|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$1,062.63 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$685.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$856.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$856.96
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Complete |
$385.84
|
| Rate for Payer: BCBS MAPPO |
$685.57
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: BCN Medicare Advantage |
$685.57
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.57
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$685.57
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$367.47
|
| Rate for Payer: Mclaren Medicare |
$685.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.85
|
| Rate for Payer: Meridian Medicaid |
$385.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$788.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PACE Medicare |
$651.29
|
| Rate for Payer: PACE SWMI |
$685.57
|
| Rate for Payer: PHP Commercial |
$754.13
|
| Rate for Payer: PHP Medicaid |
$367.47
|
| Rate for Payer: PHP Medicare Advantage |
$685.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.04
|
| Rate for Payer: Priority Health Medicare |
$685.57
|
| Rate for Payer: Priority Health Narrow Network |
$679.27
|
| Rate for Payer: Railroad Medicare Medicare |
$685.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.57
|
| Rate for Payer: UHC Exchange |
$1,062.63
|
| Rate for Payer: UHC Medicare Advantage |
$685.57
|
| Rate for Payer: UHCCP DNSP |
$685.57
|
| Rate for Payer: UHCCP Medicaid |
$367.47
|
| Rate for Payer: VA VA |
$685.57
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| 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 |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Trust/PPO |
$82.84
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.53
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| 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 |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| 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 |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| 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 |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.35
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$21.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Trust/PPO |
$82.84
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| 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 |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.44 |
| Max. Negotiated Rate |
$94.53 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: ASR ASR |
$91.69
|
| Rate for Payer: ASR Commercial |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$77.03
|
| Rate for Payer: BCN Commercial |
$73.29
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$88.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$94.53
|
| Rate for Payer: Healthscope Whirlpool |
$91.69
|
| Rate for Payer: Mclaren Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$77.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.19
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$96.32 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$91.69
|
| Rate for Payer: ASR Commercial |
$91.69
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCN Commercial |
$73.29
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$88.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$94.53
|
| Rate for Payer: Healthscope Whirlpool |
$91.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$77.51
|
| 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 |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.83
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$66.27
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,332.50 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: ASR ASR |
$1,988.50
|
| Rate for Payer: ASR Commercial |
$1,988.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.54
|
| Rate for Payer: BCN Commercial |
$1,589.36
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,927.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$2,050.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,988.50
|
| Rate for Payer: Mclaren Commercial |
$1,845.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.50
|
| Rate for Payer: Nomi Health Commercial |
$1,681.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,804.00
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: Aetna Medicare |
$1,025.00
|
| Rate for Payer: ASR ASR |
$1,988.50
|
| Rate for Payer: ASR Commercial |
$1,988.50
|
| Rate for Payer: BCBS Complete |
$820.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,678.74
|
| Rate for Payer: BCN Commercial |
$1,589.36
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,927.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$2,050.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,988.50
|
| Rate for Payer: Mclaren Commercial |
$1,845.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.50
|
| Rate for Payer: Nomi Health Commercial |
$1,681.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,796.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,437.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,804.00
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$61.92
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.77 |
| Max. Negotiated Rate |
$61.92 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: Aetna Medicare |
$30.96
|
| Rate for Payer: ASR ASR |
$60.06
|
| Rate for Payer: ASR Commercial |
$60.06
|
| Rate for Payer: BCBS Complete |
$24.77
|
| Rate for Payer: BCBS Trust/PPO |
$50.71
|
| Rate for Payer: BCN Commercial |
$48.01
|
| Rate for Payer: Cash Price |
$49.54
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.54
|
| Rate for Payer: Healthscope Commercial |
$61.92
|
| Rate for Payer: Healthscope Whirlpool |
$60.06
|
| Rate for Payer: Mclaren Commercial |
$55.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.63
|
| Rate for Payer: Nomi Health Commercial |
$50.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.25
|
| Rate for Payer: Priority Health Narrow Network |
$43.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.49
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$61.92
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$61.92 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: ASR ASR |
$60.06
|
| Rate for Payer: ASR Commercial |
$60.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.46
|
| Rate for Payer: BCN Commercial |
$48.01
|
| Rate for Payer: Cash Price |
$49.54
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.54
|
| Rate for Payer: Healthscope Commercial |
$61.92
|
| Rate for Payer: Healthscope Whirlpool |
$60.06
|
| Rate for Payer: Mclaren Commercial |
$55.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.63
|
| Rate for Payer: Nomi Health Commercial |
$50.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.49
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.46
|
| Rate for Payer: Priority Health Narrow Network |
$34.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.46
|
| Rate for Payer: Priority Health Narrow Network |
$34.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.46
|
| Rate for Payer: Priority Health Narrow Network |
$34.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.52 |
| Max. Negotiated Rate |
$154.65 |
| Rate for Payer: Aetna Commercial |
$139.18
|
| Rate for Payer: ASR ASR |
$150.01
|
| Rate for Payer: ASR Commercial |
$150.01
|
| Rate for Payer: BCBS Trust/PPO |
$126.02
|
| Rate for Payer: BCN Commercial |
$119.90
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$154.65
|
| Rate for Payer: Healthscope Whirlpool |
$150.01
|
| Rate for Payer: Mclaren Commercial |
$139.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.09
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$154.65 |
| Rate for Payer: Aetna Commercial |
$139.18
|
| Rate for Payer: Aetna Medicare |
$77.32
|
| Rate for Payer: ASR ASR |
$150.01
|
| Rate for Payer: ASR Commercial |
$150.01
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: BCBS Trust/PPO |
$126.64
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$119.90
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$154.65
|
| Rate for Payer: Healthscope Whirlpool |
$150.01
|
| Rate for Payer: Mclaren Commercial |
$139.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.09
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$174.09 |
| Rate for Payer: Aetna Commercial |
$156.68
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: ASR Commercial |
$168.87
|
| Rate for Payer: BCBS Trust/PPO |
$141.87
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$163.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$174.09
|
| Rate for Payer: Healthscope Whirlpool |
$168.87
|
| Rate for Payer: Mclaren Commercial |
$156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$189.95 |
| Rate for Payer: Aetna Commercial |
$156.68
|
| Rate for Payer: Aetna Medicare |
$87.04
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: ASR Commercial |
$168.87
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$142.56
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$163.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$174.09
|
| Rate for Payer: Healthscope Whirlpool |
$168.87
|
| Rate for Payer: Mclaren Commercial |
$156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
