|
HC SUSCEPTIBILITY, MIC
|
Facility
|
IP
|
$82.19
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$82.19 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| Rate for Payer: ASR ASR |
$79.72
|
| Rate for Payer: BCBS Trust/PPO |
$67.49
|
| Rate for Payer: BCN Commercial |
$67.49
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Healthscope Commercial |
$79.72
|
| Rate for Payer: Healthscope Whirlpool |
$82.19
|
| Rate for Payer: Mclaren Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$67.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.33
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
OP
|
$340.02
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$125.81 |
| Max. Negotiated Rate |
$340.02 |
| Rate for Payer: Aetna Commercial |
$306.02
|
| Rate for Payer: Aetna Medicare |
$125.81
|
| Rate for Payer: ASR ASR |
$329.82
|
| Rate for Payer: BCBS Complete |
$136.01
|
| Rate for Payer: BCBS Trust/PPO |
$280.35
|
| Rate for Payer: BCN Commercial |
$280.35
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cofinity Commercial |
$319.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.02
|
| Rate for Payer: Healthscope Commercial |
$329.82
|
| Rate for Payer: Healthscope Whirlpool |
$340.02
|
| Rate for Payer: Mclaren Commercial |
$306.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.02
|
| Rate for Payer: Nomi Health Commercial |
$278.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.27
|
| Rate for Payer: Priority Health Narrow Network |
$153.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.22
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
IP
|
$340.02
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$255.01 |
| Max. Negotiated Rate |
$340.02 |
| Rate for Payer: Aetna Commercial |
$306.02
|
| Rate for Payer: ASR ASR |
$329.82
|
| Rate for Payer: BCBS Trust/PPO |
$279.22
|
| Rate for Payer: BCN Commercial |
$279.22
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cofinity Commercial |
$319.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.02
|
| Rate for Payer: Healthscope Commercial |
$329.82
|
| Rate for Payer: Healthscope Whirlpool |
$340.02
|
| Rate for Payer: Mclaren Commercial |
$306.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.02
|
| Rate for Payer: Nomi Health Commercial |
$278.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.22
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
IP
|
$247.16
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$185.37 |
| Max. Negotiated Rate |
$247.16 |
| Rate for Payer: Aetna Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$239.75
|
| Rate for Payer: BCBS Trust/PPO |
$202.97
|
| Rate for Payer: BCN Commercial |
$202.97
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cofinity Commercial |
$232.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.73
|
| Rate for Payer: Healthscope Commercial |
$239.75
|
| Rate for Payer: Healthscope Whirlpool |
$247.16
|
| Rate for Payer: Mclaren Commercial |
$222.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.09
|
| Rate for Payer: Nomi Health Commercial |
$202.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.50
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
OP
|
$247.16
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$257.85 |
| Rate for Payer: Aetna Commercial |
$222.44
|
| Rate for Payer: Aetna Medicare |
$91.45
|
| Rate for Payer: ASR ASR |
$239.75
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$203.78
|
| Rate for Payer: BCN Commercial |
$203.78
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cofinity Commercial |
$232.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.73
|
| Rate for Payer: Healthscope Commercial |
$239.75
|
| Rate for Payer: Healthscope Whirlpool |
$247.16
|
| Rate for Payer: Mclaren Commercial |
$222.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.09
|
| Rate for Payer: Nomi Health Commercial |
$202.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.85
|
| Rate for Payer: Priority Health Narrow Network |
$206.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.50
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
OP
|
$240.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$240.18 |
| Rate for Payer: Aetna Commercial |
$216.16
|
| Rate for Payer: Aetna Medicare |
$88.87
|
| Rate for Payer: ASR ASR |
$232.97
|
| Rate for Payer: BCBS Complete |
$96.07
|
| Rate for Payer: BCBS Trust/PPO |
$198.03
|
| Rate for Payer: BCN Commercial |
$198.03
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Cofinity Commercial |
$225.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.14
|
| Rate for Payer: Healthscope Commercial |
$232.97
|
| Rate for Payer: Healthscope Whirlpool |
$240.18
|
| Rate for Payer: Mclaren Commercial |
$216.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.15
|
| Rate for Payer: Nomi Health Commercial |
$196.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$210.45
|
| Rate for Payer: Priority Health Narrow Network |
$168.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.36
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
IP
|
$240.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.13 |
| Max. Negotiated Rate |
$240.18 |
| Rate for Payer: Aetna Commercial |
$216.16
|
| Rate for Payer: ASR ASR |
$232.97
|
| Rate for Payer: BCBS Trust/PPO |
$197.24
|
| Rate for Payer: BCN Commercial |
$197.24
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Cofinity Commercial |
$225.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.14
|
| Rate for Payer: Healthscope Commercial |
$232.97
|
| Rate for Payer: Healthscope Whirlpool |
$240.18
|
| Rate for Payer: Mclaren Commercial |
$216.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.15
|
| Rate for Payer: Nomi Health Commercial |
$196.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.36
