|
HC AMPHETAMINE URN CMPT
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Complete |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$26.59
|
| Rate for Payer: BCN Commercial |
$26.59
|
| 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: MI Amish Medical Board Commercial |
$25.80
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.26
|
| Rate for Payer: Priority Health Narrow Network |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC AMPHIPHYSIN WESTERN BLOT
|
Facility
|
IP
|
$296.51
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$222.38 |
| Max. Negotiated Rate |
$296.51 |
| Rate for Payer: Aetna Commercial |
$266.86
|
| Rate for Payer: ASR ASR |
$287.61
|
| Rate for Payer: BCBS Trust/PPO |
$243.49
|
| Rate for Payer: BCN Commercial |
$243.49
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Commercial |
$278.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Healthscope Commercial |
$287.61
|
| Rate for Payer: Healthscope Whirlpool |
$296.51
|
| Rate for Payer: Mclaren Commercial |
$266.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.93
|
|
|
HC AMPHIPHYSIN WESTERN BLOT
|
Facility
|
OP
|
$296.51
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$296.51 |
| Rate for Payer: Aetna Commercial |
$266.86
|
| Rate for Payer: Aetna Medicare |
$29.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: ASR ASR |
$287.61
|
| Rate for Payer: BCBS Complete |
$16.04
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$244.47
|
| Rate for Payer: BCN Commercial |
$244.47
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Commercial |
$278.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$287.61
|
| Rate for Payer: Healthscope Whirlpool |
$296.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.21
|
| Rate for Payer: Mclaren Commercial |
$266.86
|
| Rate for Payer: Mclaren Medicaid |
$29.21
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Meridian Medicaid |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$32.13
|
| Rate for Payer: PHP Medicaid |
$15.66
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$259.80
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health Narrow Network |
$207.85
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.21
|
| Rate for Payer: UHC Exchange |
$45.28
|
| Rate for Payer: UHC Medicaid |
$15.28
|
| Rate for Payer: UHCCP DNSP |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$15.28
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC AMPUTATION TOE INTERPHALANGEAL JOINT
|
Facility
|
IP
|
$9,426.02
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
76100428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,069.52 |
| Max. Negotiated Rate |
$9,426.02 |
| Rate for Payer: Aetna Commercial |
$8,483.42
|
| Rate for Payer: ASR ASR |
$9,143.24
|
| Rate for Payer: BCBS Trust/PPO |
$7,740.65
|
| Rate for Payer: BCN Commercial |
$7,740.65
|
| Rate for Payer: Cash Price |
$7,540.82
|
| Rate for Payer: Cofinity Commercial |
$8,860.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,540.82
|
| Rate for Payer: Healthscope Commercial |
$9,143.24
|
| Rate for Payer: Healthscope Whirlpool |
$9,426.02
|
| Rate for Payer: Mclaren Commercial |
$8,483.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,012.12
|
| Rate for Payer: Nomi Health Commercial |
$7,729.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,069.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,294.90
|
|
|
HC AMPUTATION TOE INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$9,426.02
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
76100428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$9,426.02 |
| Rate for Payer: Aetna Commercial |
$8,483.42
|
| 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 |
$9,143.24
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,771.75
|
| Rate for Payer: BCN Commercial |
$7,771.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$7,540.82
|
| Rate for Payer: Cash Price |
$7,540.82
|
| Rate for Payer: Cofinity Commercial |
$8,860.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,540.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$9,143.24
|
| Rate for Payer: Healthscope Whirlpool |
$9,426.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$8,483.42
|
| 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 |
$8,012.12
|
| Rate for Payer: Nomi Health Commercial |
$7,729.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,069.52
|
| 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 |
$8,259.08
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$6,607.64
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,294.90
|
| 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 AMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC AMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| 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 |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC AMYLASE FLUID
|
Facility
|
OP
|
$62.84
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$60.95
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$51.81
|
| Rate for Payer: BCN Commercial |
$51.81
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$59.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$60.95
|
| Rate for Payer: Healthscope Whirlpool |
$62.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$56.56
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.41
|
| Rate for Payer: Nomi Health Commercial |
$51.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.13
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$122.25
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$97.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.48
|
| Rate for Payer: UHC Exchange |
$10.04
|
| Rate for Payer: UHC Medicaid |
$3.39
|
| Rate for Payer: UHCCP DNSP |
$6.48
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC AMYLASE FLUID
|
Facility
|
IP
|
$62.84
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$62.84 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: ASR ASR |
$60.95
|
| Rate for Payer: BCBS Trust/PPO |
$51.60
|
| Rate for Payer: BCN Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$59.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$60.95
|
| Rate for Payer: Healthscope Whirlpool |
$62.84
|
| Rate for Payer: Mclaren Commercial |
$56.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.41
|
| Rate for Payer: Nomi Health Commercial |
$51.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.30
|
|
|
HC AMYLASE PANCREATIC CYST FLUID
|
Facility
|
OP
|
$217.76
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$217.76 |
