|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| 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 |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$6.46
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.47
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$6.15
|
| 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 |
$6.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| 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 |
$6.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.47
|
| Rate for Payer: UHC Exchange |
$17.78
|
| Rate for Payer: UHC Medicare Advantage |
$11.47
|
| Rate for Payer: UHCCP DNSP |
$11.47
|
| Rate for Payer: UHCCP Medicaid |
$6.15
|
| Rate for Payer: VA VA |
$11.47
|
|
|
HC COCKROACH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC COCKROACH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC COCONUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC COCONUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC CODFISH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CODFISH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC COGNITIVE EXAM
|
Facility
|
OP
|
$300.90
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: Aetna Medicare |
$150.45
|
| Rate for Payer: ASR ASR |
$291.87
|
| Rate for Payer: ASR Commercial |
$291.87
|
| Rate for Payer: BCBS Complete |
$120.36
|
| Rate for Payer: BCBS Trust/PPO |
$246.41
|
| Rate for Payer: BCN Commercial |
$233.29
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cofinity Commercial |
$282.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.72
|
| Rate for Payer: Healthscope Commercial |
$300.90
|
| Rate for Payer: Healthscope Whirlpool |
$291.87
|
| Rate for Payer: Mclaren Commercial |
$270.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.76
|
| Rate for Payer: Nomi Health Commercial |
$246.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.65
|
| Rate for Payer: Priority Health Narrow Network |
$210.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.79
|
|
|
HC COGNITIVE EXAM
|
Facility
|
IP
|
$300.90
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$195.59 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: ASR ASR |
$291.87
|
| Rate for Payer: ASR Commercial |
$291.87
|
| Rate for Payer: BCBS Trust/PPO |
$245.20
|
| Rate for Payer: BCN Commercial |
$233.29
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cofinity Commercial |
$282.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.72
|
| Rate for Payer: Healthscope Commercial |
$300.90
|
| Rate for Payer: Healthscope Whirlpool |
$291.87
|
| Rate for Payer: Mclaren Commercial |
$270.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.76
|
| Rate for Payer: Nomi Health Commercial |
$246.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.79
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
OP
|
$113.49
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$113.49 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Medicare |
$56.74
|
| Rate for Payer: ASR ASR |
$110.09
|
| Rate for Payer: ASR Commercial |
$110.09
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS Trust/PPO |
$92.94
|
| Rate for Payer: BCN Commercial |
$87.99
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$106.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Healthscope Commercial |
$113.49
|
| Rate for Payer: Healthscope Whirlpool |
$110.09
|
| Rate for Payer: Mclaren Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.47
|
| Rate for Payer: Nomi Health Commercial |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.44
|
| Rate for Payer: Priority Health Narrow Network |
$79.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.87
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
IP
|
$113.49
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$113.49 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: ASR ASR |
$110.09
|
| Rate for Payer: ASR Commercial |
$110.09
|
| Rate for Payer: BCBS Trust/PPO |
$92.48
|
| Rate for Payer: BCN Commercial |
$87.99
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$106.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Healthscope Commercial |
$113.49
|
| Rate for Payer: Healthscope Whirlpool |
$110.09
|
| Rate for Payer: Mclaren Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.47
|
| Rate for Payer: Nomi Health Commercial |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.87
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
OP
|
$115.76
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$115.76 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: Aetna Medicare |
$57.88
|
| Rate for Payer: ASR ASR |
$112.29
|
| Rate for Payer: ASR Commercial |
$112.29
|
| Rate for Payer: BCBS Complete |
$46.30
|
| Rate for Payer: BCBS Trust/PPO |
$94.80
|
| Rate for Payer: BCN Commercial |
$89.75
|
| 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 |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$112.29
|
| 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: Priority Health Cigna Priority Health |
$75.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.87
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
IP
|
$115.76
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$115.76 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: ASR ASR |
$112.29
|
