|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$12,804.30
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,963.01 |
| Max. Negotiated Rate |
$12,804.30 |
| Rate for Payer: Aetna Commercial |
$11,523.87
|
| Rate for Payer: ASR ASR |
$12,420.17
|
| Rate for Payer: BCBS Trust/PPO |
$9,927.17
|
| Rate for Payer: BCN Commercial |
$9,927.17
|
| Rate for Payer: Cash Price |
$10,243.44
|
| Rate for Payer: Cofinity Commercial |
$12,036.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,243.44
|
| Rate for Payer: Healthscope Commercial |
$12,804.30
|
| Rate for Payer: Healthscope Whirlpool |
$12,420.17
|
| Rate for Payer: Mclaren Commercial |
$11,523.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,883.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,963.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,267.78
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Medicare |
$51.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.84
|
| Rate for Payer: ASR ASR |
$417.10
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$333.38
|
| Rate for Payer: BCN Commercial |
$333.38
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$430.00
|
| Rate for Payer: Healthscope Whirlpool |
$417.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.07
|
| Rate for Payer: Mclaren Commercial |
$387.00
|
| Rate for Payer: Mclaren Medicaid |
$27.94
|
| Rate for Payer: Mclaren Medicare |
$51.07
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.50
|
| Rate for Payer: PACE Medicare |
$48.52
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: PHP Medicaid |
$27.94
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.44
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health Narrow Network |
$45.95
|
| Rate for Payer: Railroad Medicare Medicare |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.40
|
| Rate for Payer: UHC Medicare Advantage |
$52.60
|
| Rate for Payer: VA VA |
$51.07
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: ASR ASR |
$417.10
|
| Rate for Payer: BCBS Trust/PPO |
$333.38
|
| Rate for Payer: BCN Commercial |
$333.38
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Healthscope Commercial |
$430.00
|
| Rate for Payer: Healthscope Whirlpool |
$417.10
|
| Rate for Payer: Mclaren Commercial |
$387.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.40
|
|
|
HC PREALBUMIN
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
30100398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC PREALBUMIN
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
30100398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.24
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: BCBS MAPPO |
$14.59
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: BCN Medicare Advantage |
$14.59
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.59
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$7.98
|
| Rate for Payer: Mclaren Medicare |
$14.59
|
| Rate for Payer: Meridian Medicaid |
$8.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$13.86
|
| Rate for Payer: PACE SWMI |
$14.59
|
| Rate for Payer: PHP Commercial |
$16.05
|
| Rate for Payer: PHP Medicaid |
$7.98
|
| Rate for Payer: PHP Medicare Advantage |
$14.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$14.59
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
| Rate for Payer: UHC Medicare Advantage |
$15.03
|
| Rate for Payer: VA VA |
$14.59
|
|
|
HC PREGNANCY TEST SERUM
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
30100467
|
|
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 PREGNANCY TEST SERUM
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
30100467
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$7.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.40
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| 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 |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.52
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$4.11
|
| Rate for Payer: Mclaren Medicare |
$7.52
|
| Rate for Payer: Meridian Medicaid |
$4.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$7.14
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Commercial |
$8.27
|
| Rate for Payer: PHP Medicaid |
$4.11
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: Priority Health Narrow Network |
$24.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$7.75
|
| Rate for Payer: VA VA |
$7.52
|
|
|
HC PREGNENOLONE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
30100561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
|
|
HC PREGNENOLONE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
30100561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.84
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Complete |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$20.67
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: BCN Medicare Advantage |
$20.67
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.67
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.67
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Mclaren Medicaid |
$11.31
|
| Rate for Payer: Mclaren Medicare |
$20.67
|
| Rate for Payer: Meridian Medicaid |
$11.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Medicare |
$19.64
|
| Rate for Payer: PACE SWMI |
$20.67
|
| Rate for Payer: PHP Commercial |
$22.74
|
| Rate for Payer: PHP Medicaid |
$11.31
|
| Rate for Payer: PHP Medicare Advantage |
$20.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$20.67
|
| Rate for Payer: Priority Health Narrow Network |
$63.90
|
| Rate for Payer: Railroad Medicare Medicare |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: VA VA |
$20.67
|
|
|
HC PRENATAL ANEUPLOIDY DETECTION, FISH
|
Facility
|
OP
|
$94.86
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$92.01
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$73.54
|
| Rate for Payer: BCN Commercial |
$73.54
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Healthscope Whirlpool |
$92.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$85.37
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.63
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.72
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.32
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$67.35
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.48
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC PRENATAL ANEUPLOIDY DETECTION, FISH
|
Facility
|
IP
|
$94.86
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: ASR ASR |
$92.01
|
| Rate for Payer: BCBS Trust/PPO |
$73.54
|
| Rate for Payer: BCN Commercial |
$73.54
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Healthscope Whirlpool |
$92.01
|
| Rate for Payer: Mclaren Commercial |
$85.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.48
|
|
|
HC PRENATAL ZIKA VIRUS MAC ELISA IGM
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$178.48
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCN Commercial |
$142.66
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Healthscope Whirlpool |
$178.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$165.60
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$15.61
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.92
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC PRENATAL ZIKA VIRUS MAC ELISA IGM
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: ASR ASR |
$178.48
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCN Commercial |
$142.66
