|
HC MECH CHEST WALL OSCILLATION
|
Facility
|
OP
|
$327.02
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$294.32
|
| Rate for Payer: Aetna Medicare |
$218.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: ASR ASR |
$317.21
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$269.63
|
| Rate for Payer: BCN Commercial |
$269.63
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$261.62
|
| Rate for Payer: Cash Price |
$261.62
|
| Rate for Payer: Cofinity Commercial |
$307.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$317.21
|
| Rate for Payer: Healthscope Whirlpool |
$327.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$294.32
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$119.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.97
|
| Rate for Payer: Nomi Health Commercial |
$268.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.26
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$240.01
|
| Rate for Payer: PHP Medicaid |
$116.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.66
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health Narrow Network |
$39.73
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$338.19
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP DNSP |
$218.19
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
IP
|
$1,536.90
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,152.67 |
| Max. Negotiated Rate |
$1,536.90 |
| Rate for Payer: Aetna Commercial |
$1,383.21
|
| Rate for Payer: ASR ASR |
$1,490.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.10
|
| Rate for Payer: BCN Commercial |
$1,262.10
|
| Rate for Payer: Cash Price |
$1,229.52
|
| Rate for Payer: Cofinity Commercial |
$1,444.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.52
|
| Rate for Payer: Healthscope Commercial |
$1,490.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,536.90
|
| Rate for Payer: Mclaren Commercial |
$1,383.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.37
|
| Rate for Payer: Nomi Health Commercial |
$1,260.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.47
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
OP
|
$1,536.90
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$4,454.85 |
| Rate for Payer: Aetna Commercial |
$1,383.21
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: ASR ASR |
$1,490.79
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.17
|
| Rate for Payer: BCN Commercial |
$1,267.17
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,229.52
|
| Rate for Payer: Cash Price |
$1,229.52
|
| Rate for Payer: Cofinity Commercial |
$1,444.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,490.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,536.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$615.57
|
| Rate for Payer: Mclaren Commercial |
$1,383.21
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.37
|
| Rate for Payer: Nomi Health Commercial |
$1,260.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,152.67
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$677.13
|
| Rate for Payer: PHP Medicaid |
$329.95
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,454.85
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,563.88
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$954.13
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
IP
|
$1,338.85
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,004.14 |
| Max. Negotiated Rate |
$1,338.85 |
| Rate for Payer: Aetna Commercial |
$1,204.96
|
| Rate for Payer: ASR ASR |
$1,298.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.46
|
| Rate for Payer: BCN Commercial |
$1,099.46
|
| Rate for Payer: Cash Price |
$1,071.08
|
| Rate for Payer: Cofinity Commercial |
$1,258.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.08
|
| Rate for Payer: Healthscope Commercial |
$1,298.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.85
|
| Rate for Payer: Mclaren Commercial |
$1,204.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.02
|
| Rate for Payer: Nomi Health Commercial |
$1,097.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,004.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,178.19
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
OP
|
$1,338.85
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$3,898.00 |
| Rate for Payer: Aetna Commercial |
$1,204.96
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: ASR ASR |
$1,298.68
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.88
|
| Rate for Payer: BCN Commercial |
$1,103.88
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,071.08
|
| Rate for Payer: Cash Price |
$1,071.08
|
| Rate for Payer: Cofinity Commercial |
$1,258.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,298.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$615.57
|
| Rate for Payer: Mclaren Commercial |
$1,204.96
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.02
|
| Rate for Payer: Nomi Health Commercial |
$1,097.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,004.14
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$677.13
|
| Rate for Payer: PHP Medicaid |
$329.95
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,898.00
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,118.40
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,178.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$954.13
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM BENZODIAZAPINE CONFIRMATION
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM BENZODIAZAPINE CONFIRMATION
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM BUPRENORPHINE CONFIRMATION
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30000100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM BUPRENORPHINE CONFIRMATION
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30000100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$93.53
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.50
|
| Rate for Payer: BCN Commercial |
$79.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Healthscope Whirlpool |
$96.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$86.78
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.59
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.31 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: ASR ASR |
$93.53
|
| Rate for Payer: BCBS Trust/PPO |
$79.18
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Healthscope Whirlpool |
$96.42
|
| Rate for Payer: Mclaren Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.85
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$87.50
|
| Rate for Payer: BCN Commercial |
$87.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$102.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.98
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$74.39
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$87.15
|
| Rate for Payer: BCN Commercial |
$87.15
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$102.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.12
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
IP
|
$66.44
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$49.83 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna Commercial |
$59.80
|
| Rate for Payer: ASR ASR |
$64.45
|
| Rate for Payer: BCBS Trust/PPO |
$54.56
|
| Rate for Payer: BCN Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$64.45
|
| Rate for Payer: Healthscope Whirlpool |
$66.44
|
| Rate for Payer: Mclaren Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Nomi Health Commercial |
$54.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.47
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
OP
|
$66.44
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna Commercial |
$59.80
|
| Rate for Payer: Aetna Medicare |
$24.58
|
| Rate for Payer: ASR ASR |
$64.45
|
| Rate for Payer: BCBS Complete |
$26.58
|
| Rate for Payer: BCBS Trust/PPO |
$54.78
|
| Rate for Payer: BCN Commercial |
$54.78
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$64.45
|
| Rate for Payer: Healthscope Whirlpool |
$66.44
|
| Rate for Payer: Mclaren Commercial |
$59.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Nomi Health Commercial |
$54.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.21
|
| Rate for Payer: Priority Health Narrow Network |
$46.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.47
|
|
