|
HC COCAINE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC COCCIDIOIDES TOTAL AB BY CF&ID
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200244
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC COCCIDIOIDES TOTAL AB BY CF&ID
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200244
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.47
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$11.47
|
| Rate for Payer: Mclaren Medicare |
$11.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.04
|
| Rate for Payer: Meridian Medicaid |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: PHP Medicaid |
$6.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.89
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health Narrow Network |
$22.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.47
|
| Rate for Payer: UHC Exchange |
$17.78
|
| Rate for Payer: UHC Medicaid |
$6.00
|
| Rate for Payer: UHCCP DNSP |
$11.47
|
| Rate for Payer: UHCCP Medicaid |
$6.00
|
| Rate for Payer: VA VA |
$11.47
|
|
|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.47
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$11.47
|
| Rate for Payer: Mclaren Medicare |
$11.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.04
|
| Rate for Payer: Meridian Medicaid |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: PHP Medicaid |
$6.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.25
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health Narrow Network |
$18.60
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.47
|
| Rate for Payer: UHC Exchange |
$17.78
|
| Rate for Payer: UHC Medicaid |
$6.00
|
| Rate for Payer: UHCCP DNSP |
$11.47
|
| Rate for Payer: UHCCP Medicaid |
$6.00
|
| Rate for Payer: VA VA |
$11.47
|
|
|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC COCKROACH IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC COCKROACH IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC COCONUT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC COCONUT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CODFISH IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC CODFISH IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC COGNITIVE EXAM
|
Facility
|
OP
|
$306.92
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$306.92 |
| Rate for Payer: Aetna Commercial |
$276.23
|
| Rate for Payer: Aetna Medicare |
$113.56
|
| Rate for Payer: ASR ASR |
$297.71
|
| Rate for Payer: BCBS Complete |
$122.77
|
| Rate for Payer: BCBS Trust/PPO |
$253.06
|
| Rate for Payer: BCN Commercial |
$253.06
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cofinity Commercial |
$288.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.54
|
| Rate for Payer: Healthscope Commercial |
$297.71
|
| Rate for Payer: Healthscope Whirlpool |
$306.92
|
| Rate for Payer: Mclaren Commercial |
$276.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.88
|
| Rate for Payer: Nomi Health Commercial |
$251.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$223.95
|
| Rate for Payer: Priority Health Narrow Network |
$179.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.09
|
|
|
HC COGNITIVE EXAM
|
Facility
|
IP
|
$306.92
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$306.92 |
| Rate for Payer: Aetna Commercial |
$276.23
|
| Rate for Payer: ASR ASR |
$297.71
|
| Rate for Payer: BCBS Trust/PPO |
$252.04
|
| Rate for Payer: BCN Commercial |
$252.04
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cofinity Commercial |
$288.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.54
|
| Rate for Payer: Healthscope Commercial |
$297.71
|
| Rate for Payer: Healthscope Whirlpool |
$306.92
|
| Rate for Payer: Mclaren Commercial |
$276.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.88
|
| Rate for Payer: Nomi Health Commercial |
$251.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.09
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
IP
|
$115.76
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$115.76 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: ASR ASR |
$112.29
|
| Rate for Payer: BCBS Trust/PPO |
$95.06
|
| Rate for Payer: BCN Commercial |
$95.06
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cofinity Commercial |
$108.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$112.29
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Mclaren Commercial |
$104.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.40
|
| Rate for Payer: Nomi Health Commercial |
$94.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.87
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
OP
|
$115.76
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$115.76 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: Aetna Medicare |
$42.83
|
| Rate for Payer: ASR ASR |
$112.29
|
| Rate for Payer: BCBS Complete |
$46.30
|
| Rate for Payer: BCBS Trust/PPO |
$95.44
|
| Rate for Payer: BCN Commercial |
$95.44
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cofinity Commercial |
$108.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$112.29
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Mclaren Commercial |
$104.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.40
|
| Rate for Payer: Nomi Health Commercial |
$94.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.61
|
| Rate for Payer: Priority Health Narrow Network |
$23.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.87
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
IP
|
$118.08
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$106.27
|
| Rate for Payer: ASR ASR |
$114.54
|
| Rate for Payer: BCBS Trust/PPO |
$96.97
|
| Rate for Payer: BCN Commercial |
$96.97
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cofinity Commercial |
$111.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.46
|
| Rate for Payer: Healthscope Commercial |
$114.54
|
| Rate for Payer: Healthscope Whirlpool |
$118.08
|
| Rate for Payer: Mclaren Commercial |
$106.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.37
|
| Rate for Payer: Nomi Health Commercial |
$96.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.91
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
OP
|
$118.08
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$106.27
|
| Rate for Payer: Aetna Medicare |
$43.69
|
| Rate for Payer: ASR ASR |
$114.54
|
| Rate for Payer: BCBS Complete |
$47.23
|
| Rate for Payer: BCBS Trust/PPO |
$97.36
|
| Rate for Payer: BCN Commercial |
$97.36
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cofinity Commercial |
$111.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.46
|
| Rate for Payer: Healthscope Commercial |
$114.54
|
| Rate for Payer: Healthscope Whirlpool |
$118.08
|
| Rate for Payer: Mclaren Commercial |
$106.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.37
|
| Rate for Payer: Nomi Health Commercial |
$96.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.51
|
| Rate for Payer: Priority Health Narrow Network |
