|
HC ESTRIOL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$237.27 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: ASR ASR |
$50.44
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$42.87
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$48.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$52.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.18
|
| Rate for Payer: Mclaren Commercial |
$46.80
|
| Rate for Payer: Mclaren Medicaid |
$24.18
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicaid |
$12.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$237.27
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow Network |
$189.81
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.18
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicaid |
$12.65
|
| Rate for Payer: UHCCP DNSP |
$24.18
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: VA VA |
$24.18
|
|
|
HC ESTROGEN FRACTIONATED E1 & E2
|
Facility
|
OP
|
$51.85
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
30100527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$277.83 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: Aetna Medicare |
$32.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: ASR ASR |
$50.29
|
| Rate for Payer: BCBS Complete |
$17.74
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$42.75
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$48.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$50.29
|
| Rate for Payer: Healthscope Whirlpool |
$51.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$32.30
|
| Rate for Payer: Mclaren Commercial |
$46.66
|
| Rate for Payer: Mclaren Medicaid |
$32.30
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.91
|
| Rate for Payer: Meridian Medicaid |
$17.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$42.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.89
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$35.53
|
| Rate for Payer: PHP Medicaid |
$17.31
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$277.83
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$222.26
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.30
|
| Rate for Payer: UHC Exchange |
$50.06
|
| Rate for Payer: UHC Medicaid |
$16.89
|
| Rate for Payer: UHCCP DNSP |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$16.89
|
| Rate for Payer: VA VA |
$32.30
|
|
|
HC ESTROGEN FRACTIONATED E1 & E2
|
Facility
|
IP
|
$51.85
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
30100527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Aetna Commercial |
$46.66
|
| Rate for Payer: ASR ASR |
$50.29
|
| Rate for Payer: BCBS Trust/PPO |
$42.58
|
| Rate for Payer: BCN Commercial |
$42.58
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$48.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.48
|
| Rate for Payer: Healthscope Commercial |
$50.29
|
| Rate for Payer: Healthscope Whirlpool |
$51.85
|
| Rate for Payer: Mclaren Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$42.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.63
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$120.55
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$223.95 |
| Rate for Payer: Aetna Commercial |
$108.50
|
| Rate for Payer: Aetna Medicare |
$87.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.85
|
| Rate for Payer: ASR ASR |
$116.93
|
| Rate for Payer: BCBS Complete |
$48.26
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCBS Trust/PPO |
$99.39
|
| Rate for Payer: BCN Commercial |
$99.39
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$113.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$116.93
|
| Rate for Payer: Healthscope Whirlpool |
$120.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$87.88
|
| Rate for Payer: Mclaren Commercial |
$108.50
|
| Rate for Payer: Mclaren Medicaid |
$87.88
|
| Rate for Payer: Mclaren Medicare |
$87.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: Meridian Medicaid |
$48.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.47
|
| Rate for Payer: Nomi Health Commercial |
$98.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.41
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$96.67
|
| Rate for Payer: PHP Medicaid |
$47.10
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$223.95
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health Narrow Network |
$179.16
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.88
|
| Rate for Payer: UHC Exchange |
$136.21
|
| Rate for Payer: UHC Medicaid |
$45.96
|
| Rate for Payer: UHCCP DNSP |
$87.88
|
| Rate for Payer: UHCCP Medicaid |
$45.96
|
| Rate for Payer: VA VA |
$87.88
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$120.55
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.41 |
| Max. Negotiated Rate |
$120.55 |
| Rate for Payer: Aetna Commercial |
$108.50
|
| Rate for Payer: ASR ASR |
$116.93
|
| Rate for Payer: BCBS Trust/PPO |
$99.00
|
| Rate for Payer: BCN Commercial |
$99.00
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$113.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.44
|
| Rate for Payer: Healthscope Commercial |
$116.93
|
| Rate for Payer: Healthscope Whirlpool |
$120.55
|
| Rate for Payer: Mclaren Commercial |
$108.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.47
|
| Rate for Payer: Nomi Health Commercial |
$98.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.08
