|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna Commercial |
$69.89
|
| Rate for Payer: ASR ASR |
$75.32
|
| Rate for Payer: BCBS Trust/PPO |
$63.77
|
| Rate for Payer: BCN Commercial |
$63.77
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$72.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.12
|
| Rate for Payer: Healthscope Commercial |
$75.32
|
| Rate for Payer: Healthscope Whirlpool |
$77.65
|
| Rate for Payer: Mclaren Commercial |
$69.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.00
|
| Rate for Payer: Nomi Health Commercial |
$63.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.33
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna Commercial |
$69.89
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$75.32
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$64.02
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$72.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$75.32
|
| Rate for Payer: Healthscope Whirlpool |
$77.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$69.89
|
| Rate for Payer: Mclaren Medicaid |
$12.00
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.00
|
| Rate for Payer: Nomi Health Commercial |
$63.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.24
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC CA 125
|
Facility
|
OP
|
$148.88
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$133.99
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: ASR ASR |
$144.41
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$122.75
|
| Rate for Payer: BCN Commercial |
$122.75
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$144.41
|
| Rate for Payer: Healthscope Whirlpool |
$148.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$133.99
|
| Rate for Payer: Mclaren Medicaid |
$20.81
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Medicaid |
$11.15
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.81
|
| Rate for Payer: UHC Exchange |
$32.26
|
| Rate for Payer: UHC Medicaid |
$10.88
|
| Rate for Payer: UHCCP DNSP |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CA 125
|
Facility
|
IP
|
$148.88
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$133.99
|
| Rate for Payer: ASR ASR |
$144.41
|
| Rate for Payer: BCBS Trust/PPO |
$122.26
|
| Rate for Payer: BCN Commercial |
$122.26
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Healthscope Commercial |
$144.41
|
| Rate for Payer: Healthscope Whirlpool |
$148.88
|
| Rate for Payer: Mclaren Commercial |
$133.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.01
|
|
|
HC CADMIUM LEVEL
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$49.61 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Aetna Medicare |
$23.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.55
|
| Rate for Payer: ASR ASR |
$48.12
|
| Rate for Payer: BCBS Complete |
$12.98
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$40.90
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$46.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$48.12
|
| Rate for Payer: Healthscope Whirlpool |
$49.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.64
|
| Rate for Payer: Mclaren Commercial |
$44.65
|
| Rate for Payer: Mclaren Medicaid |
$23.64
|
| Rate for Payer: Mclaren Medicare |
$23.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.82
|
| Rate for Payer: Meridian Medicaid |
$12.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.17
|
| Rate for Payer: Nomi Health Commercial |
$40.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.21
|
| Rate for Payer: PACE Medicare |
$22.46
|
| Rate for Payer: PACE SWMI |
$23.64
|
| Rate for Payer: PHP Commercial |
$26.00
|
| Rate for Payer: PHP Medicaid |
$12.67
|
| Rate for Payer: PHP Medicare Advantage |
$23.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow Network |
$34.78
|
| Rate for Payer: Railroad Medicare Medicare |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.64
|
| Rate for Payer: UHC Exchange |
$36.64
|
| Rate for Payer: UHC Medicaid |
$12.36
|
| Rate for Payer: UHCCP DNSP |
$23.64
|
| Rate for Payer: UHCCP Medicaid |
$12.36
|
| Rate for Payer: VA VA |
$23.64
|
|
|
HC CADMIUM LEVEL
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$49.61 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: ASR ASR |
$48.12
|
| Rate for Payer: BCBS Trust/PPO |
$40.74
|
| Rate for Payer: BCN Commercial |
$40.74
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$46.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Healthscope Commercial |
$48.12
|
| Rate for Payer: Healthscope Whirlpool |
$49.61
|
| Rate for Payer: Mclaren Commercial |
$44.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.17
|
| Rate for Payer: Nomi Health Commercial |
$40.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.66
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
IP
|
$119.92
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.94 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna Commercial |
$107.93
|
| Rate for Payer: ASR ASR |
$116.32
|
| Rate for Payer: BCBS Trust/PPO |
$98.48
|
| Rate for Payer: BCN Commercial |
$98.48
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cofinity Commercial |
$112.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.94
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Healthscope Whirlpool |
$119.92
|
| Rate for Payer: Mclaren Commercial |
$107.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.93
|
| Rate for Payer: Nomi Health Commercial |
$98.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.53
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
OP
|
$119.92
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna Commercial |
$107.93
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$116.32
|
| Rate for Payer: BCBS Complete |
$21.18
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$98.87
|
| Rate for Payer: BCN Commercial |
$98.87
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cofinity Commercial |
$112.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Healthscope Whirlpool |
$119.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$107.93
|
| Rate for Payer: Mclaren Medicaid |
$38.57
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.93
|
| Rate for Payer: Nomi Health Commercial |
$98.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.94
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.34
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicaid |
$20.17
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$150.11 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.49
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Complete |
