|
HC MECH VENT INITIAL DAY
|
Facility
|
IP
|
$1,477.22
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,034.05 |
| Max. Negotiated Rate |
$1,477.22 |
| Rate for Payer: Aetna Commercial |
$1,329.50
|
| Rate for Payer: ASR ASR |
$1,432.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.29
|
| Rate for Payer: BCN Commercial |
$1,145.29
|
| Rate for Payer: Cash Price |
$1,181.78
|
| Rate for Payer: Cofinity Commercial |
$1,388.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.78
|
| Rate for Payer: Healthscope Commercial |
$1,477.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.90
|
| Rate for Payer: Mclaren Commercial |
$1,329.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,255.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.95
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
OP
|
$1,477.22
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$304.70 |
| Max. Negotiated Rate |
$3,776.34 |
| Rate for Payer: Aetna Commercial |
$1,329.50
|
| Rate for Payer: Aetna Medicare |
$557.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$696.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$696.29
|
| Rate for Payer: ASR ASR |
$1,432.90
|
| Rate for Payer: BCBS Complete |
$319.96
|
| Rate for Payer: BCBS MAPPO |
$557.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.29
|
| Rate for Payer: BCN Commercial |
$1,145.29
|
| Rate for Payer: BCN Medicare Advantage |
$557.03
|
| Rate for Payer: Cash Price |
$1,181.78
|
| Rate for Payer: Cash Price |
$1,181.78
|
| Rate for Payer: Cofinity Commercial |
$1,388.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.03
|
| Rate for Payer: Healthscope Commercial |
$1,477.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$557.03
|
| Rate for Payer: Mclaren Commercial |
$1,329.50
|
| Rate for Payer: Mclaren Medicaid |
$304.70
|
| Rate for Payer: Mclaren Medicare |
$557.03
|
| Rate for Payer: Meridian Medicaid |
$319.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,255.64
|
| Rate for Payer: PACE Medicare |
$529.18
|
| Rate for Payer: PACE SWMI |
$557.03
|
| Rate for Payer: PHP Commercial |
$612.73
|
| Rate for Payer: PHP Medicaid |
$304.70
|
| Rate for Payer: PHP Medicare Advantage |
$557.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,776.34
|
| Rate for Payer: Priority Health Medicare |
$557.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,021.07
|
| Rate for Payer: Railroad Medicare Medicare |
$557.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.95
|
| Rate for Payer: UHC Medicare Advantage |
$573.74
|
| Rate for Payer: VA VA |
$557.03
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
IP
|
$1,286.86
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$900.80 |
| Max. Negotiated Rate |
$1,286.86 |
| Rate for Payer: Aetna Commercial |
$1,158.17
|
| Rate for Payer: ASR ASR |
$1,248.25
|
| Rate for Payer: BCBS Trust/PPO |
$997.70
|
| Rate for Payer: BCN Commercial |
$997.70
|
| Rate for Payer: Cash Price |
$1,029.49
|
| Rate for Payer: Cofinity Commercial |
$1,209.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.49
|
| Rate for Payer: Healthscope Commercial |
$1,286.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,248.25
|
| Rate for Payer: Mclaren Commercial |
$1,158.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,093.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.44
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
OP
|
$1,286.86
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$304.70 |
| Max. Negotiated Rate |
$3,304.30 |
| Rate for Payer: Aetna Commercial |
$1,158.17
|
| Rate for Payer: Aetna Medicare |
$557.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$696.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$696.29
|
| Rate for Payer: ASR ASR |
$1,248.25
|
| Rate for Payer: BCBS Complete |
$319.96
|
| Rate for Payer: BCBS MAPPO |
$557.03
|
| Rate for Payer: BCBS Trust/PPO |
$997.70
|
| Rate for Payer: BCN Commercial |
$997.70
|
| Rate for Payer: BCN Medicare Advantage |
$557.03
|
| Rate for Payer: Cash Price |
$1,029.49
|
| Rate for Payer: Cash Price |
$1,029.49
|
| Rate for Payer: Cofinity Commercial |
$1,209.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.03
|
| Rate for Payer: Healthscope Commercial |
$1,286.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,248.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$557.03
|
| Rate for Payer: Mclaren Commercial |
$1,158.17
|
| Rate for Payer: Mclaren Medicaid |
$304.70
|
| Rate for Payer: Mclaren Medicare |
$557.03
|
| Rate for Payer: Meridian Medicaid |
$319.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,093.83
|
| Rate for Payer: PACE Medicare |
$529.18
|
| Rate for Payer: PACE SWMI |
$557.03
|
| Rate for Payer: PHP Commercial |
$612.73
|
| Rate for Payer: PHP Medicaid |
$304.70
|
| Rate for Payer: PHP Medicare Advantage |
$557.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,304.30
|
| Rate for Payer: Priority Health Medicare |
$557.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,643.44
|
| Rate for Payer: Railroad Medicare Medicare |
$557.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.44
|
| Rate for Payer: UHC Medicare Advantage |
$573.74
|
| Rate for Payer: VA VA |
$557.03
|
|
|
HC MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM BENZODIAZAPINE CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM BENZODIAZAPINE CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM BUPRENORPHINE CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30000100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM BUPRENORPHINE CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30000100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.34
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$65.80
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.82
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.42
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.65
|
| Rate for Payer: Priority Health Narrow Network |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
IP
|
$63.86
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$63.86 |
| Rate for Payer: Aetna Commercial |
$57.47
|
| Rate for Payer: ASR ASR |
$61.94
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$51.09
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.09
|
| Rate for Payer: Healthscope Commercial |
$63.86
|
| Rate for Payer: Healthscope Whirlpool |
$61.94
|
| Rate for Payer: Mclaren Commercial |
$57.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.20
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
OP
|
$63.86
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$63.86 |
| Rate for Payer: Aetna Commercial |
$57.47
|
| Rate for Payer: ASR ASR |
$61.94
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$51.09
|
| Rate for Payer: Cofinity Commercial |
$60.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.09
|
| Rate for Payer: Healthscope Commercial |
$63.86
|
| Rate for Payer: Healthscope Whirlpool |
$61.94
|
| Rate for Payer: Mclaren Commercial |
$57.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Narrow Network |
$45.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.20
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$258.81
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.17 |
| Max. Negotiated Rate |
$258.81 |
| Rate for Payer: Aetna Commercial |
$232.93
|
| Rate for Payer: ASR ASR |
$251.05
|
| Rate for Payer: BCBS Trust/PPO |
$200.66
|
| Rate for Payer: BCN Commercial |
$200.66
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$243.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.05
|
| Rate for Payer: Healthscope Commercial |
$258.81
|
| Rate for Payer: Healthscope Whirlpool |
$251.05
|
| Rate for Payer: Mclaren Commercial |
$232.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.75
|
|
