|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$363.63
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$363.63 |
| Rate for Payer: Aetna Commercial |
$327.27
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$352.72
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$299.81
|
| Rate for Payer: BCN Commercial |
$299.81
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Commercial |
$341.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$352.72
|
| Rate for Payer: Healthscope Whirlpool |
$363.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$327.27
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$298.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$318.61
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$254.90
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$363.63
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$363.63 |
| Rate for Payer: Aetna Commercial |
$327.27
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$352.72
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$299.81
|
| Rate for Payer: BCN Commercial |
$299.81
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Commercial |
$341.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$352.72
|
| Rate for Payer: Healthscope Whirlpool |
$363.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$327.27
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$298.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$318.61
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$254.90
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$363.63
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.72 |
| Max. Negotiated Rate |
$363.63 |
| Rate for Payer: Aetna Commercial |
$327.27
|
| Rate for Payer: ASR ASR |
$352.72
|
| Rate for Payer: BCBS Trust/PPO |
$298.61
|
| Rate for Payer: BCN Commercial |
$298.61
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Commercial |
$341.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Healthscope Commercial |
$352.72
|
| Rate for Payer: Healthscope Whirlpool |
$363.63
|
| Rate for Payer: Mclaren Commercial |
$327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$298.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.99
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$207.04
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$207.04 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: ASR ASR |
$200.83
|
| Rate for Payer: BCBS Trust/PPO |
$170.02
|
| Rate for Payer: BCN Commercial |
$170.02
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Cofinity Commercial |
$194.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.63
|
| Rate for Payer: Healthscope Commercial |
$200.83
|
| Rate for Payer: Healthscope Whirlpool |
$207.04
|
| Rate for Payer: Mclaren Commercial |
$186.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.98
|
| Rate for Payer: Nomi Health Commercial |
$169.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.20
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$207.04
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$207.04 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Aetna Medicare |
$76.60
|
| Rate for Payer: ASR ASR |
$200.83
|
| Rate for Payer: BCBS Complete |
$82.82
|
| Rate for Payer: BCBS Trust/PPO |
$170.70
|
| Rate for Payer: BCN Commercial |
$170.70
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Cofinity Commercial |
$194.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.63
|
| Rate for Payer: Healthscope Commercial |
$200.83
|
| Rate for Payer: Healthscope Whirlpool |
$207.04
|
| Rate for Payer: Mclaren Commercial |
$186.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.98
|
| Rate for Payer: Nomi Health Commercial |
$169.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$181.41
|
| Rate for Payer: Priority Health Narrow Network |
$145.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.20
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$239.29
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$179.47 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| Rate for Payer: ASR ASR |
$232.11
|
| Rate for Payer: BCBS Trust/PPO |
$196.50
|
| Rate for Payer: BCN Commercial |
$196.50
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$224.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$232.11
|
| Rate for Payer: Healthscope Whirlpool |
$239.29
|
| Rate for Payer: Mclaren Commercial |
$215.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.58
|
|
|
HC FENTANYL UR
|
Facility
|
OP
|
$239.29
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.54 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| Rate for Payer: Aetna Medicare |
$88.54
|
| Rate for Payer: ASR ASR |
$232.11
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$197.29
|
| Rate for Payer: BCN Commercial |
$197.29
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$224.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$232.11
|
| Rate for Payer: Healthscope Whirlpool |
$239.29
|
| Rate for Payer: Mclaren Commercial |
$215.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.67
|
| Rate for Payer: Priority Health Narrow Network |
$167.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.58
|
|
|
HC FENTANYL URINE.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| 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 |
$107.91
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| 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 |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| 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 |
$97.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
| 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 FENTANYL URINE.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC FERRITIN LEVEL
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| 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 |
$61.76
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$13.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: Meridian Medicaid |
$7.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| 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 |
$7.31
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.14
|
| Rate for Payer: Priority Health Medicare |
$13.63
|
| Rate for Payer: Priority Health Narrow Network |
$85.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.63
|
| Rate for Payer: UHC Exchange |
$21.13
|
| Rate for Payer: UHC Medicaid |
