|
HC OT Z STOCKINGS NON CUSTOM $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC OT Z STOCKINGS NON CUSTOM $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC OVA & PARASITES
|
Facility
|
IP
|
$87.82
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: ASR ASR |
$85.19
|
| Rate for Payer: ASR Commercial |
$85.19
|
| Rate for Payer: BCBS Trust/PPO |
$71.56
|
| Rate for Payer: BCN Commercial |
$68.09
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$82.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Whirlpool |
$85.19
|
| Rate for Payer: Mclaren Commercial |
$79.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: Nomi Health Commercial |
$72.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.28
|
|
|
HC OVA & PARASITES
|
Facility
|
OP
|
$87.82
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| 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 |
$85.19
|
| Rate for Payer: ASR Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$5.01
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$71.92
|
| Rate for Payer: BCN Commercial |
$68.09
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$82.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Whirlpool |
$85.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.90
|
| Rate for Payer: Mclaren Commercial |
$79.04
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicare |
$8.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.34
|
| Rate for Payer: Meridian Medicaid |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: Nomi Health Commercial |
$72.01
|
| 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 |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Exchange |
$13.80
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHCCP DNSP |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$4.77
|
| Rate for Payer: VA VA |
$8.90
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| 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 |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$54.29
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.98
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| 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 |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| 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 |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.09
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$46.48
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$27.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP DNSP |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$9.64
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
HC OXALATE URINE
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC OXALATE URINE
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| 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 |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Complete |
$8.13
|
| Rate for Payer: BCBS MAPPO |
$14.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: BCN Medicare Advantage |
$14.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.45
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$7.75
|
| 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 |
$8.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Medicare |
$13.73
|
| Rate for Payer: PACE SWMI |
$14.45
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Medicaid |
$7.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.11
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health Narrow Network |
$32.09
|
| Rate for Payer: Railroad Medicare Medicare |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.45
|
| Rate for Payer: UHC Exchange |
$22.40
|
| Rate for Payer: UHC Medicare Advantage |
$14.45
|
| Rate for Payer: UHCCP DNSP |
$14.45
|
| Rate for Payer: UHCCP Medicaid |
$7.75
|
| Rate for Payer: VA VA |
$14.45
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: ASR Commercial |
$71.65
|
| Rate for Payer: BCBS Trust/PPO |
$60.20
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.65
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| 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 |
$71.65
|
| Rate for Payer: ASR Commercial |
$71.65
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$60.49
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.58
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.72
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$16.58
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Trust/PPO |
$64.83
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
HC OXYCODONE LVL
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$65.15
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.71
|
| Rate for Payer: Priority Health Narrow Network |
$55.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
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 OXYCODONE URINE.
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
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 OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: ASR Commercial |
$53.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.88
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Aetna Medicare |
$27.54
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: ASR Commercial |
$53.43
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: BCBS Trust/PPO |
$45.11
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.26
|
| Rate for Payer: Priority Health Narrow Network |
$38.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$954.74 |
| Max. Negotiated Rate |
$1,468.83 |
| Rate for Payer: Aetna Commercial |
$1,321.95
|
| Rate for Payer: ASR ASR |
$1,424.77
|
| Rate for Payer: ASR Commercial |
$1,424.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.95
|
| Rate for Payer: BCN Commercial |
$1,138.78
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,468.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,424.77
|
| Rate for Payer: Mclaren Commercial |
$1,321.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: Nomi Health Commercial |
$1,204.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.57
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$587.53 |
| Max. Negotiated Rate |
$1,468.83 |
| Rate for Payer: Aetna Commercial |
$1,321.95
|
| Rate for Payer: Aetna Medicare |
$734.42
|
| Rate for Payer: ASR ASR |
$1,424.77
|
| Rate for Payer: ASR Commercial |
$1,424.77
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.82
|
| Rate for Payer: BCN Commercial |
$1,138.78
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,468.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,424.77
|
| Rate for Payer: Mclaren Commercial |
$1,321.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: Nomi Health Commercial |
$1,204.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,286.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.57
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$805.54 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,115.37
|
| Rate for Payer: ASR ASR |
$1,202.12
|
| Rate for Payer: ASR Commercial |
$1,202.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.91
|
| Rate for Payer: BCN Commercial |
$960.83
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,164.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.12
|
| Rate for Payer: Mclaren Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,090.58
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$495.72 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,115.37
|
| Rate for Payer: Aetna Medicare |
$619.65
|
| Rate for Payer: ASR ASR |
$1,202.12
|
| Rate for Payer: ASR Commercial |
$1,202.12
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.86
|
| Rate for Payer: BCN Commercial |
$960.83
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,164.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.12
|
| Rate for Payer: Mclaren Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.87
|
| Rate for Payer: Priority Health Narrow Network |
$868.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,090.58
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Aetna Commercial |
$1,129.14
|
| Rate for Payer: Aetna Medicare |
$627.30
|
| Rate for Payer: ASR ASR |
$1,216.96
|
| Rate for Payer: ASR Commercial |
$1,216.96
|
| Rate for Payer: BCBS Complete |
$501.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,027.39
|
| Rate for Payer: BCN Commercial |
$972.69
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,179.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,254.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,216.96
|
| Rate for Payer: Mclaren Commercial |
$1,129.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: Nomi Health Commercial |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.28
|
| Rate for Payer: Priority Health Narrow Network |
$879.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.05
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$815.49 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Aetna Commercial |
$1,129.14
|
| Rate for Payer: ASR ASR |
$1,216.96
|
| Rate for Payer: ASR Commercial |
$1,216.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.37
|
| Rate for Payer: BCN Commercial |
$972.69
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,179.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,254.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,216.96
|
| Rate for Payer: Mclaren Commercial |
$1,129.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: Nomi Health Commercial |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.05
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,545.30 |
| Max. Negotiated Rate |
$3,863.25 |
| Rate for Payer: Aetna Commercial |
$3,476.92
|
| Rate for Payer: Aetna Medicare |
$1,931.62
|
| Rate for Payer: ASR ASR |
$3,747.35
|
| Rate for Payer: ASR Commercial |
$3,747.35
|
| Rate for Payer: BCBS Complete |
$1,545.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,163.62
|
| Rate for Payer: BCN Commercial |
$2,995.18
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$3,631.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,863.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,747.35
|
| Rate for Payer: Mclaren Commercial |
$3,476.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: Nomi Health Commercial |
$3,167.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,384.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,708.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,399.66
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,511.11 |
| Max. Negotiated Rate |
$3,863.25 |
| Rate for Payer: Aetna Commercial |
$3,476.92
|
| Rate for Payer: ASR ASR |
$3,747.35
|
| Rate for Payer: ASR Commercial |
$3,747.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,148.16
|
| Rate for Payer: BCN Commercial |
$2,995.18
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$3,631.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,863.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,747.35
|
| Rate for Payer: Mclaren Commercial |
$3,476.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: Nomi Health Commercial |
$3,167.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,399.66
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$802.21 |
| Rate for Payer: Aetna Commercial |
$721.99
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$778.14
|
| Rate for Payer: ASR Commercial |
$778.14
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$656.93
|
| Rate for Payer: BCN Commercial |
$621.95
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$754.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$802.21
|
| Rate for Payer: Healthscope Whirlpool |
$778.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$721.99
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: Nomi Health Commercial |
$657.81
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.06
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$197.65
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
