|
HC OT Z STOCKINGS NON CUSTOM $70
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.81
|
| Rate for Payer: BCN Commercial |
$59.81
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC OT Z STOCKINGS NON CUSTOM $70
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$60.05
|
| Rate for Payer: BCN Commercial |
$60.05
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.81
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC OT Z STOCKINGS NON CUSTOM $80
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$68.35
|
| Rate for Payer: BCN Commercial |
$68.35
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$80.73
|
| Rate for Payer: Healthscope Whirlpool |
$83.23
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC OT Z STOCKINGS NON CUSTOM $80
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: BCBS Complete |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$68.62
|
| Rate for Payer: BCN Commercial |
$68.62
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$80.73
|
| Rate for Payer: Healthscope Whirlpool |
$83.23
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.93
|
| Rate for Payer: Priority Health Narrow Network |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC OT Z STOCKINGS NON CUSTOM $90
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC OT Z STOCKINGS NON CUSTOM $90
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.90
|
| Rate for Payer: BCN Commercial |
$76.90
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC OVA & PARASITES
|
Facility
|
OP
|
$89.58
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$89.58 |
| Rate for Payer: Aetna Commercial |
$80.62
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: ASR ASR |
$86.89
|
| Rate for Payer: BCBS Complete |
$4.89
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$73.86
|
| Rate for Payer: BCN Commercial |
$73.86
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$86.89
|
| Rate for Payer: Healthscope Whirlpool |
$89.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.90
|
| Rate for Payer: Mclaren Commercial |
$80.62
|
| Rate for Payer: Mclaren Medicaid |
$8.90
|
| Rate for Payer: Mclaren Medicare |
$8.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: Meridian Medicaid |
$4.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.14
|
| Rate for Payer: Nomi Health Commercial |
$73.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.19
|
| Rate for Payer: PACE Medicare |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: PHP Medicaid |
$4.77
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.90
|
| Rate for Payer: UHC Exchange |
$13.79
|
| Rate for Payer: UHC Medicaid |
$4.65
|
| Rate for Payer: UHCCP DNSP |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$4.65
|
| Rate for Payer: VA VA |
$8.90
|
|
|
HC OVA & PARASITES
|
Facility
|
IP
|
$89.58
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.19 |
| Max. Negotiated Rate |
$89.58 |
| Rate for Payer: Aetna Commercial |
$80.62
|
| Rate for Payer: ASR ASR |
$86.89
|
| Rate for Payer: BCBS Trust/PPO |
$73.56
|
| Rate for Payer: BCN Commercial |
$73.56
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Healthscope Commercial |
$86.89
|
| Rate for Payer: Healthscope Whirlpool |
$89.58
|
| Rate for Payer: Mclaren Commercial |
$80.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.14
|
| Rate for Payer: Nomi Health Commercial |
$73.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.83
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$9.87
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.98
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$17.98
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$9.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Medicaid |
$9.64
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.98
|
| Rate for Payer: UHC Exchange |
$27.87
|
| Rate for Payer: UHC Medicaid |
$9.40
|
| Rate for Payer: UHCCP DNSP |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$9.40
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC OXALATE URINE
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
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 OXALATE URINE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: Aetna Medicare |
$14.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.06
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Complete |
$7.94
|
| Rate for Payer: BCBS MAPPO |
$14.45
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Medicare Advantage |
$14.45
|
| 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 |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.45
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$14.45
|
| Rate for Payer: Mclaren Medicare |
$14.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.17
|
| Rate for Payer: Meridian Medicaid |
$7.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.89
|
| 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 |
$13.73
|
| Rate for Payer: PACE SWMI |
$14.45
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Medicaid |
$7.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.92
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health Narrow Network |
$32.74
|
| Rate for Payer: Railroad Medicare Medicare |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.45
|
| Rate for Payer: UHC Exchange |
$22.40
|
| Rate for Payer: UHC Medicaid |
$7.56
|
| Rate for Payer: UHCCP DNSP |
$14.45
|
| Rate for Payer: UHCCP Medicaid |
$7.56
|
| Rate for Payer: VA VA |
$14.45
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$75.35
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$75.35 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: ASR ASR |
$73.09
|
| Rate for Payer: BCBS Trust/PPO |
$61.88
|
| Rate for Payer: BCN Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Healthscope Commercial |
$73.09
|
| Rate for Payer: Healthscope Whirlpool |
$75.35
|
| Rate for Payer: Mclaren Commercial |
$67.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$61.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.31
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$75.35
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$75.35 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$73.09
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$62.13
|
| Rate for Payer: BCN Commercial |
$62.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$73.09
|
| Rate for Payer: Healthscope Whirlpool |
$75.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$67.81
|
