|
HC SUSCEPTIBILITY, MIC
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$80.58 |
| Rate for Payer: Aetna Commercial |
$72.52
|
| Rate for Payer: ASR ASR |
$78.16
|
| Rate for Payer: ASR Commercial |
$78.16
|
| Rate for Payer: BCBS Trust/PPO |
$65.66
|
| Rate for Payer: BCN Commercial |
$62.47
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$80.58
|
| Rate for Payer: Healthscope Whirlpool |
$78.16
|
| Rate for Payer: Mclaren Commercial |
$72.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.91
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
IP
|
$333.35
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$216.68 |
| Max. Negotiated Rate |
$333.35 |
| Rate for Payer: Aetna Commercial |
$300.01
|
| Rate for Payer: ASR ASR |
$323.35
|
| Rate for Payer: ASR Commercial |
$323.35
|
| Rate for Payer: BCBS Trust/PPO |
$271.65
|
| Rate for Payer: BCN Commercial |
$258.45
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cofinity Commercial |
$313.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.68
|
| Rate for Payer: Healthscope Commercial |
$333.35
|
| Rate for Payer: Healthscope Whirlpool |
$323.35
|
| Rate for Payer: Mclaren Commercial |
$300.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.35
|
| Rate for Payer: Nomi Health Commercial |
$273.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.35
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
OP
|
$333.35
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$333.35 |
| Rate for Payer: Aetna Commercial |
$300.01
|
| Rate for Payer: Aetna Medicare |
$166.68
|
| Rate for Payer: ASR ASR |
$323.35
|
| Rate for Payer: ASR Commercial |
$323.35
|
| Rate for Payer: BCBS Complete |
$133.34
|
| Rate for Payer: BCBS Trust/PPO |
$272.98
|
| Rate for Payer: BCN Commercial |
$258.45
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cofinity Commercial |
$313.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.68
|
| Rate for Payer: Healthscope Commercial |
$333.35
|
| Rate for Payer: Healthscope Whirlpool |
$323.35
|
| Rate for Payer: Mclaren Commercial |
$300.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.35
|
| Rate for Payer: Nomi Health Commercial |
$273.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.08
|
| Rate for Payer: Priority Health Narrow Network |
$233.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.35
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
IP
|
$222.68
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$222.68 |
| Rate for Payer: Aetna Commercial |
$200.41
|
| Rate for Payer: ASR ASR |
$216.00
|
| Rate for Payer: ASR Commercial |
$216.00
|
| Rate for Payer: BCBS Trust/PPO |
$181.46
|
| Rate for Payer: BCN Commercial |
$172.64
|
| Rate for Payer: Cash Price |
$178.14
|
| Rate for Payer: Cofinity Commercial |
$209.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$222.68
|
| Rate for Payer: Healthscope Whirlpool |
$216.00
|
| Rate for Payer: Mclaren Commercial |
$200.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.28
|
| Rate for Payer: Nomi Health Commercial |
$182.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.96
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
OP
|
$222.68
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.07 |
| Max. Negotiated Rate |
$222.68 |
| Rate for Payer: Aetna Commercial |
$200.41
|
| Rate for Payer: Aetna Medicare |
$111.34
|
| Rate for Payer: ASR ASR |
$216.00
|
| Rate for Payer: ASR Commercial |
$216.00
|
| Rate for Payer: BCBS Complete |
$89.07
|
| Rate for Payer: BCBS Trust/PPO |
$182.35
|
| Rate for Payer: BCN Commercial |
$172.64
|
| Rate for Payer: Cash Price |
$178.14
|
| Rate for Payer: Cofinity Commercial |
$209.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$222.68
|
| Rate for Payer: Healthscope Whirlpool |
$216.00
|
| Rate for Payer: Mclaren Commercial |
$200.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.28
|
| Rate for Payer: Nomi Health Commercial |
$182.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.11
|
| Rate for Payer: Priority Health Narrow Network |
$156.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.96
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
IP
|
$235.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.06 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: Aetna Commercial |
$211.92
|
| Rate for Payer: ASR ASR |
$228.41
|
| Rate for Payer: ASR Commercial |
$228.41
|
| Rate for Payer: BCBS Trust/PPO |
$191.88
|
| Rate for Payer: BCN Commercial |
$182.56
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Commercial |
$221.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Whirlpool |
$228.41
|
| Rate for Payer: Mclaren Commercial |
$211.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.15
|
| Rate for Payer: Nomi Health Commercial |
$193.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.21
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
OP
|
$235.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: Aetna Commercial |
$211.92
|
| Rate for Payer: Aetna Medicare |
$117.73
|
| Rate for Payer: ASR ASR |
$228.41
|
| Rate for Payer: ASR Commercial |
$228.41
|
| Rate for Payer: BCBS Complete |
$94.19
