|
HC FECAL WBC LACTOFERRIN
|
Facility
|
IP
|
$73.85
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: ASR ASR |
$71.63
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$57.26
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cofinity Commercial |
$69.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.08
|
| Rate for Payer: Healthscope Commercial |
$73.85
|
| Rate for Payer: Healthscope Whirlpool |
$71.63
|
| Rate for Payer: Mclaren Commercial |
$66.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.99
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
OP
|
$73.85
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Medicare |
$19.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: ASR ASR |
$71.63
|
| Rate for Payer: BCBS Complete |
$11.32
|
| Rate for Payer: BCBS MAPPO |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$57.26
|
| Rate for Payer: BCN Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cofinity Commercial |
$69.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$73.85
|
| Rate for Payer: Healthscope Whirlpool |
$71.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.70
|
| Rate for Payer: Mclaren Commercial |
$66.46
|
| Rate for Payer: Mclaren Medicaid |
$10.78
|
| Rate for Payer: Mclaren Medicare |
$19.70
|
| Rate for Payer: Meridian Medicaid |
$11.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.77
|
| Rate for Payer: PACE Medicare |
$18.72
|
| Rate for Payer: PACE SWMI |
$19.70
|
| Rate for Payer: PHP Commercial |
$21.67
|
| Rate for Payer: PHP Medicaid |
$10.78
|
| Rate for Payer: PHP Medicare Advantage |
$19.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.20
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow Network |
$52.43
|
| Rate for Payer: Railroad Medicare Medicare |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.99
|
| Rate for Payer: UHC Medicare Advantage |
$20.29
|
| Rate for Payer: VA VA |
$19.70
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.87
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$470.40
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: ASR ASR |
$456.29
|
| Rate for Payer: BCBS Complete |
$188.16
|
| Rate for Payer: BCBS Trust/PPO |
$364.70
|
| Rate for Payer: BCN Commercial |
$364.70
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Commercial |
$442.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.32
|
| Rate for Payer: Healthscope Commercial |
$470.40
|
| Rate for Payer: Healthscope Whirlpool |
$456.29
|
| Rate for Payer: Mclaren Commercial |
$423.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.06
|
| Rate for Payer: Priority Health Narrow Network |
$333.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.95
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$470.40
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$329.28 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$423.36
|
| Rate for Payer: ASR ASR |
$456.29
|
| Rate for Payer: BCBS Trust/PPO |
$364.70
|
| Rate for Payer: BCN Commercial |
$364.70
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Commercial |
$442.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.32
|
| Rate for Payer: Healthscope Commercial |
$470.40
|
| Rate for Payer: Healthscope Whirlpool |
$456.29
|
| Rate for Payer: Mclaren Commercial |
$423.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.95
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$349.51
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$349.51 |
| Rate for Payer: Aetna Commercial |
$314.56
|
| Rate for Payer: ASR ASR |
$339.02
|
| Rate for Payer: BCBS Trust/PPO |
$270.98
|
| Rate for Payer: BCN Commercial |
$270.98
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$328.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.61
|
| Rate for Payer: Healthscope Commercial |
$349.51
|
| Rate for Payer: Healthscope Whirlpool |
$339.02
|
| Rate for Payer: Mclaren Commercial |
$314.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.57
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$349.51
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$349.51 |
| Rate for Payer: Aetna Commercial |
$314.56
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$339.02
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$270.98
|
| Rate for Payer: BCN Commercial |
$270.98
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$328.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$349.51
|
| Rate for Payer: Healthscope Whirlpool |
$339.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$314.56
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.05
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$248.15
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.57
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$349.51
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$349.51 |
| Rate for Payer: Aetna Commercial |
$314.56
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$339.02
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$270.98
|
| Rate for Payer: BCN Commercial |
$270.98
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$328.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$349.51
|
| Rate for Payer: Healthscope Whirlpool |
$339.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$314.56
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.05
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$248.15
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.57
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$349.51
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$349.51 |
| Rate for Payer: Aetna Commercial |
$314.56
|
| Rate for Payer: ASR ASR |
$339.02
|
| Rate for Payer: BCBS Trust/PPO |
$270.98
|
| Rate for Payer: BCN Commercial |
$270.98
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$328.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.61
|
| Rate for Payer: Healthscope Commercial |
$349.51
|
| Rate for Payer: Healthscope Whirlpool |
$339.02
|
| Rate for Payer: Mclaren Commercial |
$314.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.57
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: ASR ASR |
$193.03
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: BCBS Trust/PPO |
$154.28
|
| Rate for Payer: BCN Commercial |
$154.28
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cofinity Commercial |
$187.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.20
|
| Rate for Payer: Healthscope Commercial |
$199.00
|
| Rate for Payer: Healthscope Whirlpool |
$193.03
|
| Rate for Payer: Mclaren Commercial |
$179.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.09
|
| Rate for Payer: Priority Health Narrow Network |
$141.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.12
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$139.30 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: ASR ASR |
$193.03
|
| Rate for Payer: BCBS Trust/PPO |
$154.28
|
| Rate for Payer: BCN Commercial |
$154.28
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cofinity Commercial |
$187.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.20
|
| Rate for Payer: Healthscope Commercial |
$199.00
|
| Rate for Payer: Healthscope Whirlpool |
$193.03
|
| Rate for Payer: Mclaren Commercial |
$179.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.12
|
|
|
HC FENTANYL UR
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$207.00
|
| Rate for Payer: ASR ASR |
$223.10
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS Trust/PPO |
$178.32
|
| Rate for Payer: BCN Commercial |
$178.32
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$216.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.00
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Whirlpool |
$223.10
|
| Rate for Payer: Mclaren Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.30
|
| Rate for Payer: Priority Health Narrow Network |
$163.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.40
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$207.00
|
| Rate for Payer: ASR ASR |
$223.10
|
| Rate for Payer: BCBS Trust/PPO |
$178.32
|
| Rate for Payer: BCN Commercial |
$178.32
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$216.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.00
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Healthscope Whirlpool |
$223.10
|
| Rate for Payer: Mclaren Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.40
|
|
|
HC FENTANYL URINE.
