|
HC FENTANYL URINE.
|
Facility
|
OP
|
$97.31
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Aetna Commercial |
$87.58
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$94.39
|
| Rate for Payer: ASR Commercial |
$94.39
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.69
|
| Rate for Payer: BCN Commercial |
$75.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cofinity Commercial |
$91.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Healthscope Whirlpool |
$94.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$87.58
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.71
|
| Rate for Payer: Nomi Health Commercial |
$79.79
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$68.21
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC FENTANYL URINE.
|
Facility
|
IP
|
$97.31
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Aetna Commercial |
$87.58
|
| Rate for Payer: ASR ASR |
$94.39
|
| Rate for Payer: ASR Commercial |
$94.39
|
| Rate for Payer: BCBS Trust/PPO |
$79.30
|
| Rate for Payer: BCN Commercial |
$75.44
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cofinity Commercial |
$91.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.85
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Healthscope Whirlpool |
$94.39
|
| Rate for Payer: Mclaren Commercial |
$87.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.71
|
| Rate for Payer: Nomi Health Commercial |
$79.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.63
|
|
|
HC FERRITIN LEVEL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.04
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| 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 |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$13.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: Meridian Medicaid |
$7.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: PHP Medicaid |
$7.31
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.31
|
| 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 |
$13.63
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.63
|
| Rate for Payer: UHC Exchange |
$21.13
|
| Rate for Payer: UHC Medicare Advantage |
$13.63
|
| Rate for Payer: UHCCP DNSP |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$7.31
|
| Rate for Payer: VA VA |
$13.63
|
|
|
HC FERRITIN LEVEL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
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 FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: Aetna Commercial |
$307.12
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$331.01
|
| Rate for Payer: ASR Commercial |
$331.01
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$279.45
|
| Rate for Payer: BCN Commercial |
$264.57
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$320.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$341.25
|
| Rate for Payer: Healthscope Whirlpool |
$331.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$307.12
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.00
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$239.22
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$221.81 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: Aetna Commercial |
$307.12
|
| Rate for Payer: ASR ASR |
$331.01
|
| Rate for Payer: ASR Commercial |
$331.01
|
| Rate for Payer: BCBS Trust/PPO |
$278.08
|
| Rate for Payer: BCN Commercial |
$264.57
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$320.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Healthscope Commercial |
$341.25
|
| Rate for Payer: Healthscope Whirlpool |
$331.01
|
| Rate for Payer: Mclaren Commercial |
$307.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.30
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$435.23
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$435.23 |
| Rate for Payer: Aetna Commercial |
$391.71
|
| Rate for Payer: Aetna Medicare |
$64.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: ASR ASR |
$422.17
|
| Rate for Payer: ASR Commercial |
$422.17
|
| Rate for Payer: BCBS Complete |
$36.25
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$356.41
|
| Rate for Payer: BCN Commercial |
$337.43
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cofinity Commercial |
$409.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$435.23
|
| Rate for Payer: Healthscope Whirlpool |
$422.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$391.71
|
| Rate for Payer: Mclaren Medicaid |
$34.52
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: Meridian Medicaid |
$36.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.95
|
| Rate for Payer: Nomi Health Commercial |
$356.89
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$70.85
|
| Rate for Payer: PHP Medicaid |
$34.52
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.35
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health Narrow Network |
$305.10
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.41
|
| Rate for Payer: UHC Exchange |
$99.84
|
| Rate for Payer: UHC Medicare Advantage |
$64.41
|
| Rate for Payer: UHCCP DNSP |
$64.41
|
| Rate for Payer: UHCCP Medicaid |
$34.52
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$435.23
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$282.90 |
| Max. Negotiated Rate |
$435.23 |
| Rate for Payer: Aetna Commercial |
$391.71
|
| Rate for Payer: ASR ASR |
$422.17
|
| Rate for Payer: ASR Commercial |
$422.17
|
| Rate for Payer: BCBS Trust/PPO |
$354.67
|
| Rate for Payer: BCN Commercial |
$337.43
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cofinity Commercial |
$409.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.18
|
| Rate for Payer: Healthscope Commercial |
