|
HC FECAL LEUKOCYTE ASSESSMENT
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: ASR ASR |
$52.24
|
| Rate for Payer: ASR Commercial |
$52.24
|
| Rate for Payer: BCBS Trust/PPO |
$43.89
|
| Rate for Payer: BCN Commercial |
$41.76
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$50.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.24
|
| Rate for Payer: Mclaren Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: Nomi Health Commercial |
$44.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.40
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
IP
|
$1,307.32
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$849.76 |
| Max. Negotiated Rate |
$1,307.32 |
| Rate for Payer: Aetna Commercial |
$1,176.59
|
| Rate for Payer: ASR ASR |
$1,268.10
|
| Rate for Payer: ASR Commercial |
$1,268.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.34
|
| Rate for Payer: BCN Commercial |
$1,013.57
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cofinity Commercial |
$1,228.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.86
|
| Rate for Payer: Healthscope Commercial |
$1,307.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,268.10
|
| Rate for Payer: Mclaren Commercial |
$1,176.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.22
|
| Rate for Payer: Nomi Health Commercial |
$1,072.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,150.44
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
OP
|
$1,307.32
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$1,176.59
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$1,268.10
|
| Rate for Payer: ASR Commercial |
$1,268.10
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.56
|
| Rate for Payer: BCN Commercial |
$1,013.57
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cofinity Commercial |
$1,228.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,307.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,268.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$1,176.59
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.22
|
| Rate for Payer: Nomi Health Commercial |
$1,072.00
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.47
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$916.43
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,150.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| Rate for Payer: Mclaren Medicare |
$15.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: Meridian Medicaid |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Medicare |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$17.51
|
| Rate for Payer: PHP Medicaid |
$8.53
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.35
|
| Rate for Payer: Priority Health Medicare |
$15.92
|
| Rate for Payer: Priority Health Narrow Network |
$21.88
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.92
|
| Rate for Payer: UHC Exchange |
$24.68
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UHCCP DNSP |
$15.92
|
| Rate for Payer: UHCCP Medicaid |
$8.53
|
| Rate for Payer: VA VA |
$15.92
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.47
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.38
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Mclaren Medicare |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Medicare |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$4.82
|
| Rate for Payer: PHP Medicaid |
$2.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$6.79
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHCCP DNSP |
$4.38
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: VA VA |
$4.38
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC FECAL PH
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
|
|
HC FECAL PH
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.47
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.58
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$1.92
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: PHP Medicaid |
$1.92
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.97
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$16.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: UHCCP DNSP |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$42.02
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.50
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$6.05
|
| Rate for Payer: PHP Medicaid |
$2.95
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.96
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health Narrow Network |
$35.97
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Exchange |
$8.53
|
| Rate for Payer: UHC Medicare Advantage |
$5.50
|
| Rate for Payer: UHCCP DNSP |
$5.50
|
| Rate for Payer: UHCCP Medicaid |
$2.95
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$41.81
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
IP
|
$75.33
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$75.33 |
| Rate for Payer: Aetna Commercial |
$67.80
|
| Rate for Payer: ASR ASR |
$73.07
|
| Rate for Payer: ASR Commercial |
$73.07
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCN Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$70.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Healthscope Commercial |
$75.33
|
| Rate for Payer: Healthscope Whirlpool |
$73.07
|
| Rate for Payer: Mclaren Commercial |
$67.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.03
|
| Rate for Payer: Nomi Health Commercial |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.29
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
OP
|
$75.33
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$75.33 |
| Rate for Payer: Aetna Commercial |
$67.80
|
| Rate for Payer: Aetna Medicare |
$19.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: ASR ASR |
$73.07
|
| Rate for Payer: ASR Commercial |
$73.07
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$61.69
|
| Rate for Payer: BCN Commercial |
$58.40
|
| Rate for Payer: BCN Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$70.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$75.33
|
| Rate for Payer: Healthscope Whirlpool |
$73.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.70
|
| Rate for Payer: Mclaren Commercial |
$67.80
|
| Rate for Payer: Mclaren Medicaid |
$10.56
|
| Rate for Payer: Mclaren Medicare |
$19.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: Meridian Medicaid |
$11.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.03
|
| Rate for Payer: Nomi Health Commercial |
$61.77
|
| Rate for Payer: PACE Medicare |
$18.71
|
| Rate for Payer: PACE SWMI |
$19.70
|
| Rate for Payer: PHP Commercial |
$21.67
|
| Rate for Payer: PHP Medicaid |
$10.56
|
| Rate for Payer: PHP Medicare Advantage |
$19.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.00
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow Network |
$52.81
|
| Rate for Payer: Railroad Medicare Medicare |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.70
|
| Rate for Payer: UHC Exchange |
$30.54
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: UHCCP DNSP |
$19.70
|
| Rate for Payer: UHCCP Medicaid |
$10.56
|
| Rate for Payer: VA VA |
$19.70
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| 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 |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| 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 |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$311.88 |
