|
HC OPEN HEART TEG
|
Facility
|
OP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$216.62 |
| Max. Negotiated Rate |
$541.54 |
| Rate for Payer: Aetna Commercial |
$487.39
|
| Rate for Payer: ASR ASR |
$525.29
|
| Rate for Payer: BCBS Complete |
$216.62
|
| Rate for Payer: BCBS Trust/PPO |
$419.86
|
| Rate for Payer: BCN Commercial |
$419.86
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$509.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.23
|
| Rate for Payer: Healthscope Commercial |
$541.54
|
| Rate for Payer: Healthscope Whirlpool |
$525.29
|
| Rate for Payer: Mclaren Commercial |
$487.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.80
|
| Rate for Payer: Priority Health Narrow Network |
$384.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.56
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.08 |
| Max. Negotiated Rate |
$541.54 |
| Rate for Payer: Aetna Commercial |
$487.39
|
| Rate for Payer: ASR ASR |
$525.29
|
| Rate for Payer: BCBS Trust/PPO |
$419.86
|
| Rate for Payer: BCN Commercial |
$419.86
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$509.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.23
|
| Rate for Payer: Healthscope Commercial |
$541.54
|
| Rate for Payer: Healthscope Whirlpool |
$525.29
|
| Rate for Payer: Mclaren Commercial |
$487.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.56
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$342.38 |
| Rate for Payer: Aetna Commercial |
$308.14
|
| Rate for Payer: ASR ASR |
$332.11
|
| Rate for Payer: BCBS Complete |
$136.95
|
| Rate for Payer: BCBS Trust/PPO |
$265.45
|
| Rate for Payer: BCN Commercial |
$265.45
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$321.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.90
|
| Rate for Payer: Healthscope Commercial |
$342.38
|
| Rate for Payer: Healthscope Whirlpool |
$332.11
|
| Rate for Payer: Mclaren Commercial |
$308.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.57
|
| Rate for Payer: Priority Health Narrow Network |
$243.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.29
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$239.67 |
| Max. Negotiated Rate |
$342.38 |
| Rate for Payer: Aetna Commercial |
$308.14
|
| Rate for Payer: ASR ASR |
$332.11
|
| Rate for Payer: BCBS Trust/PPO |
$265.45
|
| Rate for Payer: BCN Commercial |
$265.45
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$321.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.90
|
| Rate for Payer: Healthscope Commercial |
$342.38
|
| Rate for Payer: Healthscope Whirlpool |
$332.11
|
| Rate for Payer: Mclaren Commercial |
$308.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.29
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$189.47 |
| Rate for Payer: Aetna Commercial |
$170.52
|
| Rate for Payer: ASR ASR |
$183.79
|
| Rate for Payer: BCBS Trust/PPO |
$146.90
|
| Rate for Payer: BCN Commercial |
$146.90
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$178.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$189.47
|
| Rate for Payer: Healthscope Whirlpool |
$183.79
|
| Rate for Payer: Mclaren Commercial |
$170.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.73
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$189.47 |
| Rate for Payer: Aetna Commercial |
$170.52
|
| Rate for Payer: ASR ASR |
$183.79
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$146.90
|
| Rate for Payer: BCN Commercial |
$146.90
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$178.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$189.47
|
| Rate for Payer: Healthscope Whirlpool |
$183.79
|
| Rate for Payer: Mclaren Commercial |
$170.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.42
|
| Rate for Payer: Priority Health Narrow Network |
$134.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.73
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$339.77 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$621.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$776.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$776.44
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: BCBS Complete |
$356.79
|
| Rate for Payer: BCBS MAPPO |
$621.15
|
| Rate for Payer: BCBS Trust/PPO |
$751.27
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: BCN Medicare Advantage |
$621.15
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.15
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$621.15
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$339.77
|
| Rate for Payer: Mclaren Medicare |
$621.15
|
| Rate for Payer: Meridian Medicaid |
$356.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PACE Medicare |
$590.09
|
| Rate for Payer: PACE SWMI |
$621.15
|
| Rate for Payer: PHP Commercial |
$683.26
|
| Rate for Payer: PHP Medicaid |
$339.77
|
| Rate for Payer: PHP Medicare Advantage |
$621.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.79
|
| Rate for Payer: Priority Health Medicare |
$621.15
|
| Rate for Payer: Priority Health Narrow Network |
$687.99
|
| Rate for Payer: Railroad Medicare Medicare |
$621.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
| Rate for Payer: UHC Medicare Advantage |
$639.78
|
| Rate for Payer: VA VA |
$621.15
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$678.30 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$751.27
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: ASR ASR |
$60.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.07
|
| Rate for Payer: BCN Commercial |
$48.07
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$58.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$62.00
|
| Rate for Payer: Healthscope Whirlpool |
$60.14
|
| Rate for Payer: Mclaren Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.56
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: ASR ASR |
$60.14
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS Trust/PPO |
$48.07
|
| Rate for Payer: BCN Commercial |
$48.07
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$58.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$62.00
|
| Rate for Payer: Healthscope Whirlpool |
$60.14
|
| Rate for Payer: Mclaren Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.56
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| 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 Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| 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 |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.85
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$21.73
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$85.86
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$92.54
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$73.96
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$89.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Healthscope Whirlpool |
$92.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.86
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.81
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.95
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.34
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$65.80
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$60.71
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Aetna Commercial |
$54.64
|
| Rate for Payer: ASR ASR |
$58.89
|
| Rate for Payer: BCBS Trust/PPO |
$47.07
|
| Rate for Payer: BCN Commercial |
$47.07
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$57.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Healthscope Commercial |
$60.71
|
| Rate for Payer: Healthscope Whirlpool |
$58.89
|
| Rate for Payer: Mclaren Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.42
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$60.71
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Aetna Commercial |
$54.64
|
| Rate for Payer: ASR ASR |
$58.89
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$47.07
|
| Rate for Payer: BCN Commercial |
$47.07
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$57.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Healthscope Commercial |
$60.71
|
| Rate for Payer: Healthscope Whirlpool |
$58.89
|
| Rate for Payer: Mclaren Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.25
|
| Rate for Payer: Priority Health Narrow Network |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.42
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.68
|
| Rate for Payer: Priority Health Narrow Network |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.68
|
| Rate for Payer: Priority Health Narrow Network |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.68
|
| Rate for Payer: Priority Health Narrow Network |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
