|
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 |
$35.87
|
| 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 |
$35.87
|
| 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 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 |
$35.87
|
| 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 |
$35.87
|
| 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 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 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 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 |
$49.94 |
| 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 |
$43.76
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$35.01
|
| 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 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 AMNIOCENTESIS
|
Facility
|
OP
|
$816.54
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$816.54 |
| Rate for Payer: Aetna Commercial |
$734.89
|
| Rate for Payer: Aetna Medicare |
$296.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: ASR ASR |
$792.04
|
| Rate for Payer: ASR Commercial |
$792.04
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCBS Trust/PPO |
$668.66
|
| Rate for Payer: BCN Commercial |
$633.06
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| 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 |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$792.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$296.67
|
| Rate for Payer: Mclaren Commercial |
$734.89
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$326.34
|
| Rate for Payer: PHP Medicaid |
$159.02
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| 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 |
$296.67
|
| Rate for Payer: Priority Health Narrow Network |
$572.39
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Exchange |
$459.84
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP DNSP |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$159.02
|
| Rate for Payer: VA VA |
$296.67
|
|
|
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 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 |
$1,316.29 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$849.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,061.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,061.53
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$477.94
|
| Rate for Payer: BCBS MAPPO |
$849.22
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: BCN Medicare Advantage |
$849.22
|
| 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 |
$849.22
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$849.22
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$455.18
|
| Rate for Payer: Mclaren Medicare |
$849.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.68
|
| Rate for Payer: Meridian Medicaid |
$477.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$976.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Medicare |
$806.76
|
| Rate for Payer: PACE SWMI |
$849.22
|
| Rate for Payer: PHP Commercial |
$934.14
|
| Rate for Payer: PHP Medicaid |
$455.18
|
| Rate for Payer: PHP Medicare Advantage |
$849.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Medicare |
$849.22
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: Railroad Medicare Medicare |
$849.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.22
|
| Rate for Payer: UHC Exchange |
$1,316.29
|
| Rate for Payer: UHC Medicare Advantage |
$849.22
|
| Rate for Payer: UHCCP DNSP |
$849.22
|
| Rate for Payer: UHCCP Medicaid |
$455.18
|
| Rate for Payer: VA VA |
$849.22
|
|
|
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 |
$159.02 |
| Max. Negotiated Rate |
$574.63 |
| Rate for Payer: Aetna Commercial |
$517.17
|
| Rate for Payer: Aetna Medicare |
$296.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: ASR ASR |
$557.39
|
| Rate for Payer: ASR Commercial |
$557.39
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCBS Trust/PPO |
$470.56
|
| Rate for Payer: BCN Commercial |
$445.51
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| 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 |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$574.63
|
| Rate for Payer: Healthscope Whirlpool |
$557.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$296.67
|
| Rate for Payer: Mclaren Commercial |
$517.17
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Nomi Health Commercial |
$471.20
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$326.34
|
| Rate for Payer: PHP Medicaid |
$159.02
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| 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 |
$296.67
|
| Rate for Payer: Priority Health Narrow Network |
$402.82
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$505.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Exchange |
$459.84
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP DNSP |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$159.02
|
| Rate for Payer: VA VA |
$296.67
|
|
|
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 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 |
$10.29
|
| 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 AMNISURE ROM
|
Facility
|
OP
|
$207.56
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.59 |
| Max. Negotiated Rate |
$207.56 |
| Rate for Payer: Aetna Commercial |
$186.80
|
| 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 |
$201.33
|
| Rate for Payer: ASR Commercial |
$201.33
|
| Rate for Payer: BCBS Complete |
$55.22
|
| Rate for Payer: BCBS MAPPO |
$98.11
|
| Rate for Payer: BCBS Trust/PPO |
$169.97
|
| Rate for Payer: BCN Commercial |
$160.92
|
| Rate for Payer: BCN Medicare Advantage |
$98.11
|
| Rate for Payer: Cash Price |
$166.05
|
| 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: Health Alliance Plan Medicare Advantage |
$98.11
|
| Rate for Payer: Healthscope Commercial |
$207.56
|
| Rate for Payer: Healthscope Whirlpool |
$201.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$98.11
|
| Rate for Payer: Mclaren Commercial |
$186.80
|
| Rate for Payer: Mclaren Medicaid |
$52.59
|
| 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 |
$55.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.43
|
| Rate for Payer: Nomi Health Commercial |
$170.20
|
| 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 |
$52.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.86
|
| Rate for Payer: Priority Health Medicare |
$98.11
|