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
OP
|
$1,677.77
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$2,431.16 |
| Rate for Payer: Aetna Commercial |
$1,509.99
|
| Rate for Payer: Aetna Medicare |
$1,568.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: ASR ASR |
$1,627.44
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.32
|
| Rate for Payer: BCN Commercial |
$1,383.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,342.22
|
| Rate for Payer: Cash Price |
$1,342.22
|
| Rate for Payer: Cofinity Commercial |
$1,577.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$1,627.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,677.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.49
|
| Rate for Payer: Mclaren Commercial |
$1,509.99
|
| Rate for Payer: Mclaren Medicaid |
$1,568.49
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$861.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.10
|
| Rate for Payer: Nomi Health Commercial |
$1,375.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,258.33
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,725.34
|
| Rate for Payer: PHP Medicaid |
$840.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,470.06
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,176.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,476.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Exchange |
$2,431.16
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP DNSP |
$1,568.49
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
IP
|
$1,677.77
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,258.33 |
| Max. Negotiated Rate |
$1,677.77 |
| Rate for Payer: Aetna Commercial |
$1,509.99
|
| Rate for Payer: ASR ASR |
$1,627.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.78
|
| Rate for Payer: BCN Commercial |
$1,377.78
|
| Rate for Payer: Cash Price |
$1,342.22
|
| Rate for Payer: Cofinity Commercial |
$1,577.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.22
|
| Rate for Payer: Healthscope Commercial |
$1,627.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,677.77
|
| Rate for Payer: Mclaren Commercial |
$1,509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.10
|
| Rate for Payer: Nomi Health Commercial |
$1,375.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,258.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,476.44
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
IP
|
$80.84
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$80.84 |
| Rate for Payer: Aetna Commercial |
$72.76
|
| Rate for Payer: ASR ASR |
$78.41
|
| Rate for Payer: BCBS Trust/PPO |
$66.39
|
| Rate for Payer: BCN Commercial |
$66.39
|
| Rate for Payer: Cash Price |
$64.67
|
| Rate for Payer: Cofinity Commercial |
$75.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.67
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Healthscope Whirlpool |
$80.84
|
| Rate for Payer: Mclaren Commercial |
$72.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.71
|
| Rate for Payer: Nomi Health Commercial |
$66.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.14
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
OP
|
$80.84
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$80.84 |
| Rate for Payer: Aetna Commercial |
$72.76
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: ASR ASR |
$78.41
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$66.65
|
| Rate for Payer: BCN Commercial |
$66.65
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$64.67
|
| Rate for Payer: Cash Price |
$64.67
|
| Rate for Payer: Cofinity Commercial |
$75.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Healthscope Whirlpool |
$80.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.00
|
| Rate for Payer: Mclaren Commercial |
$72.76
|
| Rate for Payer: Mclaren Medicaid |
$5.00
|
| Rate for Payer: Mclaren Medicare |
$5.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: Meridian Medicaid |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.71
|
| Rate for Payer: Nomi Health Commercial |
$66.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.63
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$5.50
|
| Rate for Payer: PHP Medicaid |
$2.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.67
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow Network |
$23.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.00
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UHC Medicaid |
$2.62
|
| Rate for Payer: UHCCP DNSP |
$5.00
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC SWEAT COLLECTION
|
Facility
|
OP
|
$101.12
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: Aetna Medicare |
$51.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: ASR ASR |
$98.09
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$83.37
|
| Rate for Payer: BCN Commercial |
$83.37
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$98.09
|
| Rate for Payer: Healthscope Whirlpool |
$101.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.92
|
| Rate for Payer: Mclaren Commercial |
$91.01
|
| Rate for Payer: Mclaren Medicaid |
$51.92
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$28.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.95
|
| Rate for Payer: Nomi Health Commercial |
$82.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.84
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicaid |
$27.83
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.60
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health Narrow Network |
$70.89
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.48
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP DNSP |
$51.92
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC SWEAT COLLECTION
|
Facility
|
IP
|
$101.12