| Rate for Payer: Aetna Commercial |
$195.98
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$211.23
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$179.54
|
| Rate for Payer: BCN Commercial |
$179.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$174.21
|
| Rate for Payer: Cash Price |
$174.21
|
| Rate for Payer: Cofinity Commercial |
$204.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$211.23
|
| Rate for Payer: Healthscope Whirlpool |
$217.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$195.98
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.10
|
| Rate for Payer: Nomi Health Commercial |
$178.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.32
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$122.25
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$97.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.48
|
| Rate for Payer: UHC Exchange |
$10.04
|
| Rate for Payer: UHC Medicaid |
$3.39
|
| Rate for Payer: UHCCP DNSP |
$6.48
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC AMYLASE PANCREATIC CYST FLUID
|
Facility
|
IP
|
$217.76
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$217.76 |
| Rate for Payer: Aetna Commercial |
$195.98
|
| Rate for Payer: ASR ASR |
$211.23
|
| Rate for Payer: BCBS Trust/PPO |
$178.82
|
| Rate for Payer: BCN Commercial |
$178.82
|
| Rate for Payer: Cash Price |
$174.21
|
| Rate for Payer: Cofinity Commercial |
$204.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.21
|
| Rate for Payer: Healthscope Commercial |
$211.23
|
| Rate for Payer: Healthscope Whirlpool |
$217.76
|
| Rate for Payer: Mclaren Commercial |
$195.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.10
|
| Rate for Payer: Nomi Health Commercial |
$178.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.63
|
|
|
HC AMYLASE SERUM
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC AMYLASE SERUM
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$122.25
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$97.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.48
|
| Rate for Payer: UHC Exchange |
$10.04
|
| Rate for Payer: UHC Medicaid |
$3.39
|
| Rate for Payer: UHCCP DNSP |
$6.48
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC ANAEROBIC CULTURE
|
Facility
|
IP
|
$127.03
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
30600077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.27 |
| Max. Negotiated Rate |
$127.03 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: ASR ASR |
$123.22
|
| Rate for Payer: BCBS Trust/PPO |
$104.32
|
| Rate for Payer: BCN Commercial |
$104.32
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cofinity Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.62
|
| Rate for Payer: Healthscope Commercial |
$123.22
|
| Rate for Payer: Healthscope Whirlpool |
$127.03
|
| Rate for Payer: Mclaren Commercial |
$114.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$104.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.79
|
|
|
HC ANAEROBIC CULTURE
|
Facility
|
OP
|
$127.03
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
30600077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$179.77 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.84
|
| Rate for Payer: ASR ASR |
$123.22
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS MAPPO |
$9.47
|
| Rate for Payer: BCBS Trust/PPO |
$104.74
|
| Rate for Payer: BCN Commercial |
$104.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.47
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cofinity Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$123.22
|
| Rate for Payer: Healthscope Whirlpool |
$127.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.47
|
| Rate for Payer: Mclaren Commercial |
$114.33
|
| Rate for Payer: Mclaren Medicaid |
$9.47
|
| Rate for Payer: Mclaren Medicare |
$9.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.94
|
| Rate for Payer: Meridian Medicaid |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$104.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.27
|
| Rate for Payer: PACE Medicare |
$9.00
|
| Rate for Payer: PACE SWMI |
$9.47
|
| Rate for Payer: PHP Commercial |
$10.42
|
| Rate for Payer: PHP Medicaid |
$5.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.77
|
| Rate for Payer: Priority Health Medicare |
$9.47
|
| Rate for Payer: Priority Health Narrow Network |
$143.82
|
| Rate for Payer: Railroad Medicare Medicare |
$9.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.47
|
| Rate for Payer: UHC Exchange |
$14.68
|
| Rate for Payer: UHC Medicaid |
$4.95
|
| Rate for Payer: UHCCP DNSP |
$9.47
|
| Rate for Payer: UHCCP Medicaid |
$4.95
|
| Rate for Payer: VA VA |
$9.47
|
|
|
HC ANAEROBIC ID
|
Facility
|
IP
|
$53.39
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
30600286
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Aetna Commercial |
$48.05
|
| Rate for Payer: ASR ASR |
$51.79
|
| Rate for Payer: BCBS Trust/PPO |
$43.84
|
| Rate for Payer: BCN Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$42.71
|
| Rate for Payer: Cofinity Commercial |
$50.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.71
|
| Rate for Payer: Healthscope Commercial |
$51.79
|
| Rate for Payer: Healthscope Whirlpool |
$53.39
|
| Rate for Payer: Mclaren Commercial |
$48.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.38
|
| Rate for Payer: Nomi Health Commercial |
$43.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.98
|
|
|
HC ANAEROBIC ID
|
Facility
|
OP
|
$53.39
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
30600286
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$93.83 |
| Rate for Payer: Aetna Commercial |
$48.05
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.10
|
| Rate for Payer: ASR ASR |
$51.79
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$8.08
|
| Rate for Payer: BCBS Trust/PPO |
$44.02
|
| Rate for Payer: BCN Commercial |
$44.02
|
| Rate for Payer: BCN Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$42.71
|
| Rate for Payer: Cash Price |
$42.71
|
| Rate for Payer: Cofinity Commercial |
$50.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.08
|
| Rate for Payer: Healthscope Commercial |
$51.79
|
| Rate for Payer: Healthscope Whirlpool |
$53.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.08
|
| Rate for Payer: Mclaren Commercial |
$48.05
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$8.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.48
|
| Rate for Payer: Meridian Medicaid |
$4.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.38
|
| Rate for Payer: Nomi Health Commercial |
