payer: PACE SWMI |
$98.11
|
| Rate for Payer: PHP Commercial |
$107.92
|
| Rate for Payer: PHP Medicaid |
$52.59
|
| Rate for Payer: PHP Medicare Advantage |
$98.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.79
|
| Rate for Payer: Priority Health Medicare |
$98.11
|
| Rate for Payer: Priority Health Narrow Network |
$201.43
|
| Rate for Payer: Railroad Medicare Medicare |
$98.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$98.11
|
| Rate for Payer: UHC Exchange |
$152.07
|
| Rate for Payer: UHC Medicaid |
$51.31
|
| Rate for Payer: UHCCP DNSP |
$98.11
|
| Rate for Payer: UHCCP Medicaid |
$51.31
|
| Rate for Payer: VA VA |
$98.11
|
|
|
HC AMNISURE ROM
|
Facility
|
IP
|
$211.71
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.78 |
| Max. Negotiated Rate |
$211.71 |
| Rate for Payer: Aetna Commercial |
$190.54
|
| Rate for Payer: ASR ASR |
$205.36
|
| Rate for Payer: BCBS Trust/PPO |
$173.86
|
| Rate for Payer: BCN Commercial |
$173.86
|
| Rate for Payer: Cash Price |
$169.37
|
| Rate for Payer: Cofinity Commercial |
$199.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.37
|
| Rate for Payer: Healthscope Commercial |
$205.36
|
| Rate for Payer: Healthscope Whirlpool |
$211.71
|
| Rate for Payer: Mclaren Commercial |
$190.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$173.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.30
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| 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 |
$504.59
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$428.90
|
| Rate for Payer: BCN Commercial |
$428.90
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$504.59
|
| Rate for Payer: Healthscope Whirlpool |
$520.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| 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 |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| 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 |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
| 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 AMPA-R AB CBA, SERUM
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$390.15 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: BCBS Trust/PPO |
$427.19
|
| Rate for Payer: BCN Commercial |
$427.19
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$504.59
|
| Rate for Payer: Healthscope Whirlpool |
$520.20
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| 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 |
$116.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| 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 |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| 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 |
$213.06
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$170.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
| 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 AMPA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
OP
|
$4,957.82
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$5,053.36 |
| Rate for Payer: Aetna Commercial |
$4,462.04
|
| Rate for Payer: Aetna Medicare |
$3,260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: ASR ASR |
$4,809.09
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,087.72
|
| Rate for Payer: BCN Commercial |
$4,087.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$3,966.26
|
| Rate for Payer: Cash Price |
$3,966.26
|
| Rate for Payer: Cofinity Commercial |
$4,660.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,966.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$4,809.09
|
| Rate for Payer: Healthscope Whirlpool |
$4,957.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$4,462.04
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$1,790.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,214.15
|
| Rate for Payer: Nomi Health Commercial |
$4,065.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,718.36
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,586.25
|
| Rate for Payer: PHP Medicaid |
$1,747.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,100.24
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,480.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,362.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$5,053.36
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP DNSP |
$3,260.23
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
IP
|
$4,957.82
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,718.36 |
| Max. Negotiated Rate |
$4,957.82 |
| Rate for Payer: Aetna Commercial |
$4,462.04
|
| Rate for Payer: ASR ASR |
$4,809.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,071.36
|
| Rate for Payer: BCN Commercial |
$4,071.36
|
| Rate for Payer: Cash Price |
$3,966.26
|
| Rate for Payer: Cofinity Commercial |
$4,660.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,966.26
|
| Rate for Payer: Healthscope Commercial |
$4,809.09
|
| Rate for Payer: Healthscope Whirlpool |
$4,957.82
|
| Rate for Payer: Mclaren Commercial |
$4,462.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,214.15
|
| Rate for Payer: Nomi Health Commercial |
$4,065.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,718.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,362.88
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
IP
|
$4,751.30
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,563.47 |
| Max. Negotiated Rate |
$4,751.30 |
| Rate for Payer: Aetna Commercial |
$4,276.17
|
| Rate for Payer: ASR ASR |
$4,608.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,901.77
|
| Rate for Payer: BCN Commercial |
$3,901.77
|
| Rate for Payer: Cash Price |
$3,801.04
|
| Rate for Payer: Cofinity Commercial |
$4,466.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.04
|
| Rate for Payer: Healthscope Commercial |
$4,608.76
|
| Rate for Payer: Healthscope Whirlpool |
$4,751.30
|
| Rate for Payer: Mclaren Commercial |
$4,276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.61
|
| Rate for Payer: Nomi Health Commercial |
$3,896.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,563.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,181.14
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
OP
|
$4,751.30
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$5,053.36 |
| Rate for Payer: Aetna Commercial |
$4,276.17
|
| Rate for Payer: Aetna Medicare |
$3,260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: ASR ASR |
$4,608.76
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,917.45
|
| Rate for Payer: BCN Commercial |
$3,917.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$3,801.04
|
| Rate for Payer: Cash Price |
$3,801.04
|
| Rate for Payer: Cofinity Commercial |
$4,466.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$4,608.76
|
| Rate for Payer: Healthscope Whirlpool |
$4,751.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$4,276.17
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$1,790.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.61
|
| Rate for Payer: Nomi Health Commercial |
$3,896.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,563.47
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,586.25
|
| Rate for Payer: PHP Medicaid |
$1,747.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,861.74
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,289.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,181.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$5,053.36
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP DNSP |
$3,260.23
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: BCBS Complete |
$15.40
|
| Rate for Payer: BCBS Trust/PPO |
$31.74
|
| Rate for Payer: BCN Commercial |
$31.74
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$37.34
|
| Rate for Payer: Healthscope Whirlpool |
$38.49
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Narrow Network |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.87 |
| Max. Negotiated Rate |
$38.49 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: ASR ASR |
$37.34
|
| Rate for Payer: BCBS Trust/PPO |
$31.61
|
| Rate for Payer: BCN Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$36.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$37.34
|
| Rate for Payer: Healthscope Whirlpool |
$38.49
|
| Rate for Payer: Mclaren Commercial |
$34.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.87
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.48
|
| Rate for Payer: BCN Commercial |
$26.48
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