| Rate for Payer: ASR Commercial |
$112.29
|
| Rate for Payer: BCBS Trust/PPO |
$94.33
|
| Rate for Payer: BCN Commercial |
$89.75
|
| 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 |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$112.29
|
| 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: Priority Health Cigna Priority Health |
$75.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.87
|
|
|
HC COLD AGGLUTININS
|
Facility
|
IP
|
$61.51
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$55.36
|
| Rate for Payer: ASR ASR |
$59.66
|
| Rate for Payer: ASR Commercial |
$59.66
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.69
|
| Rate for Payer: Cash Price |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$57.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.21
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Healthscope Whirlpool |
$59.66
|
| Rate for Payer: Mclaren Commercial |
$55.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.28
|
| Rate for Payer: Nomi Health Commercial |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.13
|
|
|
HC COLD AGGLUTININS
|
Facility
|
OP
|
$61.51
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$55.36
|
| 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 |
$59.66
|
| Rate for Payer: ASR Commercial |
$59.66
|
| Rate for Payer: BCBS Complete |
$4.54
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$50.37
|
| Rate for Payer: BCN Commercial |
$47.69
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$49.21
|
| Rate for Payer: Cash Price |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$57.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Healthscope Whirlpool |
$59.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.07
|
| Rate for Payer: Mclaren Commercial |
$55.36
|
| Rate for Payer: Mclaren Medicaid |
$4.33
|
| 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 |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.28
|
| Rate for Payer: Nomi Health Commercial |
$50.44
|
| 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 |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.90
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Narrow Network |
$43.12
|
| Rate for Payer: Railroad Medicare Medicare |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.07
|
| Rate for Payer: UHC Exchange |
$12.51
|
| Rate for Payer: UHC Medicare Advantage |
$8.07
|
| Rate for Payer: UHCCP DNSP |
$8.07
|
| Rate for Payer: UHCCP Medicaid |
$4.33
|
| Rate for Payer: VA VA |
$8.07
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
OP
|
$545.16
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$545.16 |
| Rate for Payer: Aetna Commercial |
$490.64
|
| Rate for Payer: Aetna Medicare |
$272.58
|
| Rate for Payer: ASR ASR |
$528.81
|
| Rate for Payer: ASR Commercial |
$528.81
|
| Rate for Payer: BCBS Complete |
$218.06
|
| Rate for Payer: BCBS Trust/PPO |
$446.43
|
| Rate for Payer: BCN Commercial |
$422.66
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$512.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$545.16
|
| Rate for Payer: Healthscope Whirlpool |
$528.81
|
| Rate for Payer: Mclaren Commercial |
$490.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.67
|
| Rate for Payer: Priority Health Narrow Network |
$382.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.74
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
IP
|
$545.16
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$354.35 |
| Max. Negotiated Rate |
$545.16 |
| Rate for Payer: Aetna Commercial |
$490.64
|
| Rate for Payer: ASR ASR |
$528.81
|
| Rate for Payer: ASR Commercial |
$528.81
|
| Rate for Payer: BCBS Trust/PPO |
$444.25
|
| Rate for Payer: BCN Commercial |
$422.66
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$512.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$545.16
|
| Rate for Payer: Healthscope Whirlpool |
$528.81
|
| Rate for Payer: Mclaren Commercial |
$490.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.74
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
OP
|
$1,880.98
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.39 |
| Max. Negotiated Rate |
$1,880.98 |
| Rate for Payer: Aetna Commercial |
$1,692.88
|
| Rate for Payer: Aetna Medicare |
$940.49
|
| Rate for Payer: ASR ASR |
$1,824.55
|
| Rate for Payer: ASR Commercial |
$1,824.55
|
| Rate for Payer: BCBS Complete |
$752.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.33
|
| Rate for Payer: BCN Commercial |
$1,458.32
|
| Rate for Payer: Cash Price |
$1,504.78
|
| Rate for Payer: Cofinity Commercial |
$1,768.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.78
|
| Rate for Payer: Healthscope Commercial |
$1,880.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,824.55
|
| Rate for Payer: Mclaren Commercial |
$1,692.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.83
|
| Rate for Payer: Nomi Health Commercial |
$1,542.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,648.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,318.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,655.26
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
IP
|
$1,880.98
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.64 |
| Max. Negotiated Rate |
$1,880.98 |
| Rate for Payer: Aetna Commercial |
$1,692.88
|
| Rate for Payer: ASR ASR |