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$121.40
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$121.40 |
| Rate for Payer: Aetna Commercial |
$109.26
|
| Rate for Payer: ASR ASR |
$117.76
|
| Rate for Payer: BCBS Trust/PPO |
$99.69
|
| Rate for Payer: BCN Commercial |
$99.69
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$114.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| Rate for Payer: Healthscope Whirlpool |
$121.40
|
| Rate for Payer: Mclaren Commercial |
$109.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.19
|
| Rate for Payer: Nomi Health Commercial |
$99.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.83
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$121.40
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$121.40 |
| Rate for Payer: Aetna Commercial |
$109.26
|
| Rate for Payer: Aetna Medicare |
$64.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.10
|
| Rate for Payer: ASR ASR |
$117.76
|
| Rate for Payer: BCBS Complete |
$35.63
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCBS Trust/PPO |
$100.09
|
| Rate for Payer: BCN Commercial |
$100.09
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$114.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| Rate for Payer: Healthscope Whirlpool |
$121.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.88
|
| Rate for Payer: Mclaren Commercial |
$109.26
|
| Rate for Payer: Mclaren Medicaid |
$64.88
|
| Rate for Payer: Mclaren Medicare |
$64.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.12
|
| Rate for Payer: Meridian Medicaid |
$35.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.19
|
| Rate for Payer: Nomi Health Commercial |
$99.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.05
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$71.37
|
| Rate for Payer: PHP Medicaid |
$34.78
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.37
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health Narrow Network |
$85.10
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$64.88
|
| Rate for Payer: UHC Exchange |
$100.56
|
| Rate for Payer: UHC Medicaid |
$33.93
|
| Rate for Payer: UHCCP DNSP |
$64.88
|
| Rate for Payer: UHCCP Medicaid |
$33.93
|
| Rate for Payer: VA VA |
$64.88
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Trust/PPO |
$55.78
|
| Rate for Payer: BCN Commercial |
$55.78
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$65.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.92
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$150.11 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Complete |
$13.70
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$56.00
|
| Rate for Payer: BCN Commercial |
$56.00
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$65.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.95
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Mclaren Medicaid |
$24.95
|
| Rate for Payer: Mclaren Medicare |
$24.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: Meridian Medicaid |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$27.45
|
| Rate for Payer: PHP Medicaid |
$13.37
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.11
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health Narrow Network |
$120.09
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.95
|
| Rate for Payer: UHC Exchange |
$38.67
|
| Rate for Payer: UHC Medicaid |
$13.05
|
| Rate for Payer: UHCCP DNSP |
$24.95
|
| Rate for Payer: UHCCP Medicaid |
$13.05
|
| Rate for Payer: VA VA |
$24.95
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$57.74
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$128.67
|
| Rate for Payer: BCN Commercial |
$128.67
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Trust/PPO |
$47.84
|
| Rate for Payer: BCN Commercial |
$47.84
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$48.04
|
| Rate for Payer: BCN Commercial |
$48.04
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$16.34
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$8.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicaid |
$8.76
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.27
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$61.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.34
|
| Rate for Payer: UHC Exchange |
$25.33
|
| Rate for Payer: UHC Medicaid |
$8.55
|
| Rate for Payer: UHCCP DNSP |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$167.50
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$150.75
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$162.47
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$138.10
|
| Rate for Payer: BCN Commercial |
$138.10
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$162.47
|
| Rate for Payer: Healthscope Whirlpool |
$167.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.90
|
| Rate for Payer: Mclaren Commercial |
$150.75
|
| Rate for Payer: Mclaren Medicaid |
$14.90
|
| Rate for Payer: Mclaren Medicare |
$14.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: Meridian Medicaid |
$8.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.38
|
| Rate for Payer: Nomi Health Commercial |
$137.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.62
|
| Rate for Payer: PACE Medicare |
$14.15
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$16.39
|
