|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$51.57
|
| Rate for Payer: ASR ASR |
$55.58
|
| Rate for Payer: BCBS Trust/PPO |
$47.05
|
| Rate for Payer: BCN Commercial |
$47.05
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$53.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$55.58
|
| Rate for Payer: Healthscope Whirlpool |
$57.30
|
| Rate for Payer: Mclaren Commercial |
$51.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.42
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$209.42 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: Aetna Medicare |
$62.54
|
| Rate for Payer: ASR ASR |
$163.95
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS Trust/PPO |
$139.36
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$139.36
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$163.95
|
| Rate for Payer: Healthscope Whirlpool |
$169.02
|
| Rate for Payer: Mclaren Commercial |
$152.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.42
|
| Rate for Payer: Priority Health Narrow Network |
$167.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.77 |
| Max. Negotiated Rate |
$169.02 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: ASR ASR |
$163.95
|
| Rate for Payer: BCBS Trust/PPO |
$138.80
|
| Rate for Payer: BCN Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$163.95
|
| Rate for Payer: Healthscope Whirlpool |
$169.02
|
| Rate for Payer: Mclaren Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$240.90 |
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: Aetna Medicare |
$75.89
|
| Rate for Payer: ASR ASR |
$198.95
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS Trust/PPO |
$169.10
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$198.95
|
| Rate for Payer: Healthscope Whirlpool |
$205.10
|
| Rate for Payer: Mclaren Commercial |
$184.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$240.90
|
| Rate for Payer: Priority Health Narrow Network |
$192.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.49
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.82 |
| Max. Negotiated Rate |
$205.10 |
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: ASR ASR |
$198.95
|
| Rate for Payer: BCBS Trust/PPO |
$168.43
|
| Rate for Payer: BCN Commercial |
$168.43
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$198.95
|
| Rate for Payer: Healthscope Whirlpool |
$205.10
|
| Rate for Payer: Mclaren Commercial |
$184.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.49
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.90 |
| Max. Negotiated Rate |
$294.53 |
| Rate for Payer: Aetna Commercial |
$265.08
|
| Rate for Payer: ASR ASR |
$285.69
|
| Rate for Payer: BCBS Trust/PPO |
$241.87
|
| Rate for Payer: BCN Commercial |
$241.87
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$285.69
|
| Rate for Payer: Healthscope Whirlpool |
$294.53
|
| Rate for Payer: Mclaren Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.19
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$294.53 |
| Rate for Payer: Aetna Commercial |
$265.08
|
| Rate for Payer: Aetna Medicare |
$108.98
|
| Rate for Payer: ASR ASR |
$285.69
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$242.84
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$242.84
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$285.69
|
| Rate for Payer: Healthscope Whirlpool |
$294.53
|
| Rate for Payer: Mclaren Commercial |
$265.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$258.07
|
| Rate for Payer: Priority Health Narrow Network |
$206.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.19
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$490.43 |
| Rate for Payer: Aetna Commercial |
$441.39
|
| Rate for Payer: Aetna Medicare |
$181.46
|
| Rate for Payer: ASR ASR |
$475.72
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS Trust/PPO |
$404.36
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$404.36
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$475.72
|
| Rate for Payer: Healthscope Whirlpool |
$490.43
|
| Rate for Payer: Mclaren Commercial |
$441.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$429.71
|
| Rate for Payer: Priority Health Narrow Network |
$343.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.58
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.82 |
| Max. Negotiated Rate |
$490.43 |
| Rate for Payer: Aetna Commercial |
$441.39
|
| Rate for Payer: ASR ASR |
$475.72
|
| Rate for Payer: BCBS Trust/PPO |
$402.74
|
| Rate for Payer: BCN Commercial |
$402.74
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$475.72
|
| Rate for Payer: Healthscope Whirlpool |
$490.43
|
| Rate for Payer: Mclaren Commercial |
$441.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.58
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID CEPHEID
|
Facility
|
IP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600357
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$135.26 |
| Rate for Payer: Aetna Commercial |
$121.73
|
| Rate for Payer: ASR ASR |
$131.20
|
| Rate for Payer: BCBS Trust/PPO |
$111.08
|
| Rate for Payer: BCN Commercial |
$111.08
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Healthscope Commercial |
$131.20
|
| Rate for Payer: Healthscope Whirlpool |
$135.26
|
| Rate for Payer: Mclaren Commercial |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.03
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID CEPHEID
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600357
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$135.26 |
| Rate for Payer: Aetna Commercial |
