|
HC METANEB SUPPLY
|
Facility
|
OP
|
$264.46
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.85 |
| Max. Negotiated Rate |
$264.46 |
| Rate for Payer: Aetna Commercial |
$238.01
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: ASR ASR |
$256.53
|
| Rate for Payer: BCBS Complete |
$105.78
|
| Rate for Payer: BCBS Trust/PPO |
$218.05
|
| Rate for Payer: BCN Commercial |
$218.05
|
| Rate for Payer: Cash Price |
$211.57
|
| Rate for Payer: Cofinity Commercial |
$248.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.57
|
| Rate for Payer: Healthscope Commercial |
$256.53
|
| Rate for Payer: Healthscope Whirlpool |
$264.46
|
| Rate for Payer: Mclaren Commercial |
$238.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.79
|
| Rate for Payer: Nomi Health Commercial |
$216.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.72
|
| Rate for Payer: Priority Health Narrow Network |
$185.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.72
|
|
|
HC METANEB SUPPLY
|
Facility
|
IP
|
$264.46
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.34 |
| Max. Negotiated Rate |
$264.46 |
| Rate for Payer: Aetna Commercial |
$238.01
|
| Rate for Payer: ASR ASR |
$256.53
|
| Rate for Payer: BCBS Trust/PPO |
$217.17
|
| Rate for Payer: BCN Commercial |
$217.17
|
| Rate for Payer: Cash Price |
$211.57
|
| Rate for Payer: Cofinity Commercial |
$248.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.57
|
| Rate for Payer: Healthscope Commercial |
$256.53
|
| Rate for Payer: Healthscope Whirlpool |
$264.46
|
| Rate for Payer: Mclaren Commercial |
$238.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.79
|
| Rate for Payer: Nomi Health Commercial |
$216.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.72
|
|
|
HC METANEPHRINES FRACTIONATION URINE
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Trust/PPO |
$38.35
|
| Rate for Payer: BCN Commercial |
$38.35
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
|
|
HC METANEPHRINES FRACTIONATION URINE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$16.94
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.21
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$37.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$26.26
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP DNSP |
$16.94
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES PLASMA
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30200013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$52.32
|
| Rate for Payer: BCN Commercial |
$52.32
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$16.94
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.21
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$37.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$26.26
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP DNSP |
$16.94
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES PLASMA
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30200013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$52.11
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC METANEPHRINES URINE
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$54.12 |
| Rate for Payer: Aetna Commercial |
$48.71
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$52.50
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$44.62
|
| Rate for Payer: BCN Commercial |
$44.62
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$50.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Whirlpool |
$54.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$48.71
|
| Rate for Payer: Mclaren Medicaid |
$16.94
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.21
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$37.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$26.26
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP DNSP |
$16.94
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES URINE
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$54.12 |
| Rate for Payer: Aetna Commercial |
$48.71
|
| Rate for Payer: ASR ASR |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCN Commercial |
$44.44
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$50.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Whirlpool |
$54.12
|
| Rate for Payer: Mclaren Commercial |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.63
|
|
|
HC METASTRON SR 89 THERAPEUTIC PER MCI
|
Facility
|
OP
|
$1,834.95
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
34400003
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,376.21 |
| Max. Negotiated Rate |
$6,426.83 |
| Rate for Payer: Aetna Commercial |
$1,651.45
|
| Rate for Payer: Aetna Medicare |
$4,146.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,182.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,182.93
|
| Rate for Payer: ASR ASR |
$1,779.90
|
| Rate for Payer: BCBS Complete |
$2,277.17
|
| Rate for Payer: BCBS MAPPO |
$4,146.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.92
|
| Rate for Payer: BCN Commercial |
$1,512.92
|
| Rate for Payer: BCN Medicare Advantage |
$4,146.34
|
| Rate for Payer: Cash Price |
$1,467.96
|
| Rate for Payer: Cash Price |
$1,467.96
|
| Rate for Payer: Cofinity Commercial |
$1,724.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,467.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,146.34
|
| Rate for Payer: Healthscope Commercial |
$1,779.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,834.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,146.34
|
| Rate for Payer: Mclaren Commercial |
$1,651.45
|
| Rate for Payer: Mclaren Medicaid |
$4,146.34
|
| Rate for Payer: Mclaren Medicare |
$4,146.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,353.66
|
| Rate for Payer: Meridian Medicaid |
$2,277.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,768.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,560.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.71
|
| Rate for Payer: Nomi Health Commercial |
$1,504.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.21
|
| Rate for Payer: PACE Medicare |
$3,939.02
|
| Rate for Payer: PACE SWMI |
$4,146.34
|
| Rate for Payer: PHP Commercial |
$4,560.97
|
| Rate for Payer: PHP Medicaid |
$2,222.44
|
| Rate for Payer: PHP Medicare Advantage |
$4,146.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,168.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,825.00
|
| Rate for Payer: Priority Health Medicare |
$4,146.34
|
| Rate for Payer: Priority Health Narrow Network |
$3,060.00
|
| Rate for Payer: Railroad Medicare Medicare |
$4,146.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,614.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,146.34
|
| Rate for Payer: UHC Exchange |
$6,426.83
|
| Rate for Payer: UHC Medicaid |
$2,168.54
|
| Rate for Payer: UHCCP DNSP |
$4,146.34
|
| Rate for Payer: UHCCP Medicaid |
$2,168.54
|
| Rate for Payer: VA VA |
$4,146.34
|
|
|
HC METASTRON SR 89 THERAPEUTIC PER MCI
|
Facility
|
IP
|
$1,834.95
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
34400003
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,376.21 |
| Max. Negotiated Rate |
$1,834.95 |
| Rate for Payer: Aetna Commercial |
$1,651.45
|
| Rate for Payer: ASR ASR |
