|
HC C1Q COMPL COMPONENT, S
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| 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 |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| 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 |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.17
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$48.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
IP
|
$76.13
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$76.13 |
| Rate for Payer: Aetna Commercial |
$68.52
|
| Rate for Payer: ASR ASR |
$73.85
|
| Rate for Payer: ASR Commercial |
$73.85
|
| Rate for Payer: BCBS Trust/PPO |
$62.04
|
| Rate for Payer: BCN Commercial |
$59.02
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$71.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.90
|
| Rate for Payer: Healthscope Commercial |
$76.13
|
| Rate for Payer: Healthscope Whirlpool |
$73.85
|
| Rate for Payer: Mclaren Commercial |
$68.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.71
|
| Rate for Payer: Nomi Health Commercial |
$62.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.99
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
OP
|
$76.13
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$76.13 |
| Rate for Payer: Aetna Commercial |
$68.52
|
| 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 |
$73.85
|
| Rate for Payer: ASR Commercial |
$73.85
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$59.02
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$71.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$76.13
|
| Rate for Payer: Healthscope Whirlpool |
$73.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$68.52
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.71
|
| Rate for Payer: Nomi Health Commercial |
$62.43
|
| 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 |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.71
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$53.37
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC CA 125
|
Facility
|
OP
|
$145.96
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$131.36
|
| 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 |
$141.58
|
| Rate for Payer: ASR Commercial |
$141.58
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$119.53
|
| Rate for Payer: BCN Commercial |
$113.16
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$116.77
|
| Rate for Payer: Cash Price |
$116.77
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$131.36
|
| Rate for Payer: Mclaren Medicaid |
$11.15
|
| 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 |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.07
|
| Rate for Payer: Nomi Health Commercial |
$119.69
|
| 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 |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.89
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$102.32
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$32.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP DNSP |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$11.15
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CA 125
|
Facility
|
IP
|
$145.96
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.87 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$131.36
|
| Rate for Payer: ASR ASR |
$141.58
|
| Rate for Payer: ASR Commercial |
$141.58
|
| Rate for Payer: BCBS Trust/PPO |
$118.94
|
| Rate for Payer: BCN Commercial |
$113.16
|
| Rate for Payer: Cash Price |
$116.77
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.77
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Mclaren Commercial |
$131.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.07
|
| Rate for Payer: Nomi Health Commercial |
$119.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.44
|
|
|
HC CADMIUM LEVEL
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: ASR Commercial |
$47.18
|
| Rate for Payer: BCBS Trust/PPO |
$39.64
|
| Rate for Payer: BCN Commercial |
$37.71
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Healthscope Whirlpool |
$47.18
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
|
|
HC CADMIUM LEVEL
|
Facility
|
OP
|
$48.64
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| 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 |
$47.18
|
| Rate for Payer: ASR Commercial |
$47.18
|
| Rate for Payer: BCBS Complete |
$13.30
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$39.83
|
| Rate for Payer: BCN Commercial |
$37.71
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Healthscope Whirlpool |
$47.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.64
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Mclaren Medicaid |
$12.67
|
| 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 |
$13.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| 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 |
$12.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.62
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow Network |
$34.10
|
| Rate for Payer: Railroad Medicare Medicare |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.64
|
| Rate for Payer: UHC Exchange |
$36.64
|
| Rate for Payer: UHC Medicare Advantage |
$23.64
|
| Rate for Payer: UHCCP DNSP |
$23.64
|
| Rate for Payer: UHCCP Medicaid |
$12.67
|
| Rate for Payer: VA VA |
$23.64
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: ASR Commercial |
$114.04
|
| Rate for Payer: BCBS Trust/PPO |
$95.81
|
| Rate for Payer: BCN Commercial |
$91.15
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Healthscope Whirlpool |
$114.04
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| 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 |
$114.04
|
| Rate for Payer: ASR Commercial |
$114.04
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$96.28
|
| Rate for Payer: BCN Commercial |
$91.15
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Healthscope Whirlpool |
$114.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| 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 |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| 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 |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.01
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$82.42
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| 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 |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Complete |
$15.08
|
| Rate for Payer: BCBS MAPPO |
$26.79
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: BCN Medicare Advantage |
$26.79
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.79
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.79
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$14.36
|
| 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 |
$15.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| 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 |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.17
|
| Rate for Payer: Priority Health Medicare |
$26.79
|
| Rate for Payer: Priority Health Narrow Network |
$48.14
|
| Rate for Payer: Railroad Medicare Medicare |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.79
|
| Rate for Payer: UHC Exchange |
$41.52
|
| Rate for Payer: UHC Medicare Advantage |
$26.79
|
| Rate for Payer: UHCCP DNSP |
$26.79
|
| Rate for Payer: UHCCP Medicaid |
$14.36
|
| Rate for Payer: VA VA |
$26.79
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: ASR ASR |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
OP
|
$26.88
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: ASR ASR |
$26.07
|
| Rate for Payer: ASR Commercial |
$26.07
|
| Rate for Payer: BCBS Complete |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$22.01
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$26.88
|
| Rate for Payer: Healthscope Whirlpool |
$26.07
|