| Rate for Payer: Priority Health Narrow Network |
$145.50
|
| Rate for Payer: Railroad Medicare Medicare |
$98.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.11
|
| Rate for Payer: UHC Exchange |
$152.07
|
| Rate for Payer: UHC Medicare Advantage |
$98.11
|
| Rate for Payer: UHCCP DNSP |
$98.11
|
| Rate for Payer: UHCCP Medicaid |
$52.59
|
| Rate for Payer: VA VA |
$98.11
|
|
|
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
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$494.70
|
| Rate for Payer: ASR Commercial |
$494.70
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$417.64
|
| Rate for Payer: BCN Commercial |
$395.40
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$479.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$510.00
|
| Rate for Payer: Healthscope Whirlpool |
$494.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$418.20
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.86
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$357.51
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: ASR ASR |
$494.70
|
| Rate for Payer: ASR Commercial |
$494.70
|
| Rate for Payer: BCBS Trust/PPO |
$415.60
|
| Rate for Payer: BCN Commercial |
$395.40
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$479.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$510.00
|
| Rate for Payer: Healthscope Whirlpool |
$494.70
|
| Rate for Payer: Mclaren Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$418.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.80
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| 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 |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.78
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$82.23
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
OP
|
$4,860.61
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$4,374.55
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$4,714.79
|
| Rate for Payer: ASR Commercial |
$4,714.79
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,980.35
|
| Rate for Payer: BCN Commercial |
$3,768.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$3,888.49
|
| Rate for Payer: Cash Price |
$3,888.49
|
| Rate for Payer: Cofinity Commercial |
$4,568.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$4,860.61
|
| Rate for Payer: Healthscope Whirlpool |
$4,714.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$4,374.55
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.52
|
| Rate for Payer: Nomi Health Commercial |
$3,985.70
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,159.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,258.87
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,407.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,277.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
IP
|
$4,860.61
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,159.40 |
| Max. Negotiated Rate |
$4,860.61 |
| Rate for Payer: Aetna Commercial |
$4,374.55
|
| Rate for Payer: ASR ASR |
$4,714.79
|
| Rate for Payer: ASR Commercial |
$4,714.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,960.91
|
| Rate for Payer: BCN Commercial |
$3,768.43
|
| Rate for Payer: Cash Price |
$3,888.49
|
| Rate for Payer: Cofinity Commercial |
$4,568.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.49
|
| Rate for Payer: Healthscope Commercial |
$4,860.61
|
| Rate for Payer: Healthscope Whirlpool |
$4,714.79
|
| Rate for Payer: Mclaren Commercial |
$4,374.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.52
|
| Rate for Payer: Nomi Health Commercial |
$3,985.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,159.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,277.34
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
IP
|
$4,658.14
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,027.79 |
| Max. Negotiated Rate |
$4,658.14 |
| Rate for Payer: Aetna Commercial |
$4,192.33
|
| Rate for Payer: ASR ASR |
$4,518.40
|
| Rate for Payer: ASR Commercial |
$4,518.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,795.92
|
| Rate for Payer: BCN Commercial |
$3,611.46
|
| Rate for Payer: Cash Price |
$3,726.51
|
| Rate for Payer: Cofinity Commercial |
$4,378.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.51
|
| Rate for Payer: Healthscope Commercial |
$4,658.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,518.40
|
| Rate for Payer: Mclaren Commercial |
$4,192.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.42
|
| Rate for Payer: Nomi Health Commercial |
$3,819.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,027.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,099.16
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
OP
|
$4,658.14
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$4,192.33
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$4,518.40
|
| Rate for Payer: ASR Commercial |
$4,518.40
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,814.55
|
| Rate for Payer: BCN Commercial |
$3,611.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$3,726.51
|
| Rate for Payer: Cash Price |
$3,726.51
|
| Rate for Payer: Cofinity Commercial |
$4,378.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$4,658.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,518.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$4,192.33
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.42
|
| Rate for Payer: Nomi Health Commercial |
$3,819.67
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,027.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,081.46
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,265.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,099.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$37.74 |
| Rate for Payer: Aetna Commercial |
$33.97
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: ASR ASR |
$36.61
|
| Rate for Payer: ASR Commercial |
$36.61
|
| Rate for Payer: BCBS Complete |
$15.10
|
| Rate for Payer: BCBS Trust/PPO |
$30.91
|
| Rate for Payer: BCN Commercial |
$29.26
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$35.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$37.74
|
| Rate for Payer: Healthscope Whirlpool |
$36.61
|
| Rate for Payer: Mclaren Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.08
|
| Rate for Payer: Nomi Health Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.07
|
| Rate for Payer: Priority Health Narrow Network |
$26.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.21
|
|