| Rate for Payer: Mclaren Medicaid |
$13.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$61.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.85
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$18.28
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
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 OXYCODONE LVL
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
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 OXYCODONE URINE.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| 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 |
$107.91
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| 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 |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| 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 |
$97.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
| 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 OXYCODONE URINE.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: BCBS Trust/PPO |
$46.14
|
| Rate for Payer: BCN Commercial |
$46.14
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$54.49
|
| Rate for Payer: Healthscope Whirlpool |
$56.18
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: Aetna Medicare |
$20.79
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: BCBS Complete |
$22.47
|
| Rate for Payer: BCBS Trust/PPO |
$46.32
|
| Rate for Payer: BCN Commercial |
$46.32
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$54.49
|
| Rate for Payer: Healthscope Whirlpool |
$56.18
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.22
|
| Rate for Payer: Priority Health Narrow Network |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,498.21
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$554.34 |
| Max. Negotiated Rate |
$1,498.21 |
| Rate for Payer: Aetna Commercial |
$1,348.39
|
| Rate for Payer: Aetna Medicare |
$554.34
|
| Rate for Payer: ASR ASR |
$1,453.26
|
| Rate for Payer: BCBS Complete |
$599.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.27
|
| Rate for Payer: BCN Commercial |
$1,235.27
|
| Rate for Payer: Cash Price |
$1,198.57
|
| Rate for Payer: Cofinity Commercial |
$1,408.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.57
|
| Rate for Payer: Healthscope Commercial |
$1,453.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,498.21
|
| Rate for Payer: Mclaren Commercial |
$1,348.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,198.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.48
|
| Rate for Payer: Nomi Health Commercial |
$1,228.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,312.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,050.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,318.42
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,498.21
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,123.66 |
| Max. Negotiated Rate |
$1,498.21 |
| Rate for Payer: Aetna Commercial |
$1,348.39
|
| Rate for Payer: ASR ASR |
$1,453.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.33
|
| Rate for Payer: BCN Commercial |
$1,230.33
|
| Rate for Payer: Cash Price |
$1,198.57
|
| Rate for Payer: Cofinity Commercial |
$1,408.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.57
|
| Rate for Payer: Healthscope Commercial |
$1,453.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,498.21
|
| Rate for Payer: Mclaren Commercial |
$1,348.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.48
|
| Rate for Payer: Nomi Health Commercial |
$1,228.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,318.42
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,264.09
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$467.71 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,137.68
|
| Rate for Payer: Aetna Medicare |
$467.71
|
| Rate for Payer: ASR ASR |
$1,226.17
|
| Rate for Payer: BCBS Complete |
$505.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.24
|
| Rate for Payer: BCN Commercial |
$1,042.24
|
| Rate for Payer: Cash Price |
$1,011.27
|
| Rate for Payer: Cofinity Commercial |
$1,188.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.27
|
| Rate for Payer: Healthscope Commercial |
$1,226.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,264.09
|
| Rate for Payer: Mclaren Commercial |
$1,137.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,011.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.48
|
| Rate for Payer: Nomi Health Commercial |
$1,036.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,107.60
|
| Rate for Payer: Priority Health Narrow Network |
$886.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.40
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,264.09
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$948.07 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,137.68
|
| Rate for Payer: ASR ASR |
$1,226.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.07
|
| Rate for Payer: BCN Commercial |
$1,038.07
|
| Rate for Payer: Cash Price |
$1,011.27
|
| Rate for Payer: Cofinity Commercial |
$1,188.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.27
|
| Rate for Payer: Healthscope Commercial |
$1,226.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,264.09
|
| Rate for Payer: Mclaren Commercial |
$1,137.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.48
|
| Rate for Payer: Nomi Health Commercial |
$1,036.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.40
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,279.69
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$473.49 |
| Max. Negotiated Rate |
$1,279.69 |
| Rate for Payer: Aetna Commercial |
$1,151.72
|
| Rate for Payer: Aetna Medicare |
$473.49
|
| Rate for Payer: ASR ASR |
$1,241.30
|
| Rate for Payer: BCBS Complete |
$511.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.10
|
| Rate for Payer: BCN Commercial |
$1,055.10
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cofinity Commercial |
$1,202.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.75
|
| Rate for Payer: Healthscope Commercial |
$1,241.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.69
|
| Rate for Payer: Mclaren Commercial |
$1,151.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,023.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.74
|
| Rate for Payer: Nomi Health Commercial |
$1,049.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,121.26
|
| Rate for Payer: Priority Health Narrow Network |
$897.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.13
|
|