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
|
|
HC FENTANYL URINE.
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC FERRITIN LEVEL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC FERRITIN LEVEL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$90.82 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.04
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$7.46
|
| Rate for Payer: Mclaren Medicare |
$13.63
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: PHP Medicaid |
$7.46
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.82
|
| Rate for Payer: Priority Health Medicare |
$13.63
|
| Rate for Payer: Priority Health Narrow Network |
$72.66
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$14.04
|
| Rate for Payer: VA VA |
$13.63
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$334.56
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Aetna Commercial |
$301.10
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$324.52
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$259.38
|
| Rate for Payer: BCN Commercial |
$259.38
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cofinity Commercial |
$314.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$334.56
|
| Rate for Payer: Healthscope Whirlpool |
$324.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$301.10
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.38
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.45
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$237.54
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.41
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$334.56
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.19 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Aetna Commercial |
$301.10
|
| Rate for Payer: ASR ASR |
$324.52
|
| Rate for Payer: BCBS Trust/PPO |
$259.38
|
| Rate for Payer: BCN Commercial |
$259.38
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cofinity Commercial |
$314.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.65
|
| Rate for Payer: Healthscope Commercial |
$334.56
|
| Rate for Payer: Healthscope Whirlpool |
$324.52
|
| Rate for Payer: Mclaren Commercial |
$301.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$426.70
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$508.99 |
| Rate for Payer: Aetna Commercial |
$384.03
|
| Rate for Payer: Aetna Medicare |
$64.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: ASR ASR |
$413.90
|
| Rate for Payer: BCBS Complete |
$37.00
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$330.82
|
| Rate for Payer: BCN Commercial |
$330.82
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$341.36
|
| Rate for Payer: Cash Price |
$341.36
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$426.70
|
| Rate for Payer: Healthscope Whirlpool |
$413.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$384.03
|
| Rate for Payer: Mclaren Medicaid |
$35.23
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Medicaid |
$37.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.70
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$70.85
|
| Rate for Payer: PHP Medicaid |
$35.23
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.99
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health Narrow Network |
$407.19
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.50
|
| Rate for Payer: UHC Medicare Advantage |
$66.34
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$426.70
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$298.69 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Aetna Commercial |
$384.03
|
| Rate for Payer: ASR ASR |
$413.90
|
| Rate for Payer: BCBS Trust/PPO |
$330.82
|
| Rate for Payer: BCN Commercial |
$330.82
|
| Rate for Payer: Cash Price |
$341.36
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.36
|
| Rate for Payer: Healthscope Commercial |
$426.70
|
| Rate for Payer: Healthscope Whirlpool |
$413.90
|
| Rate for Payer: Mclaren Commercial |
$384.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.50
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$299.27
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Aetna Commercial |
$269.34
|
| Rate for Payer: ASR ASR |
$290.29
|
| Rate for Payer: BCBS Complete |
$119.71
|
| Rate for Payer: BCBS Trust/PPO |
$232.02
|
| Rate for Payer: BCN Commercial |
$232.02
|
| Rate for Payer: Cash Price |
$239.42
|
| Rate for Payer: Cofinity Commercial |
$281.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.42
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Healthscope Whirlpool |
$290.29
|
| Rate for Payer: Mclaren Commercial |
$269.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.34
|
| Rate for Payer: Priority Health Narrow Network |
$212.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.36
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$299.27
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.49 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Aetna Commercial |
$269.34
|
| Rate for Payer: ASR ASR |
$290.29
|
| Rate for Payer: BCBS Trust/PPO |
$232.02
|
| Rate for Payer: BCN Commercial |
$232.02
|
| Rate for Payer: Cash Price |
$239.42
|
| Rate for Payer: Cofinity Commercial |
$281.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.42
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Healthscope Whirlpool |
$290.29
|
| Rate for Payer: Mclaren Commercial |
$269.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.36
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$72.60
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Aetna Commercial |
$65.34
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: ASR ASR |
$70.42
|
| Rate for Payer: BCBS Complete |
$5.38
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$56.29
|
| Rate for Payer: BCN Commercial |
$56.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$72.60
|
| Rate for Payer: Healthscope Whirlpool |
$70.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.36
|
| Rate for Payer: Mclaren Commercial |
$65.34
|
| Rate for Payer: Mclaren Medicaid |
$5.12
|
| Rate for Payer: Mclaren Medicare |
$9.36
|
| Rate for Payer: Meridian Medicaid |
$5.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.71
|
| Rate for Payer: PACE Medicare |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.30
|
| Rate for Payer: PHP Medicaid |
$5.12
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.74
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health Narrow Network |
$38.99
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.64
|
| Rate for Payer: VA VA |
$9.36
|
|