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: ASR ASR |
$98.09
|
| Rate for Payer: BCBS Trust/PPO |
$83.04
|
| Rate for Payer: BCN Commercial |
$83.04
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.90
|
| Rate for Payer: Healthscope Commercial |
$98.09
|
| Rate for Payer: Healthscope Whirlpool |
$101.12
|
| Rate for Payer: Mclaren Commercial |
$91.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.95
|
| Rate for Payer: Nomi Health Commercial |
$82.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.99
|
|
|
HC SWEET VERNAL IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC SWEET VERNAL IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SYCAMORE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC SYCAMORE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SYPHILIS ANTIBODY CMPT
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$44.78 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$27.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC SYPHILIS ANTIBODY CMPT
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$27.02
|
| Rate for Payer: BCN Commercial |
$27.02
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
|
|
HC SYPHILLIS AB TP-PA REFLEX
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$68.62
|
| Rate for Payer: BCN Commercial |
$68.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$66.58
|
| 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: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$80.73
|
| Rate for Payer: Healthscope Whirlpool |
$83.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$13.24
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$7.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| 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: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$14.56
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.96
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$50.37
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP DNSP |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC SYPHILLIS AB TP-PA REFLEX
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| 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 SYPHYLIS NON-TREPONEMAL AB (RPR)
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 0065U
|
| Hospital Charge Code |
30200437
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$18.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.61
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: BCBS MAPPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.89
|
| Rate for Payer: BCN Commercial |
$42.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$52.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.09
|
| Rate for Payer: Mclaren Medicare |
$18.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.99
|
| Rate for Payer: Meridian Medicaid |
$9.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PACE Medicare |
$17.19
|
| Rate for Payer: PACE SWMI |
$18.09
|
| Rate for Payer: PHP Commercial |
$19.90
|
| Rate for Payer: PHP Medicaid |
$9.70
|
| Rate for Payer: PHP Medicare Advantage |
$18.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$18.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.09
|
| Rate for Payer: UHC Exchange |
$28.04
|
| Rate for Payer: UHC Medicaid |
$9.46
|
| Rate for Payer: UHCCP DNSP |
$18.09
|
| Rate for Payer: UHCCP Medicaid |
$9.46
|
| Rate for Payer: VA VA |
$18.09
|
|
|
HC SYPHYLIS NON-TREPONEMAL AB (RPR)
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 0065U
|
| Hospital Charge Code |
30200437
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.72
|
| Rate for Payer: BCN Commercial |
$42.72
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$52.02
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC T3 FREE
|
Facility
|
OP
|
$134.83
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
30100448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Aetna Commercial |
$121.35
|
| Rate for Payer: Aetna Medicare |
$16.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: ASR ASR |
$130.79
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$111.17
|
| Rate for Payer: BCN Commercial |
$111.17
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$107.86
|
| Rate for Payer: Cash Price |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$126.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$130.79
|
| Rate for Payer: Healthscope Whirlpool |
$134.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$121.35
|
| Rate for Payer: Mclaren Medicaid |
$16.94
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.61
|
| Rate for Payer: Nomi Health Commercial |
$110.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.12
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$18.63
|
| Rate for Payer: PHP Medicaid |
$9.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$26.26
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP DNSP |
$16.94
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC T3 FREE
|
Facility
|
IP
|
$134.83
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
30100448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.12 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Aetna Commercial |
$121.35
|
| Rate for Payer: ASR ASR |
$130.79
|
| Rate for Payer: BCBS Trust/PPO |
$110.72
|
| Rate for Payer: BCN Commercial |
$110.72
|
| Rate for Payer: Cash Price |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$126.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.86
|
| Rate for Payer: Healthscope Commercial |
$130.79
|
| Rate for Payer: Healthscope Whirlpool |
$134.83
|
| Rate for Payer: Mclaren Commercial |
$121.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.61
|
| Rate for Payer: Nomi Health Commercial |
$110.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.65
|
|