$1,779.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,506.86
|
| Rate for Payer: BCN Commercial |
$1,506.86
|
| Rate for Payer: Cash Price |
$1,467.96
|
| Rate for Payer: Cofinity Commercial |
$1,724.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,467.96
|
| Rate for Payer: Healthscope Commercial |
$1,779.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,834.95
|
| Rate for Payer: Mclaren Commercial |
$1,651.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.71
|
| Rate for Payer: Nomi Health Commercial |
$1,504.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,614.76
|
|
|
HC METHADONE CONFIRM MECON
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100574
|
|
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 METHADONE CONFIRM MECON
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100574
|
|
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 METHADONE SCRN URIN
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000118
|
|
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 METHADONE SCRN URIN
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000118
|
|
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 METHADONE SCRN URN
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC METHADONE SCRN URN
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| 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 |
$41.18
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| 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 |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC METHADONE SERUM LVL
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$81.15 |
| Rate for Payer: Aetna Commercial |
$73.03
|
| Rate for Payer: ASR ASR |
$78.72
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$76.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Healthscope Whirlpool |
$81.15
|
| Rate for Payer: Mclaren Commercial |
$73.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.41
|
|
|
HC METHADONE SERUM LVL
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$81.15 |
| Rate for Payer: Aetna Commercial |
$73.03
|
| Rate for Payer: Aetna Medicare |
$30.03
|
| Rate for Payer: ASR ASR |
$78.72
|
| Rate for Payer: BCBS Complete |
$32.46
|
| Rate for Payer: BCBS Trust/PPO |
$66.91
|
| Rate for Payer: BCN Commercial |
$66.91
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$76.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Healthscope Whirlpool |
$81.15
|
| Rate for Payer: Mclaren Commercial |
$73.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.10
|
| Rate for Payer: Priority Health Narrow Network |
$56.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.41
|
|
|
HC METHADONE URN
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$51.26
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC METHADONE URN
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC METHANOL LVL
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: Aetna Commercial |
$146.07
|
| Rate for Payer: ASR ASR |
$157.43
|
| Rate for Payer: BCBS Trust/PPO |
$133.28
|
| Rate for Payer: BCN Commercial |
$133.28
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$152.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$157.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.30
|
| Rate for Payer: Mclaren Commercial |
$146.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$133.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.82
|
|
|
HC METHANOL LVL
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.05 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: Aetna Commercial |
$146.07
|
| Rate for Payer: Aetna Medicare |
$60.05
|
| Rate for Payer: ASR ASR |
$157.43
|
| Rate for Payer: BCBS Complete |
$64.92
|
| Rate for Payer: BCBS Trust/PPO |
$133.82
|
| Rate for Payer: BCN Commercial |
$133.82
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$152.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$157.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.30
|
| Rate for Payer: Mclaren Commercial |
$146.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$133.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.82
|
|
|
HC METHEMOGLOBIN
|
Facility
|
OP
|
$47.96
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna Commercial |
$43.16
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.25
|
| Rate for Payer: ASR ASR |
$46.52
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.20
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cofinity Commercial |
$45.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.20
|
| Rate for Payer: Healthscope Commercial |
$46.52
|
| Rate for Payer: Healthscope Whirlpool |
$47.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.20
|
| Rate for Payer: Mclaren Commercial |
$43.16
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$8.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.61
|
| Rate for Payer: Meridian Medicaid |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.77
|
| Rate for Payer: Nomi Health Commercial |
$39.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.97
|
| Rate for Payer: PACE Medicare |
$7.79
|
| Rate for Payer: PACE SWMI |
$8.20
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: PHP Medicaid |
$4.40
|
| Rate for Payer: PHP Medicare Advantage |
$8.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.27
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health Narrow Network |
$61.02
|
| Rate for Payer: Railroad Medicare Medicare |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.20
|
| Rate for Payer: UHC Exchange |
$12.71
|
| Rate for Payer: UHC Medicaid |
$4.29
|
| Rate for Payer: UHCCP DNSP |
$8.20
|
| Rate for Payer: UHCCP Medicaid |
$4.29
|
| Rate for Payer: VA VA |
$8.20
|
|
|
HC METHEMOGLOBIN
|
Facility
|
IP
|
$47.96
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$47.96 |
| Rate for Payer: Aetna Commercial |
$43.16
|
| Rate for Payer: ASR ASR |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$39.38
|
| Rate for Payer: BCN Commercial |
$39.38
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cofinity Commercial |
$45.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.37
|
| Rate for Payer: Healthscope Commercial |
$46.52
|
| Rate for Payer: Healthscope Whirlpool |
$47.96
|
| Rate for Payer: Mclaren Commercial |
$43.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.77
|
| Rate for Payer: Nomi Health Commercial |
$39.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.20
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
OP
|
$180.51
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$162.46
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$175.09
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$148.83
|
| Rate for Payer: BCN Commercial |
$148.83
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cofinity Commercial |
$169.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Healthscope Whirlpool |
$180.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$162.46
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.43
|
| Rate for Payer: Nomi Health Commercial |
$148.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.38
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