$7.13
|
| Rate for Payer: UHCCP DNSP |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$7.13
|
| Rate for Payer: VA VA |
$13.63
|
|
|
HC FERRITIN LEVEL
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$348.08
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.06 |
| Max. Negotiated Rate |
$348.08 |
| Rate for Payer: Aetna Commercial |
$313.27
|
| Rate for Payer: ASR ASR |
$337.64
|
| Rate for Payer: BCBS Trust/PPO |
$285.84
|
| Rate for Payer: BCN Commercial |
$285.84
|
| Rate for Payer: Cash Price |
$278.46
|
| Rate for Payer: Cofinity Commercial |
$327.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.46
|
| Rate for Payer: Healthscope Commercial |
$337.64
|
| Rate for Payer: Healthscope Whirlpool |
$348.08
|
| Rate for Payer: Mclaren Commercial |
$313.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.87
|
| Rate for Payer: Nomi Health Commercial |
$285.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.31
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$348.08
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$348.08 |
| Rate for Payer: Aetna Commercial |
$313.27
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$337.64
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$286.99
|
| Rate for Payer: BCN Commercial |
$286.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$278.46
|
| Rate for Payer: Cash Price |
$278.46
|
| Rate for Payer: Cofinity Commercial |
$327.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$337.64
|
| Rate for Payer: Healthscope Whirlpool |
$348.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$313.27
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.87
|
| Rate for Payer: Nomi Health Commercial |
$285.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.06
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.99
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$244.00
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$443.93
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.69 |
| Max. Negotiated Rate |
$600.44 |
| Rate for Payer: Aetna Commercial |
$399.54
|
| 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 |
$430.61
|
| Rate for Payer: BCBS Complete |
$35.37
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$366.02
|
| Rate for Payer: BCN Commercial |
$366.02
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cofinity Commercial |
$417.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$430.61
|
| Rate for Payer: Healthscope Whirlpool |
$443.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$399.54
|
| Rate for Payer: Mclaren Medicaid |
$64.41
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: Meridian Medicaid |
$35.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.34
|
| Rate for Payer: Nomi Health Commercial |
$364.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.95
|
| 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 |
$34.52
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$600.44
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health Narrow Network |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$64.41
|
| Rate for Payer: UHC Exchange |
$99.84
|
| Rate for Payer: UHC Medicaid |
$33.69
|
| Rate for Payer: UHCCP DNSP |
$64.41
|
| Rate for Payer: UHCCP Medicaid |
$33.69
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$443.93
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$332.95 |
| Max. Negotiated Rate |
$443.93 |
| Rate for Payer: Aetna Commercial |
$399.54
|
| Rate for Payer: ASR ASR |
$430.61
|
| Rate for Payer: BCBS Trust/PPO |
$364.56
|
| Rate for Payer: BCN Commercial |
$364.56
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cofinity Commercial |
$417.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.14
|
| Rate for Payer: Healthscope Commercial |
$430.61
|
| Rate for Payer: Healthscope Whirlpool |
$443.93
|
| Rate for Payer: Mclaren Commercial |
$399.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.34
|
| Rate for Payer: Nomi Health Commercial |
$364.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.66
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$311.37
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.53 |
| Max. Negotiated Rate |
$311.37 |
| Rate for Payer: Aetna Commercial |
$280.23
|
| Rate for Payer: ASR ASR |
$302.03
|
| Rate for Payer: BCBS Trust/PPO |
$255.70
|
| Rate for Payer: BCN Commercial |
$255.70
|
| Rate for Payer: Cash Price |
$249.10
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.10
|
| Rate for Payer: Healthscope Commercial |
$302.03
|
| Rate for Payer: Healthscope Whirlpool |
$311.37
|
| Rate for Payer: Mclaren Commercial |
$280.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.66
|
| Rate for Payer: Nomi Health Commercial |
$255.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.01
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$311.37
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$311.37 |
| Rate for Payer: Aetna Commercial |
$280.23
|
| Rate for Payer: Aetna Medicare |
$115.21
|
| Rate for Payer: ASR ASR |
$302.03
|
| Rate for Payer: BCBS Complete |
$124.55
|
| Rate for Payer: BCBS Trust/PPO |
$256.72
|
| Rate for Payer: BCN Commercial |
$256.72
|
| Rate for Payer: Cash Price |
$249.10
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.10
|
| Rate for Payer: Healthscope Commercial |
$302.03
|
| Rate for Payer: Healthscope Whirlpool |
$311.37
|
| Rate for Payer: Mclaren Commercial |
$280.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.66
|
| Rate for Payer: Nomi Health Commercial |
$255.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.82
|
| Rate for Payer: Priority Health Narrow Network |
$218.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.01
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$75.53
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$75.53 |
| Rate for Payer: Aetna Commercial |
$67.98
|
| Rate for Payer: ASR ASR |
$73.26
|
| Rate for Payer: BCBS Trust/PPO |
$62.03
|
| Rate for Payer: BCN Commercial |
$62.03
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cofinity Commercial |
$71.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.42
|
| Rate for Payer: Healthscope Commercial |
$73.26
|
| Rate for Payer: Healthscope Whirlpool |
$75.53
|
| Rate for Payer: Mclaren Commercial |
$67.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.20
|
| Rate for Payer: Nomi Health Commercial |