$24.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.91
|
|
|
HC COLD AGGLUTININS
|
Facility
|
OP
|
$62.74
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.09
|
| Rate for Payer: ASR ASR |
$60.86
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$51.73
|
| Rate for Payer: BCN Commercial |
$51.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cofinity Commercial |
$58.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$60.86
|
| Rate for Payer: Healthscope Whirlpool |
$62.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.07
|
| Rate for Payer: Mclaren Commercial |
$56.47
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$8.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.33
|
| Rate for Payer: Nomi Health Commercial |
$51.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.05
|
| Rate for Payer: PACE Medicare |
$7.67
|
| Rate for Payer: PACE SWMI |
$8.07
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Medicaid |
$4.33
|
| Rate for Payer: PHP Medicare Advantage |
$8.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.97
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Narrow Network |
$43.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.07
|
| Rate for Payer: UHC Exchange |
$12.51
|
| Rate for Payer: UHC Medicaid |
$4.22
|
| Rate for Payer: UHCCP DNSP |
$8.07
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$8.07
|
|
|
HC COLD AGGLUTININS
|
Facility
|
IP
|
$62.74
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: ASR ASR |
$60.86
|
| Rate for Payer: BCBS Trust/PPO |
$51.52
|
| Rate for Payer: BCN Commercial |
$51.52
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cofinity Commercial |
$58.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.19
|
| Rate for Payer: Healthscope Commercial |
$60.86
|
| Rate for Payer: Healthscope Whirlpool |
$62.74
|
| Rate for Payer: Mclaren Commercial |
$56.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.33
|
| Rate for Payer: Nomi Health Commercial |
$51.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.21
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
OP
|
$556.06
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$205.74 |
| Max. Negotiated Rate |
$556.06 |
| Rate for Payer: Aetna Commercial |
$500.45
|
| Rate for Payer: Aetna Medicare |
$205.74
|
| Rate for Payer: ASR ASR |
$539.38
|
| Rate for Payer: BCBS Complete |
$222.42
|
| Rate for Payer: BCBS Trust/PPO |
$458.47
|
| Rate for Payer: BCN Commercial |
$458.47
|
| Rate for Payer: Cash Price |
$444.85
|
| Rate for Payer: Cofinity Commercial |
$522.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.85
|
| Rate for Payer: Healthscope Commercial |
$539.38
|
| Rate for Payer: Healthscope Whirlpool |
$556.06
|
| Rate for Payer: Mclaren Commercial |
$500.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.65
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$417.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$487.22
|
| Rate for Payer: Priority Health Narrow Network |
$389.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.33
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
IP
|
$556.06
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.05 |
| Max. Negotiated Rate |
$556.06 |
| Rate for Payer: Aetna Commercial |
$500.45
|
| Rate for Payer: ASR ASR |
$539.38
|
| Rate for Payer: BCBS Trust/PPO |
$456.64
|
| Rate for Payer: BCN Commercial |
$456.64
|
| Rate for Payer: Cash Price |
$444.85
|
| Rate for Payer: Cofinity Commercial |
$522.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.85
|
| Rate for Payer: Healthscope Commercial |
$539.38
|
| Rate for Payer: Healthscope Whirlpool |
$556.06
|
| Rate for Payer: Mclaren Commercial |
$500.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.65
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$417.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.33
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
OP
|
$1,918.60
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.88 |
| Max. Negotiated Rate |
$1,918.60 |
| Rate for Payer: Aetna Commercial |
$1,726.74
|
| Rate for Payer: Aetna Medicare |
$709.88
|
| Rate for Payer: ASR ASR |
$1,861.04
|
| Rate for Payer: BCBS Complete |
$767.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,581.89
|
| Rate for Payer: BCN Commercial |
$1,581.89
|
| Rate for Payer: Cash Price |
$1,534.88
|
| Rate for Payer: Cofinity Commercial |
$1,803.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,534.88
|
| Rate for Payer: Healthscope Commercial |
$1,861.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.60
|
| Rate for Payer: Mclaren Commercial |
$1,726.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.81
|
| Rate for Payer: Nomi Health Commercial |
$1,573.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,438.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,681.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,688.37
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
IP
|
$1,918.60
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.95 |
| Max. Negotiated Rate |
$1,918.60 |
| Rate for Payer: Aetna Commercial |
$1,726.74
|
| Rate for Payer: ASR ASR |
$1,861.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.55
|
| Rate for Payer: BCN Commercial |
$1,575.55
|
| Rate for Payer: Cash Price |
$1,534.88
|
| Rate for Payer: Cofinity Commercial |
$1,803.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,534.88
|
| Rate for Payer: Healthscope Commercial |
$1,861.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.60
|
| Rate for Payer: Mclaren Commercial |
$1,726.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.81
|
| Rate for Payer: Nomi Health Commercial |
$1,573.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,438.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,688.37
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.91
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: ASR ASR |
$8.64
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$7.35
|
| Rate for Payer: BCN Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.13
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Healthscope Whirlpool |
$8.91
|
| Rate for Payer: Mclaren Commercial |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.57
|
| Rate for Payer: Nomi Health Commercial |
$7.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$2.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.84
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.91
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna Commercial |
$8.02
|
| Rate for Payer: ASR ASR |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$7.32
|
| Rate for Payer: BCN Commercial |
$7.32
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.13
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Healthscope Whirlpool |
$8.91
|
| Rate for Payer: Mclaren Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.57
|
| Rate for Payer: Nomi Health Commercial |
$7.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.84
|
|