$43.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.04
|
| Rate for Payer: PACE Medicare |
$7.68
|
| Rate for Payer: PACE SWMI |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Medicaid |
$4.33
|
| Rate for Payer: PHP Medicare Advantage |
$8.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$93.83
|
| Rate for Payer: Priority Health Medicare |
$8.08
|
| Rate for Payer: Priority Health Narrow Network |
$75.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.08
|
| Rate for Payer: UHC Exchange |
$12.52
|
| Rate for Payer: UHC Medicaid |
$4.23
|
| Rate for Payer: UHCCP DNSP |
$8.08
|
| Rate for Payer: UHCCP Medicaid |
$4.23
|
| Rate for Payer: VA VA |
$8.08
|
|
|
HC ANALYSIS BRAIN NPGT PRGRMG 15 MIN
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$256.31
|
| Rate for Payer: BCN Commercial |
$256.31
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC ANALYSIS BRAIN NPGT PRGRMG 15 MIN
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$94.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$257.34
|
| Rate for Payer: BCN Commercial |
$257.34
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$94.73
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$94.73
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$52.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$104.20
|
| Rate for Payer: PHP Medicaid |
$50.78
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.90
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health Narrow Network |
$37.52
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$146.83
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP DNSP |
$94.73
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Facility
|
OP
|
$446.76
|
|
|
Service Code
|
CPT 92603
|
| Hospital Charge Code |
47100019
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$446.76 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| 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 |
$433.36
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$368.35
|
| Rate for Payer: BCN Commercial |
$368.35
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cofinity Commercial |
$419.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$433.36
|
| Rate for Payer: Healthscope Whirlpool |
$446.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$402.08
|
| 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 |
$379.75
|
| Rate for Payer: Nomi Health Commercial |
$366.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.07
|
| 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 |
$391.45
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$313.18
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.15
|
| 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 ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Facility
|
IP
|
$446.76
|
|
|
Service Code
|
CPT 92603
|
| Hospital Charge Code |
47100019
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$335.07 |
| Max. Negotiated Rate |
$446.76 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| Rate for Payer: ASR ASR |
$433.36
|
| Rate for Payer: BCBS Trust/PPO |
$366.88
|
| Rate for Payer: BCN Commercial |
$366.88
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cofinity Commercial |
$419.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.41
|
| Rate for Payer: Healthscope Commercial |
$433.36
|
| Rate for Payer: Healthscope Whirlpool |
$446.76
|
| Rate for Payer: Mclaren Commercial |
$402.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.75
|
| Rate for Payer: Nomi Health Commercial |
$366.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.15
|
|
|
HC ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Facility
|
IP
|
$446.76
|
|
|
Service Code
|
CPT 92604
|
| Hospital Charge Code |
47100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.07 |
| Max. Negotiated Rate |
$446.76 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| Rate for Payer: ASR ASR |
$433.36
|
| Rate for Payer: BCBS Trust/PPO |
$366.88
|
| Rate for Payer: BCN Commercial |
$366.88
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cofinity Commercial |
$419.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.41
|
| Rate for Payer: Healthscope Commercial |
$433.36
|
| Rate for Payer: Healthscope Whirlpool |
$446.76
|
| Rate for Payer: Mclaren Commercial |
$402.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.75
|
| Rate for Payer: Nomi Health Commercial |
$366.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.15
|
|
|
HC ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Facility
|
OP
|
$446.76
|
|
|
Service Code
|
CPT 92604
|
| Hospital Charge Code |
47100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$446.76 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| 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 |
$433.36
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$368.35
|
| Rate for Payer: BCN Commercial |
$368.35
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cofinity Commercial |
$419.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$433.36
|
| Rate for Payer: Healthscope Whirlpool |
$446.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$402.08
|
| 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 |
$379.75
|
| Rate for Payer: Nomi Health Commercial |
$366.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.07
|
| 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 |
$391.45
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$313.18
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.15
|
| 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 ANALYSIS SMPL OR COMPLEX CN NPGT PRGRMG
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$94.36
|
| Rate for Payer: BCN Commercial |
$94.36
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$111.01
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.19
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Mclaren Medicaid |
$37.19
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$40.91
|
| Rate for Payer: PHP Medicaid |
$19.93
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.90
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$37.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$57.64
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP DNSP |
$37.19
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: VA VA |
$37.19
|
|
|
HC ANALYSIS SMPL OR COMPLEX CN NPGT PRGRMG
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: BCBS Trust/PPO |
$93.98
|
| Rate for Payer: BCN Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$111.01
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
