|
HC AMIKACIN LEVEL
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| 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 |
$76.10
|
| Rate for Payer: ASR Commercial |
$76.10
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$64.24
|
| Rate for Payer: BCN Commercial |
$60.82
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$78.45
|
| Rate for Payer: Healthscope Whirlpool |
$76.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$70.60
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| 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 |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| 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 |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.74
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$54.99
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$23.37
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP DNSP |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.60
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: ASR Commercial |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$63.93
|
| Rate for Payer: BCN Commercial |
$60.82
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$78.45
|
| Rate for Payer: Healthscope Whirlpool |
$76.10
|
| Rate for Payer: Mclaren Commercial |
$70.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
IP
|
$158.14
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.79 |
| Max. Negotiated Rate |
$158.14 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| Rate for Payer: ASR ASR |
$153.40
|
| Rate for Payer: ASR Commercial |
$153.40
|
| Rate for Payer: BCBS Trust/PPO |
$128.87
|
| Rate for Payer: BCN Commercial |
$122.61
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$148.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Healthscope Commercial |
$158.14
|
| Rate for Payer: Healthscope Whirlpool |
$153.40
|
| Rate for Payer: Mclaren Commercial |
$142.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: Nomi Health Commercial |
$129.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.16
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
OP
|
$158.14
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$158.14 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| 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 |
$153.40
|
| Rate for Payer: ASR Commercial |
$153.40
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$129.50
|
| Rate for Payer: BCN Commercial |
$122.61
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$148.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$158.14
|
| Rate for Payer: Healthscope Whirlpool |
$153.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$142.33
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| 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 |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: Nomi Health Commercial |
$129.67
|
| 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 |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.56
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$110.86
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
IP
|
$234.09
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: ASR ASR |
$227.07
|
| Rate for Payer: ASR Commercial |
$227.07
|
| Rate for Payer: BCBS Trust/PPO |
$190.76
|
| Rate for Payer: BCN Commercial |
$181.49
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$220.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Healthscope Whirlpool |
$227.07
|
| Rate for Payer: Mclaren Commercial |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.00
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
OP
|
$234.09
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| 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 |
$227.07
|
| Rate for Payer: ASR Commercial |
$227.07
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$191.70
|
| Rate for Payer: BCN Commercial |
$181.49
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$220.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Healthscope Whirlpool |
$227.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$210.68
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| 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 |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| 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 |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.11
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$164.10
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$213.28 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| 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 |
$206.88
|
| Rate for Payer: ASR Commercial |
$206.88
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$174.65
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$200.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Whirlpool |
$206.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$191.95
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| 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 |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| 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 |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.88
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$149.51
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$213.28 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: ASR ASR |
$206.88
|
| Rate for Payer: ASR Commercial |
$206.88
|
| Rate for Payer: BCBS Trust/PPO |
$173.80
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$200.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Whirlpool |
$206.88
|
| Rate for Payer: Mclaren Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.69
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| 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 |
$85.09
|
| Rate for Payer: ASR Commercial |
$85.09
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$71.83
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.45
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$8.82
|
| 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 |
$9.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: PACE Medicare |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$18.10
|
| Rate for Payer: PHP Medicaid |
$8.82
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$16.45
|
| Rate for Payer: Priority Health Narrow Network |
$61.49
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.45
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$16.45
|
| Rate for Payer: UHCCP DNSP |
$16.45
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: VA VA |
$16.45
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: ASR Commercial |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$71.48
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
OP
|
$39.85
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna Commercial |
$35.86
|
| 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 |
$38.65
|
| Rate for Payer: ASR Commercial |
$38.65
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$32.63
|
| Rate for Payer: BCN Commercial |
$30.90
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$37.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$35.86
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| 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 |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.87
|
| Rate for Payer: Nomi Health Commercial |
$32.68
|
| 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 |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.92
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$27.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
IP
|
$39.85
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna Commercial |
$35.86
|
| Rate for Payer: ASR ASR |
$38.65
|
| Rate for Payer: ASR Commercial |
$38.65
|
| Rate for Payer: BCBS Trust/PPO |
$32.47
|
| Rate for Payer: BCN Commercial |
$30.90
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$37.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$35.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.87
|
| Rate for Payer: Nomi Health Commercial |
$32.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.07
|
|
|
HC AMITRIPTYLINE
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: ASR Commercial |
$42.54
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$35.92
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.43
|
| Rate for Payer: Priority Health Narrow Network |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC AMITRIPTYLINE
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: ASR Commercial |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$35.74
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC AMMONIA LEVEL
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
|
|
HC AMMONIA LEVEL