$14.71
|
| Rate for Payer: BCBS MAPPO |
$26.79
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: BCN Medicare Advantage |
$26.79
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.79
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.79
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$26.79
|
| Rate for Payer: Mclaren Medicare |
$26.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.13
|
| Rate for Payer: Meridian Medicaid |
$14.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$25.45
|
| Rate for Payer: PACE SWMI |
$26.79
|
| Rate for Payer: PHP Commercial |
$29.47
|
| Rate for Payer: PHP Medicaid |
$14.36
|
| Rate for Payer: PHP Medicare Advantage |
$26.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.11
|
| Rate for Payer: Priority Health Medicare |
$26.79
|
| Rate for Payer: Priority Health Narrow Network |
$120.09
|
| Rate for Payer: Railroad Medicare Medicare |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.79
|
| Rate for Payer: UHC Exchange |
$41.52
|
| Rate for Payer: UHC Medicaid |
$14.01
|
| Rate for Payer: UHCCP DNSP |
$26.79
|
| Rate for Payer: UHCCP Medicaid |
$14.01
|
| Rate for Payer: VA VA |
$26.79
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Trust/PPO |
$57.52
|
| Rate for Payer: BCN Commercial |
$57.52
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
IP
|
$27.42
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: ASR ASR |
$26.60
|
| Rate for Payer: BCBS Trust/PPO |
$22.52
|
| Rate for Payer: BCN Commercial |
$22.52
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$26.60
|
| Rate for Payer: Healthscope Whirlpool |
$27.42
|
| Rate for Payer: Mclaren Commercial |
$24.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.13
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
OP
|
$27.42
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: ASR ASR |
$26.60
|
| Rate for Payer: BCBS Complete |
$10.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.61
|
| Rate for Payer: BCN Commercial |
$22.61
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$26.60
|
| Rate for Payer: Healthscope Whirlpool |
$27.42
|
| Rate for Payer: Mclaren Commercial |
$24.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.03
|
| Rate for Payer: Priority Health Narrow Network |
$19.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.13
|
|
|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
OP
|
$19.26
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$19.26 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$7.13
|
| Rate for Payer: ASR ASR |
$18.68
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.41
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Whirlpool |
$19.26
|
| Rate for Payer: Mclaren Commercial |
$17.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.37
|
| Rate for Payer: Nomi Health Commercial |
$15.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.88
|
| Rate for Payer: Priority Health Narrow Network |
$13.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.95
|
|
|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
IP
|
$19.26
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$19.26 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: ASR ASR |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.41
|
| Rate for Payer: Healthscope Commercial |
$18.68
|
| Rate for Payer: Healthscope Whirlpool |
$19.26
|
| Rate for Payer: Mclaren Commercial |
$17.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.37
|
| Rate for Payer: Nomi Health Commercial |
$15.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.95
|
|
|
HC CALCIUM LEVEL, TOTAL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
30100129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$2.83
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.16
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$5.16
|
| Rate for Payer: Mclaren Medicare |
$5.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$2.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.90
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: PHP Medicaid |
$2.77
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.40
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health Narrow Network |
$17.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.16
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicaid |
$2.70
|
| Rate for Payer: UHCCP DNSP |
$5.16
|
| Rate for Payer: UHCCP Medicaid |
$2.70
|
| Rate for Payer: VA VA |
$5.16
|
|
|
HC CALCIUM LEVEL, TOTAL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
30100129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC CALCIUM URINE
|
Facility
|
IP
|
$54.94
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
30100131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$54.94 |
| Rate for Payer: Aetna Commercial |
$49.45
|
| Rate for Payer: ASR ASR |
$53.29
|
| Rate for Payer: BCBS Trust/PPO |
$45.12
|
| Rate for Payer: BCN Commercial |
$45.12
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$51.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Healthscope Commercial |
$53.29
|
| Rate for Payer: Healthscope Whirlpool |
$54.94
|
| Rate for Payer: Mclaren Commercial |
$49.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: Nomi Health Commercial |
$45.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.35
|
|
|
HC CALCIUM URINE
|
Facility
|
OP
|
$54.94
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
30100131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$54.94 |
| Rate for Payer: Aetna Commercial |
$49.45
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.54
|
| Rate for Payer: ASR ASR |
$53.29
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$6.03
|
| Rate for Payer: BCBS Trust/PPO |
$45.30
|
| Rate for Payer: BCN Commercial |
$45.30
|
| Rate for Payer: BCN Medicare Advantage |
$6.03
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$51.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$53.29
|
| Rate for Payer: Healthscope Whirlpool |
$54.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.03
|
| Rate for Payer: Mclaren Commercial |
$49.45
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$6.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.33
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: Nomi Health Commercial |
$45.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.20
|
| Rate for Payer: PACE Medicare |
$5.73
|
| Rate for Payer: PACE SWMI |
$6.03
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: PHP Medicaid |
$3.23
|
| Rate for Payer: PHP Medicare Advantage |
$6.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.68
|
| Rate for Payer: Priority Health Medicare |