| Rate for Payer: Mclaren Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: Nomi Health Commercial |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.55
|
| Rate for Payer: Priority Health Narrow Network |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.65
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
IP
|
$26.88
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$26.07
|
| Rate for Payer: ASR Commercial |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$21.90
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$26.88
|
| Rate for Payer: Healthscope Whirlpool |
$26.07
|
| Rate for Payer: Mclaren Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: Nomi Health Commercial |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.65
|
|
|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
IP
|
$18.88
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
OP
|
$18.88
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$18.31
|
| Rate for Payer: ASR Commercial |
$18.31
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.31
|
| Rate for Payer: Mclaren Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: Nomi Health Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.54
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.61
|
|
|
HC CALCIUM LEVEL, TOTAL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
30100129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| 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 |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.90
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.16
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.77
|
| 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 |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| 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 |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.16
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHCCP DNSP |
$5.16
|
| Rate for Payer: UHCCP Medicaid |
$2.77
|
| Rate for Payer: VA VA |
$5.16
|
|
|
HC CALCIUM LEVEL, TOTAL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
30100129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC CALCIUM URINE
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
30100131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: ASR ASR |
$52.24
|
| Rate for Payer: ASR Commercial |
$52.24
|
| Rate for Payer: BCBS Trust/PPO |
$43.89
|
| Rate for Payer: BCN Commercial |
$41.76
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$50.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.24
|
| Rate for Payer: Mclaren Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: Nomi Health Commercial |
$44.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.40
|
|
|
HC CALCIUM URINE
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
30100131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| 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 |
$52.24
|
| Rate for Payer: ASR Commercial |
$52.24
|
| Rate for Payer: BCBS Complete |
$3.39
|
| Rate for Payer: BCBS MAPPO |
$6.03
|
| Rate for Payer: BCBS Trust/PPO |
$44.11
|
| Rate for Payer: BCN Commercial |
$41.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.03
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$50.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.03
|
| Rate for Payer: Mclaren Commercial |
$48.47
|
| Rate for Payer: Mclaren Medicaid |
$3.23
|
| 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 |
$3.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: Nomi Health Commercial |
$44.17
|
| 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 |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.19
|
| Rate for Payer: Priority Health Medicare |
$6.03
|
| Rate for Payer: Priority Health Narrow Network |
$37.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.03
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$3.23
|
| Rate for Payer: VA VA |
$6.03
|
|
|
HC CALCULI
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
30100132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: ASR ASR |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
|
|
HC CALCULI
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
30100132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| 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 |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$34.93
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Mclaren Medicaid |
$6.91
|
| 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 |
$7.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| 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 |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.38
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$29.90
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$20.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP DNSP |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$6.91
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC CALORIC VESTIBULAR BILATERAL MONOTHERMAL
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47100007
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$301.24 |
| Max. Negotiated Rate |
$463.45 |
| Rate for Payer: Aetna Commercial |
$417.11
|
| Rate for Payer: ASR ASR |
$449.55
|
| Rate for Payer: ASR Commercial |
$449.55
|
| Rate for Payer: BCBS Trust/PPO |
$377.67
|
| Rate for Payer: BCN Commercial |
$359.31
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$435.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$463.45
|
| Rate for Payer: Healthscope Whirlpool |
$449.55
|
| Rate for Payer: Mclaren Commercial |
$417.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.84
|
|
|
HC CALORIC VESTIBULAR BILATERAL MONOTHERMAL
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47100007
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$463.45 |
| Rate for Payer: Aetna Commercial |
$417.11
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$449.55
|
| Rate for Payer: ASR Commercial |
$449.55
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$379.52
|
| Rate for Payer: BCN Commercial |
$359.31
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$435.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$463.45
|
| Rate for Payer: Healthscope Whirlpool |
$449.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$417.11
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.07
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$324.88
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC CALORIC VESTIBULAR TEST BILAT BITHERMAL
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47100006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$301.24 |
| Max. Negotiated Rate |
$463.45 |
| Rate for Payer: Aetna Commercial |
$417.11
|
| Rate for Payer: ASR ASR |
$449.55
|
| Rate for Payer: ASR Commercial |
$449.55
|
| Rate for Payer: BCBS Trust/PPO |
$377.67
|
| Rate for Payer: BCN Commercial |
$359.31
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$435.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$463.45
|
| Rate for Payer: Healthscope Whirlpool |
$449.55
|
| Rate for Payer: Mclaren Commercial |
$417.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.84
|
|
|
HC CALORIC VESTIBULAR TEST BILAT BITHERMAL
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47100006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$463.45 |
| Rate for Payer: Aetna Commercial |
$417.11
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$449.55
|
| Rate for Payer: ASR Commercial |
$449.55
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$379.52
|
| Rate for Payer: BCN Commercial |
$359.31
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$435.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$463.45
|
| Rate for Payer: Healthscope Whirlpool |
$449.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$417.11
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.07
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$324.88
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