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Healthscope Whirlpool |
$178.48
|
| Rate for Payer: Mclaren Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.92
|
|
|
HC PRENATLA ANEUPLOIDY DETECTION, FISH CMPT
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000131
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$53.77
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| 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 |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.72
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.12
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$49.25
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC PRENATLA ANEUPLOIDY DETECTION, FISH CMPT
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000131
|
|
Hospital Revenue Code
|
310
|
| 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 PREOP DUPLX HEMODIALYSIS ASSESS BIL
|
Facility
|
OP
|
$1,467.38
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
92100036
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,467.38 |
| Rate for Payer: Aetna Commercial |
$1,320.64
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,423.36
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.66
|
| Rate for Payer: BCN Commercial |
$1,137.66
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cofinity Commercial |
$1,379.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,467.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,423.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,320.64
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.27
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.32
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$199.46
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,291.29
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS BIL
|
Facility
|
IP
|
$1,467.38
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
92100036
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,027.17 |
| Max. Negotiated Rate |
$1,467.38 |
| Rate for Payer: Aetna Commercial |
$1,320.64
|
| Rate for Payer: ASR ASR |
$1,423.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.66
|
| Rate for Payer: BCN Commercial |
$1,137.66
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cofinity Commercial |
$1,379.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.90
|
| Rate for Payer: Healthscope Commercial |
$1,467.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,423.36
|
| Rate for Payer: Mclaren Commercial |
$1,320.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,291.29
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS UNI.
|
Facility
|
IP
|
$850.62
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
92100037
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$595.43 |
| Max. Negotiated Rate |
$850.62 |
| Rate for Payer: Aetna Commercial |
$765.56
|
| Rate for Payer: ASR ASR |
$825.10
|
| Rate for Payer: BCBS Trust/PPO |
$659.49
|
| Rate for Payer: BCN Commercial |
$659.49
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$799.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
| Rate for Payer: Healthscope Commercial |
$850.62
|
| Rate for Payer: Healthscope Whirlpool |
$825.10
|
| Rate for Payer: Mclaren Commercial |
$765.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.55
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS UNI.
|
Facility
|
OP
|
$850.62
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
92100037
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$850.62 |
| Rate for Payer: Aetna Commercial |
$765.56
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$825.10
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$659.49
|
| Rate for Payer: BCN Commercial |
$659.49
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$799.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$850.62
|
| Rate for Payer: Healthscope Whirlpool |
$825.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$765.56
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.91
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$95.93
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.55
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.37 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare |
$558.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: ASR ASR |
$970.00
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$775.30
|
| Rate for Payer: BCN Commercial |
$775.30
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$940.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$1,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$970.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.26
|
| Rate for Payer: Mclaren Commercial |
$900.00
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$614.09
|
| Rate for Payer: PHP Medicaid |
$305.37
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$910.00
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$710.00
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.00
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
HC PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: ASR ASR |
$970.00
|
| Rate for Payer: BCBS Trust/PPO |
$775.30
|
| Rate for Payer: BCN Commercial |
$775.30
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$940.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.00
|
| Rate for Payer: Healthscope Commercial |
$1,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$970.00
|
| Rate for Payer: Mclaren Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.00
|
|
|
HC PRESBYOPIA LENS
|
Facility
|
OP
|
$3,586.48
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
27600001
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,434.59 |
| Max. Negotiated Rate |
$3,586.48 |
| Rate for Payer: Aetna Commercial |
$3,227.83
|
| Rate for Payer: ASR ASR |
$3,478.89
|
| Rate for Payer: BCBS Complete |
$1,434.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,780.60
|
| Rate for Payer: BCN Commercial |
$2,780.60
|
| Rate for Payer: Cash Price |
$2,869.18
|
| Rate for Payer: Cofinity Commercial |
$3,371.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,869.18
|
| Rate for Payer: Healthscope Commercial |
$3,586.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,478.89
|
| Rate for Payer: Mclaren Commercial |
$3,227.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,048.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,510.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,263.70
|
| Rate for Payer: Priority Health Narrow Network |
$2,546.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,156.10
|
|
|
HC PRESBYOPIA LENS
|
Facility
|
IP
|
$3,586.48
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
27600001
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,510.54 |
| Max. Negotiated Rate |
$3,586.48 |
| Rate for Payer: Aetna Commercial |
$3,227.83
|
| Rate for Payer: ASR ASR |
$3,478.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,780.60
|
| Rate for Payer: BCN Commercial |
$2,780.60
|
| Rate for Payer: Cash Price |
$2,869.18
|
| Rate for Payer: Cofinity Commercial |
$3,371.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,869.18
|
| Rate for Payer: Healthscope Commercial |
$3,586.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,478.89
|
| Rate for Payer: Mclaren Commercial |
$3,227.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,048.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,510.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,156.10
|
|