$1,824.55
|
| Rate for Payer: ASR Commercial |
$1,824.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.81
|
| Rate for Payer: BCN Commercial |
$1,458.32
|
| Rate for Payer: Cash Price |
$1,504.78
|
| Rate for Payer: Cofinity Commercial |
$1,768.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.78
|
| Rate for Payer: Healthscope Commercial |
$1,880.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,824.55
|
| Rate for Payer: Mclaren Commercial |
$1,692.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.83
|
| Rate for Payer: Nomi Health Commercial |
$1,542.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,655.26
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.74
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.87
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: ASR ASR |
$8.48
|
| Rate for Payer: ASR Commercial |
$8.48
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCN Commercial |
$6.78
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: Healthscope Whirlpool |
$8.48
|
| Rate for Payer: Mclaren Commercial |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.43
|
| Rate for Payer: Nomi Health Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.66
|
| Rate for Payer: Priority Health Narrow Network |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.69
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.74
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.87
|
| Rate for Payer: ASR ASR |
$8.48
|
| Rate for Payer: ASR Commercial |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$7.12
|
| Rate for Payer: BCN Commercial |
$6.78
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: Healthscope Whirlpool |
$8.48
|
| Rate for Payer: Mclaren Commercial |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.43
|
| Rate for Payer: Nomi Health Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.69
|
|
|
HC COLLECT CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.74
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.87
|
| Rate for Payer: ASR ASR |
$8.48
|
| Rate for Payer: ASR Commercial |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$7.12
|
| Rate for Payer: BCN Commercial |
$6.78
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: Healthscope Whirlpool |
$8.48
|
| Rate for Payer: Mclaren Commercial |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.43
|
| Rate for Payer: Nomi Health Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.69
|
|
|
HC COLLECT CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.74
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.87
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: ASR ASR |
$8.48
|
| Rate for Payer: ASR Commercial |
$8.48
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCN Commercial |
$6.78
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: Healthscope Whirlpool |
$8.48
|
| Rate for Payer: Mclaren Commercial |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.43
|
| Rate for Payer: Nomi Health Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.66
|
| Rate for Payer: Priority Health Narrow Network |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.69
|
|
|
HC COLON DECOMPRESSION
|
Facility
|
OP
|
$2,402.54
|
|
| Hospital Charge Code |
36000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$961.02 |
| Max. Negotiated Rate |
$2,402.54 |
| Rate for Payer: Aetna Commercial |
$2,162.29
|
| Rate for Payer: Aetna Medicare |
$1,201.27
|
| Rate for Payer: ASR ASR |
$2,330.46
|
| Rate for Payer: ASR Commercial |
$2,330.46
|
| Rate for Payer: BCBS Complete |
$961.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,967.44
|
| Rate for Payer: BCN Commercial |
$1,862.69
|
| Rate for Payer: Cash Price |
$1,922.03
|
| Rate for Payer: Cofinity Commercial |
$2,258.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,922.03
|
| Rate for Payer: Healthscope Commercial |
$2,402.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,330.46
|
| Rate for Payer: Mclaren Commercial |
$2,162.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,042.16
|
| Rate for Payer: Nomi Health Commercial |
$1,970.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,561.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,105.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,684.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,114.24
|
|
|
HC COLON DECOMPRESSION
|
Facility
|
IP
|
$2,402.54
|
|
| Hospital Charge Code |
36000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,561.65 |
| Max. Negotiated Rate |
$2,402.54 |
| Rate for Payer: Aetna Commercial |
$2,162.29
|
| Rate for Payer: ASR ASR |
$2,330.46
|
| Rate for Payer: ASR Commercial |
$2,330.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,957.83
|
| Rate for Payer: BCN Commercial |
$1,862.69
|
| Rate for Payer: Cash Price |
$1,922.03
|
| Rate for Payer: Cofinity Commercial |
$2,258.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,922.03
|
| Rate for Payer: Healthscope Commercial |
$2,402.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,330.46
|
| Rate for Payer: Mclaren Commercial |
$2,162.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,042.16
|
| Rate for Payer: Nomi Health Commercial |
$1,970.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,561.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,114.24
|
|