$121.73
|
| Rate for Payer: Aetna Medicare |
$70.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.72
|
| Rate for Payer: ASR ASR |
$131.20
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS MAPPO |
$70.18
|
| Rate for Payer: BCBS Trust/PPO |
$111.52
|
| Rate for Payer: BCN Commercial |
$111.52
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$131.20
|
| Rate for Payer: Healthscope Whirlpool |
$135.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.18
|
| Rate for Payer: Mclaren Commercial |
$121.73
|
| Rate for Payer: Mclaren Medicaid |
$70.18
|
| Rate for Payer: Mclaren Medicare |
$70.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.69
|
| Rate for Payer: Meridian Medicaid |
$38.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$66.67
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PHP Commercial |
$77.20
|
| Rate for Payer: PHP Medicaid |
$37.62
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.69
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health Narrow Network |
$58.95
|
| Rate for Payer: Railroad Medicare Medicare |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.18
|
| Rate for Payer: UHC Exchange |
$108.78
|
| Rate for Payer: UHC Medicaid |
$36.70
|
| Rate for Payer: UHCCP DNSP |
$70.18
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: VA VA |
$70.18
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID HOLOGIC
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$135.26 |
| Rate for Payer: Aetna Commercial |
$121.73
|
| Rate for Payer: Aetna Medicare |
$70.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.72
|
| Rate for Payer: ASR ASR |
$131.20
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS MAPPO |
$70.18
|
| Rate for Payer: BCBS Trust/PPO |
$111.52
|
| Rate for Payer: BCN Commercial |
$111.52
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$131.20
|
| Rate for Payer: Healthscope Whirlpool |
$135.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.18
|
| Rate for Payer: Mclaren Commercial |
$121.73
|
| Rate for Payer: Mclaren Medicaid |
$70.18
|
| Rate for Payer: Mclaren Medicare |
$70.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.69
|
| Rate for Payer: Meridian Medicaid |
$38.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$66.67
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PHP Commercial |
$77.20
|
| Rate for Payer: PHP Medicaid |
$37.62
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.69
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health Narrow Network |
$58.95
|
| Rate for Payer: Railroad Medicare Medicare |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.18
|
| Rate for Payer: UHC Exchange |
$108.78
|
| Rate for Payer: UHC Medicaid |
$36.70
|
| Rate for Payer: UHCCP DNSP |
$70.18
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: VA VA |
$70.18
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID HOLOGIC
|
Facility
|
IP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$135.26 |
| Rate for Payer: Aetna Commercial |
$121.73
|
| Rate for Payer: ASR ASR |
$131.20
|
| Rate for Payer: BCBS Trust/PPO |
$111.08
|
| Rate for Payer: BCN Commercial |
$111.08
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Healthscope Commercial |
$131.20
|
| Rate for Payer: Healthscope Whirlpool |
$135.26
|
| Rate for Payer: Mclaren Commercial |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.03
|
|
|
HC NG/CT DETECT BY PCR CEPHEID
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600355
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$135.26 |
| Rate for Payer: Aetna Commercial |
$121.73
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: ASR ASR |
$131.20
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$111.52
|
| Rate for Payer: BCN Commercial |
$111.52
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$131.20
|
| Rate for Payer: Healthscope Whirlpool |
$135.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.20
|
| Rate for Payer: Mclaren Commercial |
$121.73
|
| Rate for Payer: Mclaren Medicaid |
$70.20
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$38.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$77.22
|
| Rate for Payer: PHP Medicaid |
$37.63
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$118.51
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health Narrow Network |
$94.82
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$108.81
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP DNSP |
$70.20
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC NG/CT DETECT BY PCR CEPHEID
|
Facility
|
IP
|
$135.26
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600355
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$135.26 |
| Rate for Payer: Aetna Commercial |
$121.73
|
| Rate for Payer: ASR ASR |
$131.20
|
| Rate for Payer: BCBS Trust/PPO |
$111.08
|
| Rate for Payer: BCN Commercial |
$111.08
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$127.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Healthscope Commercial |
$131.20
|
| Rate for Payer: Healthscope Whirlpool |
$135.26
|
| Rate for Payer: Mclaren Commercial |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.03
|
|
|
HC NG/CT DETECTION BY NUCLEIC ACID AMP
|
Facility
|
IP
|
$137.97
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600348
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$124.17
|
| Rate for Payer: ASR ASR |
$133.83
|
| Rate for Payer: BCBS Trust/PPO |
$113.30
|
| Rate for Payer: BCN Commercial |
$113.30
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$129.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$133.83