$6.03
|
| Rate for Payer: Priority Health Narrow Network |
$26.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.03
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicaid |
$3.15
|
| Rate for Payer: UHCCP DNSP |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: VA VA |
$6.03
|
|
|
HC CALCULI
|
Facility
|
IP
|
$43.51
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
30100132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: Aetna Commercial |
$39.16
|
| Rate for Payer: ASR ASR |
$42.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.73
|
| Rate for Payer: BCN Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$40.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Healthscope Whirlpool |
$43.51
|
| Rate for Payer: Mclaren Commercial |
$39.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$35.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.29
|
|
|
HC CALCULI
|
Facility
|
OP
|
$43.51
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
30100132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$136.79 |
| Rate for Payer: Aetna Commercial |
$39.16
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: ASR ASR |
$42.20
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$35.87
|
| Rate for Payer: BCN Commercial |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$40.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Healthscope Whirlpool |
$43.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$39.16
|
| Rate for Payer: Mclaren Medicaid |
$12.90
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$35.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: PHP Medicaid |
$6.91
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.79
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$109.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.90
|
| Rate for Payer: UHC Exchange |
$20.00
|
| Rate for Payer: UHC Medicaid |
$6.75
|
| Rate for Payer: UHCCP DNSP |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC CALORIC VESTIBULAR BILATERAL MONOTHERMAL
|
Facility
|
OP
|
$472.72
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47100007
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$472.72 |
| Rate for Payer: Aetna Commercial |
$425.45
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$458.54
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$389.76
|
| Rate for Payer: BCN Commercial |
$389.76
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cofinity Commercial |
$444.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$458.54
|
| Rate for Payer: Healthscope Whirlpool |
$472.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$425.45
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.81
|
| Rate for Payer: Nomi Health Commercial |
$387.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.54
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$414.20
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$331.38
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC CALORIC VESTIBULAR BILATERAL MONOTHERMAL
|
Facility
|
IP
|
$472.72
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47100007
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$354.54 |
| Max. Negotiated Rate |
$472.72 |
| Rate for Payer: Aetna Commercial |
$425.45
|
| Rate for Payer: ASR ASR |
$458.54
|
| Rate for Payer: BCBS Trust/PPO |
$388.20
|
| Rate for Payer: BCN Commercial |
$388.20
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cofinity Commercial |
$444.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.18
|
| Rate for Payer: Healthscope Commercial |
$458.54
|
| Rate for Payer: Healthscope Whirlpool |
$472.72
|
| Rate for Payer: Mclaren Commercial |
$425.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.81
|
| Rate for Payer: Nomi Health Commercial |
$387.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.99
|
|
|
HC CALORIC VESTIBULAR TEST BILAT BITHERMAL
|
Facility
|
OP
|
$472.72
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47100006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$472.72 |
| Rate for Payer: Aetna Commercial |
$425.45
|
| 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 |
$458.54
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$389.76
|
| Rate for Payer: BCN Commercial |
$389.76
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cofinity Commercial |
$444.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$458.54
|
| Rate for Payer: Healthscope Whirlpool |
$472.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$425.45
|
| 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 |
$401.81
|
| Rate for Payer: Nomi Health Commercial |
$387.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.54
|
| 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 |
$414.20
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$331.38
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.99
|
| 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 CALORIC VESTIBULAR TEST BILAT BITHERMAL
|
Facility
|
IP
|
$472.72
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47100006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$354.54 |
| Max. Negotiated Rate |
$472.72 |
| Rate for Payer: Aetna Commercial |
$425.45
|
| Rate for Payer: ASR ASR |
$458.54
|
| Rate for Payer: BCBS Trust/PPO |
$388.20
|
| Rate for Payer: BCN Commercial |
$388.20
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cofinity Commercial |
$444.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.18
|
| Rate for Payer: Healthscope Commercial |
$458.54
|
| Rate for Payer: Healthscope Whirlpool |
$472.72
|
| Rate for Payer: Mclaren Commercial |
$425.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.81
|
| Rate for Payer: Nomi Health Commercial |
$387.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.99
|
|
|
HC CALPROTECTIN FECAL
|
Facility
|
IP
|
$241.37
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
30100638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.03 |
| Max. Negotiated Rate |
$241.37 |
| Rate for Payer: Aetna Commercial |
$217.23
|
| Rate for Payer: ASR ASR |
$234.13
|
| Rate for Payer: BCBS Trust/PPO |
$198.21
|
| Rate for Payer: BCN Commercial |
$198.21
|
| Rate for Payer: Cash Price |
$193.10
|
| Rate for Payer: Cofinity Commercial |
$226.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.10
|
| Rate for Payer: Healthscope Commercial |
$234.13
|
| Rate for Payer: Healthscope Whirlpool |
$241.37
|
| Rate for Payer: Mclaren Commercial |
$217.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.16
|
| Rate for Payer: Nomi Health Commercial |
$197.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.41
|
|