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$120.77 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| 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 |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| 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 |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| 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 |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.77
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$96.62
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC AMNIOCENTESIS
|
Facility
|
IP
|
$816.54
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.75 |
| Max. Negotiated Rate |
$816.54 |
| Rate for Payer: Aetna Commercial |
$734.89
|
| Rate for Payer: ASR ASR |
$792.04
|
| Rate for Payer: ASR Commercial |
$792.04
|
| Rate for Payer: BCBS Trust/PPO |
$665.40
|
| Rate for Payer: BCN Commercial |
$633.06
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$767.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$792.04
|
| Rate for Payer: Mclaren Commercial |
$734.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.56
|
|
|
HC AMNIOCENTESIS
|
Facility
|
OP
|
$816.54
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$816.54 |
| Rate for Payer: Aetna Commercial |
$734.89
|
| Rate for Payer: Aetna Medicare |
$298.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: ASR ASR |
$792.04
|
| Rate for Payer: ASR Commercial |
$792.04
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$668.66
|
| Rate for Payer: BCN Commercial |
$633.06
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$767.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$792.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$298.04
|
| Rate for Payer: Mclaren Commercial |
$734.89
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: PHP Medicaid |
$159.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.45
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$572.39
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$461.96
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP DNSP |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: VA VA |
$298.04
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$1,322.35 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$853.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,066.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,066.41
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$480.14
|
| Rate for Payer: BCBS MAPPO |
$853.13
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: BCN Medicare Advantage |
$853.13
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.13
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$853.13
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$457.28
|
| Rate for Payer: Mclaren Medicare |
$853.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.79
|
| Rate for Payer: Meridian Medicaid |
$480.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$981.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Medicare |
$810.47
|
| Rate for Payer: PACE SWMI |
$853.13
|
| Rate for Payer: PHP Commercial |
$938.44
|
| Rate for Payer: PHP Medicaid |
$457.28
|
| Rate for Payer: PHP Medicare Advantage |
$853.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$493.00
|
| Rate for Payer: Priority Health Medicare |
$853.13
|
| Rate for Payer: Priority Health Narrow Network |
$394.40
|
| Rate for Payer: Railroad Medicare Medicare |
$853.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.13
|
| Rate for Payer: UHC Exchange |
$1,322.35
|
| Rate for Payer: UHC Medicare Advantage |
$853.13
|
| Rate for Payer: UHCCP DNSP |
$853.13
|
| Rate for Payer: UHCCP Medicaid |
$457.28
|
| Rate for Payer: VA VA |
$853.13
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Trust/PPO |
$356.62
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC AMNIOINFUSION
|
Facility
|
IP
|
$574.63
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$574.63 |
| Rate for Payer: Aetna Commercial |
$517.17
|
| Rate for Payer: ASR ASR |
$557.39
|
| Rate for Payer: ASR Commercial |
$557.39
|
| Rate for Payer: BCBS Trust/PPO |
$468.27
|
| Rate for Payer: BCN Commercial |
$445.51
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cofinity Commercial |
$540.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.70
|
| Rate for Payer: Healthscope Commercial |
$574.63
|
| Rate for Payer: Healthscope Whirlpool |
$557.39
|
| Rate for Payer: Mclaren Commercial |
$517.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Nomi Health Commercial |
$471.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$505.67
|
|
|
HC AMNIOINFUSION
|
Facility
|
OP
|
$574.63
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$574.63 |
| Rate for Payer: Aetna Commercial |
$517.17
|
| Rate for Payer: Aetna Medicare |
$298.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: ASR ASR |
$557.39
|
| Rate for Payer: ASR Commercial |
$557.39
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$470.56
|
| Rate for Payer: BCN Commercial |
$445.51
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cofinity Commercial |
$540.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$574.63
|
| Rate for Payer: Healthscope Whirlpool |
$557.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$298.04
|
| Rate for Payer: Mclaren Commercial |
$517.17
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Nomi Health Commercial |
$471.20
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: PHP Medicaid |
$159.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$503.49
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$402.82
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$505.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$461.96
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP DNSP |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: VA VA |
$298.04
|
|
|
HC AMNIOTIC FLUID DELTA OD
|
Facility
|
OP
|
$70.48
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
30100095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$70.48 |
| Rate for Payer: Aetna Commercial |
$63.43
|
| 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 |
$68.37
|
| Rate for Payer: ASR Commercial |
$68.37
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$57.72
|
| Rate for Payer: BCN Commercial |
$54.64
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$70.48
|
| Rate for Payer: Healthscope Whirlpool |
$68.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.35
|
| Rate for Payer: Mclaren Commercial |
$63.43
|
| Rate for Payer: Mclaren Medicaid |
$5.01
|
| 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 |
$5.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.91
|
| Rate for Payer: Nomi Health Commercial |
$57.79
|
| Rate for Payer: PACE Medicare |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Medicaid |
$5.01
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.75
|
| Rate for Payer: Priority Health Medicare |
$9.35
|
| Rate for Payer: Priority Health Narrow Network |
$49.41
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.35
|
| Rate for Payer: UHC Exchange |
$14.49
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: UHCCP DNSP |
$9.35
|
| Rate for Payer: UHCCP Medicaid |
$5.01
|
| Rate for Payer: VA VA |
$9.35
|
|
|
HC AMNIOTIC FLUID DELTA OD
|
Facility
|
IP
|
$70.48
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
30100095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$70.48 |
| Rate for Payer: Aetna Commercial |
$63.43
|
| Rate for Payer: ASR ASR |
$68.37
|
| Rate for Payer: ASR Commercial |
$68.37
|
| Rate for Payer: BCBS Trust/PPO |
$57.43
|
| Rate for Payer: BCN Commercial |
$54.64
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.38
|
| Rate for Payer: Healthscope Commercial |
$70.48
|
| Rate for Payer: Healthscope Whirlpool |
$68.37
|
| Rate for Payer: Mclaren Commercial |
$63.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.91
|
| Rate for Payer: Nomi Health Commercial |
$57.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.02
|
|
|
HC AMNISURE ROM
|
Facility
|
IP
|
$207.56
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.91 |
| Max. Negotiated Rate |
$207.56 |
| Rate for Payer: Aetna Commercial |
$186.80
|
| Rate for Payer: ASR ASR |
$201.33
|
| Rate for Payer: ASR Commercial |
$201.33
|
| Rate for Payer: BCBS Trust/PPO |
$169.14
|
| Rate for Payer: BCN Commercial |
$160.92
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cofinity Commercial |
$195.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.05
|
| Rate for Payer: Healthscope Commercial |
$207.56
|
| Rate for Payer: Healthscope Whirlpool |
$201.33
|
| Rate for Payer: Mclaren Commercial |
$186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.43
|
| Rate for Payer: Nomi Health Commercial |
$170.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.65
|
|