$61.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.47
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$75.53
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$75.53 |
| Rate for Payer: Aetna Commercial |
$67.98
|
| 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 |
$73.26
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$62.27
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cofinity Commercial |
$71.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$73.26
|
| Rate for Payer: Healthscope Whirlpool |
$75.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.36
|
| Rate for Payer: Mclaren Commercial |
$67.98
|
| Rate for Payer: Mclaren Medicaid |
$9.36
|
| Rate for Payer: Mclaren Medicare |
$9.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.20
|
| Rate for Payer: Nomi Health Commercial |
$61.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.65
|
| 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 |
$5.02
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.50
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health Narrow Network |
$46.00
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.36
|
| Rate for Payer: UHC Exchange |
$14.51
|
| Rate for Payer: UHC Medicaid |
$4.90
|
| Rate for Payer: UHCCP DNSP |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: VA VA |
$9.36
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$210.77 |
| Rate for Payer: Aetna Commercial |
$189.69
|
| Rate for Payer: Aetna Medicare |
$77.98
|
| Rate for Payer: ASR ASR |
$204.45
|
| Rate for Payer: BCBS Complete |
$84.31
|
| Rate for Payer: BCBS Trust/PPO |
$173.78
|
| Rate for Payer: BCN Commercial |
$173.78
|
| Rate for Payer: Cash Price |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$198.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.62
|
| Rate for Payer: Healthscope Commercial |
$204.45
|
| Rate for Payer: Healthscope Whirlpool |
$210.77
|
| Rate for Payer: Mclaren Commercial |
$189.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.15
|
| Rate for Payer: Nomi Health Commercial |
$172.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$184.68
|
| Rate for Payer: Priority Health Narrow Network |
$147.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.48
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$210.77 |
| Rate for Payer: Aetna Commercial |
$189.69
|
| Rate for Payer: ASR ASR |
$204.45
|
| Rate for Payer: BCBS Trust/PPO |
$173.08
|
| Rate for Payer: BCN Commercial |
$173.08
|
| Rate for Payer: Cash Price |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$198.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.62
|
| Rate for Payer: Healthscope Commercial |
$204.45
|
| Rate for Payer: Healthscope Whirlpool |
$210.77
|
| Rate for Payer: Mclaren Commercial |
$189.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.15
|
| Rate for Payer: Nomi Health Commercial |
$172.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.48
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$374.54
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$363.30
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$308.81
|
| Rate for Payer: BCN Commercial |
$308.81
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Cofinity Commercial |
$352.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$363.30
|
| Rate for Payer: Healthscope Whirlpool |
$374.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$337.09
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.36
|
| Rate for Payer: Nomi Health Commercial |
$307.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.90
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$328.17
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$262.55
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$374.54
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: ASR ASR |
$363.30
|
| Rate for Payer: BCBS Trust/PPO |
$307.57
|
| Rate for Payer: BCN Commercial |
$307.57
|
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Cofinity Commercial |
$352.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.63
|
| Rate for Payer: Healthscope Commercial |
$363.30
|
| Rate for Payer: Healthscope Whirlpool |
$374.54
|
| Rate for Payer: Mclaren Commercial |
$337.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.36
|
| Rate for Payer: Nomi Health Commercial |
$307.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.60
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,138.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.22 |
| Max. Negotiated Rate |
$2,138.43 |
| Rate for Payer: Aetna Commercial |
$1,924.59
|
| Rate for Payer: Aetna Medicare |
$791.22
|
| Rate for Payer: ASR ASR |
$2,074.28
|
| Rate for Payer: BCBS Complete |
$855.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,763.14
|
| Rate for Payer: BCN Commercial |
$1,763.14
|
| Rate for Payer: Cash Price |
$1,710.74
|
| Rate for Payer: Cofinity Commercial |
$2,010.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,710.74
|
| Rate for Payer: Healthscope Commercial |
$2,074.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.43
|
| Rate for Payer: Mclaren Commercial |
$1,924.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,710.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,817.67
|
| Rate for Payer: Nomi Health Commercial |
$1,753.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,603.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,873.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,499.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,881.82
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,138.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,603.82 |
| Max. Negotiated Rate |
$2,138.43 |
| Rate for Payer: Aetna Commercial |
$1,924.59
|
| Rate for Payer: ASR ASR |
$2,074.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,756.08
|
| Rate for Payer: BCN Commercial |
$1,756.08
|
| Rate for Payer: Cash Price |
$1,710.74
|
| Rate for Payer: Cofinity Commercial |
$2,010.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,710.74
|
| Rate for Payer: Healthscope Commercial |
$2,074.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.43
|
| Rate for Payer: Mclaren Commercial |
$1,924.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,817.67
|
| Rate for Payer: Nomi Health Commercial |
$1,753.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,603.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,881.82
|
|