$435.23
|
| Rate for Payer: Healthscope Whirlpool |
$422.17
|
| Rate for Payer: Mclaren Commercial |
$391.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.95
|
| Rate for Payer: Nomi Health Commercial |
$356.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.00
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$305.26
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.42 |
| Max. Negotiated Rate |
$305.26 |
| Rate for Payer: Aetna Commercial |
$274.73
|
| Rate for Payer: ASR ASR |
$296.10
|
| Rate for Payer: ASR Commercial |
$296.10
|
| Rate for Payer: BCBS Trust/PPO |
$248.76
|
| Rate for Payer: BCN Commercial |
$236.67
|
| Rate for Payer: Cash Price |
$244.21
|
| Rate for Payer: Cofinity Commercial |
$286.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.21
|
| Rate for Payer: Healthscope Commercial |
$305.26
|
| Rate for Payer: Healthscope Whirlpool |
$296.10
|
| Rate for Payer: Mclaren Commercial |
$274.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.47
|
| Rate for Payer: Nomi Health Commercial |
$250.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.63
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$305.26
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$305.26 |
| Rate for Payer: Aetna Commercial |
$274.73
|
| Rate for Payer: Aetna Medicare |
$152.63
|
| Rate for Payer: ASR ASR |
$296.10
|
| Rate for Payer: ASR Commercial |
$296.10
|
| Rate for Payer: BCBS Complete |
$122.10
|
| Rate for Payer: BCBS Trust/PPO |
$249.98
|
| Rate for Payer: BCN Commercial |
$236.67
|
| Rate for Payer: Cash Price |
$244.21
|
| Rate for Payer: Cofinity Commercial |
$286.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.21
|
| Rate for Payer: Healthscope Commercial |
$305.26
|
| Rate for Payer: Healthscope Whirlpool |
$296.10
|
| Rate for Payer: Mclaren Commercial |
$274.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.47
|
| Rate for Payer: Nomi Health Commercial |
$250.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.47
|
| Rate for Payer: Priority Health Narrow Network |
$213.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.63
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$74.05
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$66.64
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: ASR ASR |
$71.83
|
| Rate for Payer: ASR Commercial |
$71.83
|
| Rate for Payer: BCBS Complete |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: BCN Commercial |
$57.41
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$69.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$74.05
|
| Rate for Payer: Healthscope Whirlpool |
$71.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.36
|
| Rate for Payer: Mclaren Commercial |
$66.64
|
| Rate for Payer: Mclaren Medicaid |
$5.02
|
| Rate for Payer: Mclaren Medicare |
$9.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.94
|
| Rate for Payer: Nomi Health Commercial |
$60.72
|
| Rate for Payer: PACE Medicare |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.30
|
| Rate for Payer: PHP Medicaid |
$5.02
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.88
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health Narrow Network |
$51.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Exchange |
$14.51
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$5.02
|
| Rate for Payer: VA VA |
$9.36
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$74.05
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$66.64
|
| Rate for Payer: ASR ASR |
$71.83
|
| Rate for Payer: ASR Commercial |
$71.83
|
| Rate for Payer: BCBS Trust/PPO |
$60.34
|
| Rate for Payer: BCN Commercial |
$57.41
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$69.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.24
|
| Rate for Payer: Healthscope Commercial |
$74.05
|
| Rate for Payer: Healthscope Whirlpool |
$71.83
|
| Rate for Payer: Mclaren Commercial |
$66.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.94
|
| Rate for Payer: Nomi Health Commercial |
$60.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.16
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$206.64
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$185.98
|
| Rate for Payer: ASR ASR |
$200.44
|
| Rate for Payer: ASR Commercial |
$200.44
|
| Rate for Payer: BCBS Trust/PPO |
$168.39
|
| Rate for Payer: BCN Commercial |
$160.21
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$194.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Healthscope Commercial |
$206.64
|
| Rate for Payer: Healthscope Whirlpool |
$200.44
|
| Rate for Payer: Mclaren Commercial |
$185.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: Nomi Health Commercial |
$169.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.84
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$206.64
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$185.98
|
| Rate for Payer: Aetna Medicare |
$103.32
|
| Rate for Payer: ASR ASR |
$200.44
|
| Rate for Payer: ASR Commercial |
$200.44
|
| Rate for Payer: BCBS Complete |
$82.66
|
| Rate for Payer: BCBS Trust/PPO |
$169.22
|
| Rate for Payer: BCN Commercial |
$160.21
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$194.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Healthscope Commercial |
$206.64
|
| Rate for Payer: Healthscope Whirlpool |
$200.44
|
| Rate for Payer: Mclaren Commercial |
$185.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: Nomi Health Commercial |
$169.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.06
|
| Rate for Payer: Priority Health Narrow Network |
$144.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.84