| Rate for Payer: PHP Medicaid |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.76
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health Narrow Network |
$117.42
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.90
|
| Rate for Payer: UHC Exchange |
$23.09
|
| Rate for Payer: UHC Medicaid |
$7.79
|
| Rate for Payer: UHCCP DNSP |
$14.90
|
| Rate for Payer: UHCCP Medicaid |
$7.79
|
| Rate for Payer: VA VA |
$14.90
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$167.50
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$150.75
|
| Rate for Payer: ASR ASR |
$162.47
|
| Rate for Payer: BCBS Trust/PPO |
$137.55
|
| Rate for Payer: BCN Commercial |
$137.55
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.00
|
| Rate for Payer: Healthscope Commercial |
$162.47
|
| Rate for Payer: Healthscope Whirlpool |
$167.50
|
| Rate for Payer: Mclaren Commercial |
$150.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.38
|
| Rate for Payer: Nomi Health Commercial |
$137.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.40
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$130.99
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.24 |
| Max. Negotiated Rate |
$130.99 |
| Rate for Payer: Aetna Commercial |
$117.89
|
| Rate for Payer: ASR ASR |
$127.06
|
| Rate for Payer: BCBS Trust/PPO |
$107.57
|
| Rate for Payer: BCN Commercial |
$107.57
|
| Rate for Payer: Cash Price |
$104.79
|
| Rate for Payer: Cofinity Commercial |
$123.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.79
|
| Rate for Payer: Healthscope Commercial |
$127.06
|
| Rate for Payer: Healthscope Whirlpool |
$130.99
|
| Rate for Payer: Mclaren Commercial |
$117.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.34
|
| Rate for Payer: Nomi Health Commercial |
$107.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.27
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$130.99
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$130.99 |
| Rate for Payer: Aetna Commercial |
$117.89
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$127.06
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$108.00
|
| Rate for Payer: BCN Commercial |
$108.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$104.79
|
| Rate for Payer: Cash Price |
$104.79
|
| Rate for Payer: Cofinity Commercial |
$123.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$127.06
|
| Rate for Payer: Healthscope Whirlpool |
$130.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$117.89
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.34
|
| Rate for Payer: Nomi Health Commercial |
$107.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.24
|
| 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 |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.77
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$91.82
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,577.34
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$583.62 |
| Max. Negotiated Rate |
$1,577.34 |
| Rate for Payer: Aetna Commercial |
$1,419.61
|
| Rate for Payer: Aetna Medicare |
$583.62
|
| Rate for Payer: ASR ASR |
$1,530.02
|
| Rate for Payer: BCBS Complete |
$630.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.52
|
| Rate for Payer: BCN Commercial |
$1,300.52
|
| Rate for Payer: Cash Price |
$1,261.87
|
| Rate for Payer: Cash Price |
$1,261.87
|
| Rate for Payer: Cofinity Commercial |
$1,482.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.87
|
| Rate for Payer: Healthscope Commercial |
$1,530.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,577.34
|
| Rate for Payer: Mclaren Commercial |
$1,419.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.74
|
| Rate for Payer: Nomi Health Commercial |
$1,293.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,183.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,300.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,040.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,388.06
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,577.34
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,183.01 |
| Max. Negotiated Rate |
$1,577.34 |
| Rate for Payer: Aetna Commercial |
$1,419.61
|
| Rate for Payer: ASR ASR |
$1,530.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.31
|
| Rate for Payer: BCN Commercial |
$1,295.31
|
| Rate for Payer: Cash Price |
$1,261.87
|
| Rate for Payer: Cofinity Commercial |
$1,482.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.87
|
| Rate for Payer: Healthscope Commercial |
$1,530.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,577.34
|
| Rate for Payer: Mclaren Commercial |
$1,419.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.74
|
| Rate for Payer: Nomi Health Commercial |
$1,293.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,183.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,388.06
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$307.01
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$307.01 |
| Rate for Payer: Aetna Commercial |
$276.31
|
| Rate for Payer: Aetna Medicare |
$105.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.97
|
| Rate for Payer: ASR ASR |
$297.80
|
| Rate for Payer: BCBS Complete |
$57.98
|
| Rate for Payer: BCBS MAPPO |
$105.58
|
| Rate for Payer: BCBS Trust/PPO |
$253.13
|
| Rate for Payer: BCN Commercial |
$253.13
|
| Rate for Payer: BCN Medicare Advantage |
$105.58
|
| Rate for Payer: Cash Price |
