|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$60.59
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$65.30
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$52.19
|
| Rate for Payer: BCN Commercial |
$52.19
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$67.32
|
| Rate for Payer: Healthscope Whirlpool |
$65.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$60.59
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.24
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: Aetna Commercial |
$60.59
|
| Rate for Payer: ASR ASR |
$65.30
|
| Rate for Payer: BCBS Trust/PPO |
$52.19
|
| Rate for Payer: BCN Commercial |
$52.19
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$67.32
|
| Rate for Payer: Healthscope Whirlpool |
$65.30
|
| Rate for Payer: Mclaren Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.24
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$53.77
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.46
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$53.77
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
OP
|
$68.34
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$595.52 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.47
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$116.38
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
IP
|
$68.34
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: BCBS Trust/PPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.49
|
| Rate for Payer: Priority Health Narrow Network |
$25.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: ASR ASR |
$1,455.00
|
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.95
|
| Rate for Payer: BCN Commercial |
$1,162.95
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,410.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,455.00
|
| Rate for Payer: Mclaren Commercial |
$1,350.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,365.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,065.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: ASR ASR |
$1,455.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.95
|
| Rate for Payer: BCN Commercial |
$1,162.95
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,410.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,455.00
|
| Rate for Payer: Mclaren Commercial |
$1,350.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$2,250.00
|
| Rate for Payer: ASR ASR |
$2,425.00
|
| Rate for Payer: BCBS Complete |
$1,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.25
|
| Rate for Payer: BCN Commercial |
$1,938.25
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$2,350.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,000.00
|
| Rate for Payer: Healthscope Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,425.00
|
| Rate for Payer: Mclaren Commercial |
$2,250.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,125.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,275.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,775.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,200.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$2,250.00
|
| Rate for Payer: ASR ASR |
$2,425.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.25
|
| Rate for Payer: BCN Commercial |
$1,938.25
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$2,350.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,000.00
|
| Rate for Payer: Healthscope Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,425.00
|
| Rate for Payer: Mclaren Commercial |
$2,250.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,125.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,200.00
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$155.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$150.59
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$120.37
|
| Rate for Payer: BCN Commercial |
$120.37
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$145.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Healthscope Whirlpool |
$150.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$139.72
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.96
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.62
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
IP
|
$155.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: ASR ASR |
$150.59
|
| Rate for Payer: BCBS Trust/PPO |
$120.37
|
| Rate for Payer: BCN Commercial |
$120.37
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$145.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.20
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Healthscope Whirlpool |
$150.59
|
| Rate for Payer: Mclaren Commercial |
$139.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.62
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: BCBS Trust/PPO |
$42.70
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: BCBS Trust/PPO |
$42.70
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.31 |
| Max. Negotiated Rate |
$169.02 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: ASR ASR |
$163.95
|
| Rate for Payer: BCBS Trust/PPO |
$131.04
|
| Rate for Payer: BCN Commercial |
$131.04
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$169.02
|
| Rate for Payer: Healthscope Whirlpool |
$163.95
|
| Rate for Payer: Mclaren Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$177.52 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: ASR ASR |
$163.95
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS Trust/PPO |
$131.04
|
| Rate for Payer: BCCCP Commercial |
$45.00
|
| Rate for Payer: BCN Commercial |
$131.04
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$169.02
|
| Rate for Payer: Healthscope Whirlpool |
$163.95
|
| Rate for Payer: Mclaren Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.52
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$205.10 |
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: ASR ASR |
$198.95
|
| Rate for Payer: BCBS Trust/PPO |
$159.01
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$205.10
|
| Rate for Payer: Healthscope Whirlpool |
$198.95
|
| Rate for Payer: Mclaren Commercial |
$184.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.49
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$205.10 |
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: ASR ASR |
$198.95
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS Trust/PPO |
$159.01
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$205.10
|
| Rate for Payer: Healthscope Whirlpool |
$198.95
|
| Rate for Payer: Mclaren Commercial |
$184.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.21
|
| Rate for Payer: Priority Health Narrow Network |
$163.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.49
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.17 |
| Max. Negotiated Rate |
$294.53 |
| Rate for Payer: Aetna Commercial |
$265.08
|
| Rate for Payer: ASR ASR |
$285.69
|
| Rate for Payer: BCBS Trust/PPO |
$228.35
|
| Rate for Payer: BCN Commercial |
$228.35
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$294.53
|
| Rate for Payer: Healthscope Whirlpool |
$285.69
|
| Rate for Payer: Mclaren Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.19
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$294.53 |
| Rate for Payer: Aetna Commercial |
$265.08
|
| Rate for Payer: ASR ASR |
$285.69
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$228.35
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$228.35
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$294.53
|
| Rate for Payer: Healthscope Whirlpool |
$285.69
|
| Rate for Payer: Mclaren Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.02
|
| Rate for Payer: Priority Health Narrow Network |
$209.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.19
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.30 |
| Max. Negotiated Rate |
$490.43 |
| Rate for Payer: Aetna Commercial |
$441.39
|
| Rate for Payer: ASR ASR |
$475.72
|
| Rate for Payer: BCBS Trust/PPO |
$380.23
|
| Rate for Payer: BCN Commercial |
$380.23
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$490.43
|
| Rate for Payer: Healthscope Whirlpool |
$475.72
|
| Rate for Payer: Mclaren Commercial |
$441.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.58
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$490.43 |
| Rate for Payer: Aetna Commercial |
$441.39
|
| Rate for Payer: ASR ASR |
$475.72
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS Trust/PPO |
$380.23
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$380.23
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$490.43
|
| Rate for Payer: Healthscope Whirlpool |
$475.72
|
| Rate for Payer: Mclaren Commercial |
$441.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.29
|
| Rate for Payer: Priority Health Narrow Network |
$348.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.58
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