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$255.60
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.48
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$218.80
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.88 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$254.35
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.60 |
| Max. Negotiated Rate |
$2,096.50 |
| Rate for Payer: Aetna Commercial |
$1,886.85
|
| Rate for Payer: Aetna Medicare |
$1,048.25
|
| Rate for Payer: ASR ASR |
$2,033.61
|
| Rate for Payer: ASR Commercial |
$2,033.61
|
| Rate for Payer: BCBS Complete |
$838.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.82
|
| Rate for Payer: BCN Commercial |
$1,625.42
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,970.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$2,096.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,033.61
|
| Rate for Payer: Mclaren Commercial |
$1,886.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.03
|
| Rate for Payer: Nomi Health Commercial |
$1,719.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,836.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,469.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,844.92
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,362.72 |
| Max. Negotiated Rate |
$2,096.50 |
| Rate for Payer: Aetna Commercial |
$1,886.85
|
| Rate for Payer: ASR ASR |
$2,033.61
|
| Rate for Payer: ASR Commercial |
$2,033.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.44
|
| Rate for Payer: BCN Commercial |
$1,625.42
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,970.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$2,096.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,033.61
|
| Rate for Payer: Mclaren Commercial |
$1,886.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.03
|
| Rate for Payer: Nomi Health Commercial |
$1,719.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,844.92
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,551.43 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: Aetna Medicare |
$1,939.29
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Complete |
$1,551.43
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.16
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,398.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,718.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,521.07 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,160.65
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$840.56 |
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: ASR ASR |
$815.34
|
| Rate for Payer: ASR Commercial |
$815.34
|
| Rate for Payer: BCBS Trust/PPO |
$684.97
|
| Rate for Payer: BCN Commercial |
$651.69
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$790.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$840.56
|
| Rate for Payer: Healthscope Whirlpool |
$815.34
|
| Rate for Payer: Mclaren Commercial |
$756.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: Nomi Health Commercial |
$689.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.69
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$336.22 |
| Max. Negotiated Rate |
$840.56 |
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: ASR ASR |
$815.34
|
| Rate for Payer: ASR Commercial |
$815.34
|
| Rate for Payer: BCBS Complete |
$336.22
|
| Rate for Payer: BCBS Trust/PPO |
$688.33
|
| Rate for Payer: BCN Commercial |
$651.69
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$790.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$840.56
|
| Rate for Payer: Healthscope Whirlpool |
$815.34
|
| Rate for Payer: Mclaren Commercial |
$756.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: Nomi Health Commercial |
$689.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.50
|
| Rate for Payer: Priority Health Narrow Network |
$589.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.69
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,739.68 |
| Max. Negotiated Rate |
$2,676.43 |
| Rate for Payer: Aetna Commercial |
$2,408.79
|
| Rate for Payer: ASR ASR |
$2,596.14
|
| Rate for Payer: ASR Commercial |
$2,596.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.02
|
| Rate for Payer: BCN Commercial |
$2,075.04
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$2,515.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,676.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,596.14
|
| Rate for Payer: Mclaren Commercial |
$2,408.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: Nomi Health Commercial |
$2,194.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,355.26
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,070.57 |
| Max. Negotiated Rate |
$2,676.43 |
| Rate for Payer: Aetna Commercial |
$2,408.79
|
| Rate for Payer: Aetna Medicare |
$1,338.21
|
| Rate for Payer: ASR ASR |
$2,596.14
|
| Rate for Payer: ASR Commercial |
$2,596.14
|
| Rate for Payer: BCBS Complete |
$1,070.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,191.73
|
| Rate for Payer: BCN Commercial |
$2,075.04
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$2,515.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,676.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,596.14
|
| Rate for Payer: Mclaren Commercial |
$2,408.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: Nomi Health Commercial |
$2,194.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,345.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,876.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,355.26
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.67
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