| Max. Negotiated Rate |
$479.81 |
| Rate for Payer: Aetna Commercial |
$431.83
|
| Rate for Payer: ASR ASR |
$465.42
|
| Rate for Payer: ASR Commercial |
$465.42
|
| Rate for Payer: BCBS Trust/PPO |
$391.00
|
| Rate for Payer: BCN Commercial |
$372.00
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$451.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$479.81
|
| Rate for Payer: Healthscope Whirlpool |
$465.42
|
| Rate for Payer: Mclaren Commercial |
$431.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: Nomi Health Commercial |
$393.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.23
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.92 |
| Max. Negotiated Rate |
$479.81 |
| Rate for Payer: Aetna Commercial |
$431.83
|
| Rate for Payer: Aetna Medicare |
$239.91
|
| Rate for Payer: ASR ASR |
$465.42
|
| Rate for Payer: ASR Commercial |
$465.42
|
| Rate for Payer: BCBS Complete |
$191.92
|
| Rate for Payer: BCBS Trust/PPO |
$392.92
|
| Rate for Payer: BCN Commercial |
$372.00
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$451.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$479.81
|
| Rate for Payer: Healthscope Whirlpool |
$465.42
|
| Rate for Payer: Mclaren Commercial |
$431.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: Nomi Health Commercial |
$393.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.41
|
| Rate for Payer: Priority Health Narrow Network |
$336.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.23
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$356.50 |
| Rate for Payer: Aetna Commercial |
$320.85
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$345.81
|
| Rate for Payer: ASR Commercial |
$345.81
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$291.94
|
| Rate for Payer: BCN Commercial |
$276.39
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$335.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$356.50
|
| Rate for Payer: Healthscope Whirlpool |
$345.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$320.85
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: Nomi Health Commercial |
$292.33
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.37
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$249.91
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.72 |
| Max. Negotiated Rate |
$356.50 |
| Rate for Payer: Aetna Commercial |
$320.85
|
| Rate for Payer: ASR ASR |
$345.81
|
| Rate for Payer: ASR Commercial |
$345.81
|
| Rate for Payer: BCBS Trust/PPO |
$290.51
|
| Rate for Payer: BCN Commercial |
$276.39
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$335.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$356.50
|
| Rate for Payer: Healthscope Whirlpool |
$345.81
|
| Rate for Payer: Mclaren Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: Nomi Health Commercial |
$292.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.72
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$356.50 |
| Rate for Payer: Aetna Commercial |
$320.85
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$345.81
|
| Rate for Payer: ASR Commercial |
$345.81
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$291.94
|
| Rate for Payer: BCN Commercial |
$276.39
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$335.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$356.50
|
| Rate for Payer: Healthscope Whirlpool |
$345.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$320.85
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: Nomi Health Commercial |
$292.33
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.37
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$249.91
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.72 |
| Max. Negotiated Rate |
$356.50 |
| Rate for Payer: Aetna Commercial |
$320.85
|
| Rate for Payer: ASR ASR |
$345.81
|
| Rate for Payer: ASR Commercial |
$345.81
|
| Rate for Payer: BCBS Trust/PPO |
$290.51
|
| Rate for Payer: BCN Commercial |
$276.39
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$335.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$356.50
|
| Rate for Payer: Healthscope Whirlpool |
$345.81
|
| Rate for Payer: Mclaren Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: Nomi Health Commercial |
$292.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.72
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.94 |
| Max. Negotiated Rate |
$202.98 |
| Rate for Payer: Aetna Commercial |
$182.68
|
| Rate for Payer: ASR ASR |
$196.89
|
| Rate for Payer: ASR Commercial |
$196.89
|
| Rate for Payer: BCBS Trust/PPO |
$165.41
|
| Rate for Payer: BCN Commercial |
$157.37
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$190.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$202.98
|
| Rate for Payer: Healthscope Whirlpool |
$196.89
|
| Rate for Payer: Mclaren Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: Nomi Health Commercial |
$166.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.62
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.19 |
| Max. Negotiated Rate |
$202.98 |
| Rate for Payer: Aetna Commercial |
$182.68
|
| Rate for Payer: Aetna Medicare |
$101.49
|
| Rate for Payer: ASR ASR |
$196.89
|
| Rate for Payer: ASR Commercial |
$196.89
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: BCBS Trust/PPO |
$166.22
|
| Rate for Payer: BCN Commercial |
$157.37
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$190.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$202.98
|
| Rate for Payer: Healthscope Whirlpool |
$196.89
|
| Rate for Payer: Mclaren Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: Nomi Health Commercial |
$166.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.85
|
| Rate for Payer: Priority Health Narrow Network |
$142.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.62
|
|
|
HC FENTANYL UR
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$211.14
|
| Rate for Payer: Aetna Medicare |
$117.30
|
| Rate for Payer: ASR ASR |
$227.56
|
| Rate for Payer: ASR Commercial |
$227.56
|
| Rate for Payer: BCBS Complete |
$93.84
|
| Rate for Payer: BCBS Trust/PPO |
$192.11
|
| Rate for Payer: BCN Commercial |
$181.89
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$220.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$234.60
|
| Rate for Payer: Healthscope Whirlpool |
$227.56
|
| Rate for Payer: Mclaren Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Nomi Health Commercial |
$192.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.56
|
| Rate for Payer: Priority Health Narrow Network |
$164.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.45
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$152.49 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$211.14
|
| Rate for Payer: ASR ASR |
$227.56
|
| Rate for Payer: ASR Commercial |
$227.56
|
| Rate for Payer: BCBS Trust/PPO |
$191.18
|
| Rate for Payer: BCN Commercial |
$181.89
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$220.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$234.60
|
| Rate for Payer: Healthscope Whirlpool |
$227.56
|
| Rate for Payer: Mclaren Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: Nomi Health Commercial |
$192.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.45
|
|
