|
HC METANEB SUPPLY
|
Facility
|
IP
|
$254.19
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$177.93 |
| Max. Negotiated Rate |
$254.19 |
| Rate for Payer: Aetna Commercial |
$228.77
|
| Rate for Payer: ASR ASR |
$246.56
|
| Rate for Payer: BCBS Trust/PPO |
$197.07
|
| Rate for Payer: BCN Commercial |
$197.07
|
| Rate for Payer: Cash Price |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$238.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.35
|
| Rate for Payer: Healthscope Commercial |
$254.19
|
| Rate for Payer: Healthscope Whirlpool |
$246.56
|
| Rate for Payer: Mclaren Commercial |
$228.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.69
|
|
|
HC METANEPHRINES FRACTIONATION URINE
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Aetna Commercial |
$40.39
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$43.53
|
| Rate for Payer: BCBS Complete |
$9.73
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Whirlpool |
$43.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$9.27
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$9.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.27
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$32.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.49
|
| Rate for Payer: UHC Medicare Advantage |
$17.45
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES FRACTIONATION URINE
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Aetna Commercial |
$40.39
|
| Rate for Payer: ASR ASR |
$43.53
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Whirlpool |
$43.53
|
| Rate for Payer: Mclaren Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.49
|
|
|
HC METANEPHRINES PLASMA
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30200013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$59.17
|
| Rate for Payer: BCBS Complete |
$9.73
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Mclaren Medicaid |
$9.27
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$9.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.27
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$32.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
| Rate for Payer: UHC Medicare Advantage |
$17.45
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES PLASMA
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30200013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: ASR ASR |
$59.17
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
|
|
HC METANEPHRINES URINE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC METANEPHRINES URINE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Complete |
$9.73
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$9.27
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$9.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.27
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$32.02
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Medicare Advantage |
$17.45
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METASTRON SR 89 THERAPEUTIC PER MCI
|
Facility
|
IP
|
$1,763.70
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
34400003
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,234.59 |
| Max. Negotiated Rate |
$1,763.70 |
| Rate for Payer: Aetna Commercial |
$1,587.33
|
| Rate for Payer: ASR ASR |
$1,710.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.40
|
| Rate for Payer: BCN Commercial |
$1,367.40
|
| Rate for Payer: Cash Price |
$1,410.96
|
| Rate for Payer: Cofinity Commercial |
$1,657.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,410.96
|
| Rate for Payer: Healthscope Commercial |
$1,763.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,710.79
|
| Rate for Payer: Mclaren Commercial |
$1,587.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,499.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,234.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,552.06
|
|
|
HC METASTRON SR 89 THERAPEUTIC PER MCI
|
Facility
|
OP
|
$1,763.70
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
34400003
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,234.59 |
| Max. Negotiated Rate |
$5,195.72 |
| Rate for Payer: Aetna Commercial |
$1,587.33
|
| Rate for Payer: Aetna Medicare |
$4,156.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,195.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,195.72
|
| Rate for Payer: ASR ASR |
$1,710.79
|
| Rate for Payer: BCBS Complete |
$2,387.54
|
| Rate for Payer: BCBS MAPPO |
$4,156.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.40
|
| Rate for Payer: BCN Commercial |
$1,367.40
|
| Rate for Payer: BCN Medicare Advantage |
$4,156.57
|
| Rate for Payer: Cash Price |
$1,410.96
|
| Rate for Payer: Cash Price |
$1,410.96
|
| Rate for Payer: Cofinity Commercial |
$1,657.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,410.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,156.57
|
| Rate for Payer: Healthscope Commercial |
$1,763.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,710.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,156.57
|
| Rate for Payer: Mclaren Commercial |
$1,587.33
|
| Rate for Payer: Mclaren Medicaid |
$2,273.65
|
| Rate for Payer: Mclaren Medicare |
$4,156.57
|
| Rate for Payer: Meridian Medicaid |
$2,387.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,364.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,780.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,499.14
|
| Rate for Payer: PACE Medicare |
$3,948.74
|
| Rate for Payer: PACE SWMI |
$4,156.57
|
| Rate for Payer: PHP Commercial |
$4,572.23
|
| Rate for Payer: PHP Medicaid |
$2,273.65
|
| Rate for Payer: PHP Medicare Advantage |
$4,156.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,273.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,234.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,604.97
|
| Rate for Payer: Priority Health Medicare |
$4,156.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,252.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,156.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,552.06
|
| Rate for Payer: UHC Medicare Advantage |
$4,281.27
|
| Rate for Payer: VA VA |
$4,156.57
|
|
|
HC METHADONE CONFIRM MECON
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100574
|
|
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 METHADONE CONFIRM MECON
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100574
|
|