|
| Rate for Payer: Healthscope Whirlpool |
$137.97
|
| Rate for Payer: Mclaren Commercial |
$124.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.41
|
|
|
HC NG/CT DETECTION BY NUCLEIC ACID AMP
|
Facility
|
OP
|
$137.97
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600348
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$137.97 |
| Rate for Payer: Aetna Commercial |
$124.17
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: ASR ASR |
$133.83
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$113.76
|
| Rate for Payer: BCN Commercial |
$113.76
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$129.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$133.83
|
| Rate for Payer: Healthscope Whirlpool |
$137.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.20
|
| Rate for Payer: Mclaren Commercial |
$124.17
|
| Rate for Payer: Mclaren Medicaid |
$70.20
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$38.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Nomi Health Commercial |
$113.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$77.22
|
| Rate for Payer: PHP Medicaid |
$37.63
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$120.89
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health Narrow Network |
$96.72
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$108.81
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP DNSP |
$70.20
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$23.48
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$52.32
|
| Rate for Payer: BCN Commercial |
$52.32
|
| 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: MI Amish Medical Board Commercial |
$50.77
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.60
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| 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 NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$19.25
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.89
|
| Rate for Payer: BCN Commercial |
$42.89
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$52.02
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.72
|
| Rate for Payer: BCN Commercial |
$42.72
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$52.02
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,499.11
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,624.33 |
| Max. Negotiated Rate |
$3,499.11 |
| Rate for Payer: Aetna Commercial |
$3,149.20
|
| Rate for Payer: ASR ASR |
$3,394.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,873.47
|
| Rate for Payer: BCN Commercial |
$2,873.47
|
| Rate for Payer: Cash Price |
$2,799.29
|
| Rate for Payer: Cofinity Commercial |
$3,289.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,799.29
|
| Rate for Payer: Healthscope Commercial |
$3,394.14
|
| Rate for Payer: Healthscope Whirlpool |
$3,499.11
|
| Rate for Payer: Mclaren Commercial |
$3,149.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,974.24
|
| Rate for Payer: Nomi Health Commercial |
$2,869.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,624.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,079.22
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$5,187.47
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$3,890.60 |
| Max. Negotiated Rate |
$5,187.47 |
| Rate for Payer: Aetna Commercial |
$4,668.72
|
| Rate for Payer: ASR ASR |
$5,031.85
|
| Rate for Payer: BCBS Trust/PPO |
$4,259.95
|
| Rate for Payer: BCN Commercial |
$4,259.95
|
| Rate for Payer: Cash Price |
$4,149.98
|
| Rate for Payer: Cofinity Commercial |
$4,876.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,149.98
|
| Rate for Payer: Healthscope Commercial |
$5,031.85
|
| Rate for Payer: Healthscope Whirlpool |
$5,187.47
|
| Rate for Payer: Mclaren Commercial |
$4,668.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,409.35
|
| Rate for Payer: Nomi Health Commercial |
$4,253.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,890.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,564.97
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,432.11
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$4,074.08 |
| Max. Negotiated Rate |
$5,432.11 |
| Rate for Payer: Aetna Commercial |
$4,888.90
|
| Rate for Payer: ASR ASR |
$5,269.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,460.85
|
| Rate for Payer: BCN Commercial |
$4,460.85
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cofinity Commercial |
$5,106.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.69
|
| Rate for Payer: Healthscope Commercial |
$5,269.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,432.11
|
| Rate for Payer: Mclaren Commercial |
$4,888.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.29
|
| Rate for Payer: Nomi Health Commercial |
$4,454.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,074.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,780.26
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$153.72 |
| Max. Negotiated Rate |
$204.96 |
| Rate for Payer: Aetna Commercial |
$184.46
|
| Rate for Payer: ASR ASR |
$198.81
|
| Rate for Payer: BCBS Trust/PPO |
$168.31
|
| Rate for Payer: BCN Commercial |
$168.31
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Commercial |
$192.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Healthscope Whirlpool |
$204.96
|
| Rate for Payer: Mclaren Commercial |
$184.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Nomi Health Commercial |
$168.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.36
|
|