$245.61
|
| Rate for Payer: Cash Price |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$288.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.58
|
| Rate for Payer: Healthscope Commercial |
$297.80
|
| Rate for Payer: Healthscope Whirlpool |
$307.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$105.58
|
| Rate for Payer: Mclaren Commercial |
$276.31
|
| Rate for Payer: Mclaren Medicaid |
$105.58
|
| Rate for Payer: Mclaren Medicare |
$105.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.86
|
| Rate for Payer: Meridian Medicaid |
$57.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.96
|
| Rate for Payer: Nomi Health Commercial |
$251.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.26
|
| Rate for Payer: PACE Medicare |
$100.30
|
| Rate for Payer: PACE SWMI |
$105.58
|
| Rate for Payer: PHP Commercial |
$116.14
|
| Rate for Payer: PHP Medicaid |
$56.59
|
| Rate for Payer: PHP Medicare Advantage |
$105.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Medicare |
$105.58
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: Railroad Medicare Medicare |
$105.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.58
|
| Rate for Payer: UHC Exchange |
$163.65
|
| Rate for Payer: UHC Medicaid |
$55.22
|
| Rate for Payer: UHCCP DNSP |
$105.58
|
| Rate for Payer: UHCCP Medicaid |
$55.22
|
| Rate for Payer: VA VA |
$105.58
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$307.01
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.26 |
| Max. Negotiated Rate |
$307.01 |
| Rate for Payer: Aetna Commercial |
$276.31
|
| Rate for Payer: ASR ASR |
$297.80
|
| Rate for Payer: BCBS Trust/PPO |
$252.12
|
| Rate for Payer: BCN Commercial |
$252.12
|
| Rate for Payer: Cash Price |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$288.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.61
|
| Rate for Payer: Healthscope Commercial |
$297.80
|
| Rate for Payer: Healthscope Whirlpool |
$307.01
|
| Rate for Payer: Mclaren Commercial |
$276.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.96
|
| Rate for Payer: Nomi Health Commercial |
$251.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.17
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$94.03
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$84.63
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$91.21
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$77.53
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$88.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$91.21
|
| Rate for Payer: Healthscope Whirlpool |
$94.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$84.63
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Nomi Health Commercial |
$77.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.52
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.30
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$110.64
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$94.03
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.52 |
| Max. Negotiated Rate |
$94.03 |
| Rate for Payer: Aetna Commercial |
$84.63
|
| Rate for Payer: ASR ASR |
$91.21
|
| Rate for Payer: BCBS Trust/PPO |
$77.22
|
| Rate for Payer: BCN Commercial |
$77.22
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$88.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.22
|
| Rate for Payer: Healthscope Commercial |
$91.21
|
| Rate for Payer: Healthscope Whirlpool |
$94.03
|
| Rate for Payer: Mclaren Commercial |
$84.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Nomi Health Commercial |
$77.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.75
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$266.96
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$200.22 |
| Max. Negotiated Rate |
$266.96 |
| Rate for Payer: Aetna Commercial |
$240.26
|
| Rate for Payer: ASR ASR |
$258.95
|
| Rate for Payer: BCBS Trust/PPO |
$219.23
|
| Rate for Payer: BCN Commercial |
$219.23
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cofinity Commercial |
$250.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.57
|
| Rate for Payer: Healthscope Commercial |
$258.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.96
|
| Rate for Payer: Mclaren Commercial |
$240.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.92
|
| Rate for Payer: Nomi Health Commercial |
$218.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.92
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$266.96
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$98.78 |
| Max. Negotiated Rate |
$292.96 |
| Rate for Payer: Aetna Commercial |
$240.26
|
| Rate for Payer: Aetna Medicare |
$98.78
|
| Rate for Payer: ASR ASR |
$258.95
|
| Rate for Payer: BCBS Complete |
$106.78
|
| Rate for Payer: BCBS Trust/PPO |
$220.11
|
| Rate for Payer: BCN Commercial |
$220.11
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cofinity Commercial |
$250.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.57
|
| Rate for Payer: Healthscope Commercial |
$258.95
|
| Rate for Payer: Healthscope Whirlpool |
$266.96
|
| Rate for Payer: Mclaren Commercial |
$240.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.92
|
| Rate for Payer: Nomi Health Commercial |
$218.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$292.96
|
| Rate for Payer: Priority Health Narrow Network |
$234.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.92
|
|