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 METHADONE SCRN URIN
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000118
|
|
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 METHADONE SCRN URIN
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000118
|
|
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 METHADONE SCRN URN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC METHADONE SCRN URN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC METHADONE SERUM LVL
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: ASR ASR |
$75.66
|
| Rate for Payer: BCBS Trust/PPO |
$60.47
|
| Rate for Payer: BCN Commercial |
$60.47
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$73.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$78.00
|
| Rate for Payer: Healthscope Whirlpool |
$75.66
|
| Rate for Payer: Mclaren Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.64
|
|
|
HC METHADONE SERUM LVL
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: ASR ASR |
$75.66
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$60.47
|
| Rate for Payer: BCN Commercial |
$60.47
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$73.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$78.00
|
| Rate for Payer: Healthscope Whirlpool |
$75.66
|
| Rate for Payer: Mclaren Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.98
|
| Rate for Payer: Priority Health Narrow Network |
$55.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.64
|
|
|
HC METHADONE URN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.52
|
| Rate for Payer: BCN Commercial |
$46.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$60.00
|
| Rate for Payer: Healthscope Whirlpool |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.60
|
| Rate for Payer: Priority Health Narrow Network |
$42.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC METHADONE URN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$46.52
|
| Rate for Payer: BCN Commercial |
$46.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$60.00
|
| Rate for Payer: Healthscope Whirlpool |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC METHANOL LVL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: ASR ASR |
$151.32
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$120.95
|
| Rate for Payer: BCN Commercial |
$120.95
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$156.00
|
| Rate for Payer: Healthscope Whirlpool |
$151.32
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.96
|
| Rate for Payer: Priority Health Narrow Network |
$110.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
|
|
HC METHANOL LVL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: ASR ASR |
$151.32
|
| Rate for Payer: BCBS Trust/PPO |
$120.95
|
| Rate for Payer: BCN Commercial |
$120.95
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$156.00
|
| Rate for Payer: Healthscope Whirlpool |
$151.32
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
|
|
HC METHEMOGLOBIN
|
Facility
|
OP
|
$46.10
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$64.65 |
| Rate for Payer: Aetna Commercial |
$41.49
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.25
|
| Rate for Payer: ASR ASR |
$44.72
|
| Rate for Payer: BCBS Complete |
$4.71
|
| Rate for Payer: BCBS MAPPO |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.74
|
| Rate for Payer: BCN Commercial |
$35.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.20
|
| Rate for Payer: Cash Price |
$36.88
|
| Rate for Payer: Cash Price |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$43.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.20
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Healthscope Whirlpool |
$44.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.20
|
| Rate for Payer: Mclaren Commercial |
$41.49
|
| Rate for Payer: Mclaren Medicaid |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$8.20
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.18
|
| Rate for Payer: PACE Medicare |
$7.79
|
| Rate for Payer: PACE SWMI |
$8.20
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: PHP Medicaid |
$4.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.65
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health Narrow Network |
$51.72
|
| Rate for Payer: Railroad Medicare Medicare |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.57
|
| Rate for Payer: UHC Medicare Advantage |
$8.45
|
| Rate for Payer: VA VA |
$8.20
|
|
|
HC METHEMOGLOBIN
|
Facility
|
IP
|
$46.10
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$41.49
|
| Rate for Payer: ASR ASR |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$35.74
|
| Rate for Payer: BCN Commercial |
$35.74
|
| Rate for Payer: Cash Price |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$43.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.88
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Healthscope Whirlpool |
$44.72
|
| Rate for Payer: Mclaren Commercial |
$41.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.57
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
OP
|
$173.50
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$156.15
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$168.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$134.51
|
| Rate for Payer: BCN Commercial |
$134.51
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cofinity Commercial |
$163.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$173.50
|
| Rate for Payer: Healthscope Whirlpool |
$168.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$156.15
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.48
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.87
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.68
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
IP
|
$173.50
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.45 |
| Max. Negotiated Rate |
$173.50 |
| Rate for Payer: Aetna Commercial |
$156.15
|
| Rate for Payer: ASR ASR |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$134.51
|
| Rate for Payer: BCN Commercial |
$134.51
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cofinity Commercial |
$163.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.80
|
| Rate for Payer: Healthscope Commercial |
$173.50
|
| Rate for Payer: Healthscope Whirlpool |
$168.30
|
| Rate for Payer: Mclaren Commercial |
$156.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.68
|
|