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: BCN Commercial |
$182.56
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Commercial |
$221.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Whirlpool |
$228.41
|
| Rate for Payer: Mclaren Commercial |
$211.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.15
|
| Rate for Payer: Nomi Health Commercial |
$193.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.32
|
| Rate for Payer: Priority Health Narrow Network |
$165.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.21
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
OP
|
$1,644.87
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$2,348.31 |
| Rate for Payer: Aetna Commercial |
$1,480.38
|
| Rate for Payer: Aetna Medicare |
$1,515.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: ASR ASR |
$1,595.52
|
| Rate for Payer: ASR Commercial |
$1,595.52
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,346.98
|
| Rate for Payer: BCN Commercial |
$1,275.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$1,315.90
|
| Rate for Payer: Cash Price |
$1,315.90
|
| Rate for Payer: Cofinity Commercial |
$1,546.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,315.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$1,644.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,595.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,515.04
|
| Rate for Payer: Mclaren Commercial |
$1,480.38
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,398.14
|
| Rate for Payer: Nomi Health Commercial |
$1,348.79
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,666.54
|
| Rate for Payer: PHP Medicaid |
$812.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,441.24
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,153.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,447.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP DNSP |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
IP
|
$1,644.87
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,069.17 |
| Max. Negotiated Rate |
$1,644.87 |
| Rate for Payer: Aetna Commercial |
$1,480.38
|
| Rate for Payer: ASR ASR |
$1,595.52
|
| Rate for Payer: ASR Commercial |
$1,595.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.40
|
| Rate for Payer: BCN Commercial |
$1,275.27
|
| Rate for Payer: Cash Price |
$1,315.90
|
| Rate for Payer: Cofinity Commercial |
$1,546.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,315.90
|
| Rate for Payer: Healthscope Commercial |
$1,644.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,595.52
|
| Rate for Payer: Mclaren Commercial |
$1,480.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,398.14
|
| Rate for Payer: Nomi Health Commercial |
$1,348.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,447.49
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
IP
|
$79.25
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$79.25 |
| Rate for Payer: Aetna Commercial |
$71.33
|
| Rate for Payer: ASR ASR |
$76.87
|
| Rate for Payer: ASR Commercial |
$76.87
|
| Rate for Payer: BCBS Trust/PPO |
$64.58
|
| Rate for Payer: BCN Commercial |
$61.44
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cofinity Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.40
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Healthscope Whirlpool |
$76.87
|
| Rate for Payer: Mclaren Commercial |
$71.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.36
|
| Rate for Payer: Nomi Health Commercial |
$64.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.74
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
OP
|
$79.25
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$79.25 |
| Rate for Payer: Aetna Commercial |
$71.33
|
| 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 |
$76.87
|
| Rate for Payer: ASR Commercial |
$76.87
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$64.90
|
| Rate for Payer: BCN Commercial |
$61.44
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cofinity Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Healthscope Whirlpool |
$76.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.00
|
| Rate for Payer: Mclaren Commercial |
$71.33
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| 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 |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.36
|
| Rate for Payer: Nomi Health Commercial |
$64.98
|
| 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 |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.44
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow Network |
$55.55
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: UHCCP DNSP |
$5.00
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC SWEAT COLLECTION
|
Facility
|
IP
|
$99.14
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.44 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$89.23
|
| Rate for Payer: ASR ASR |
$96.17
|
| Rate for Payer: ASR Commercial |
$96.17
|
| Rate for Payer: BCBS Trust/PPO |
$80.79
|
| Rate for Payer: BCN Commercial |
$76.86
|
| Rate for Payer: Cash Price |
$79.31
|
| Rate for Payer: Cofinity Commercial |
$93.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Healthscope Whirlpool |
$96.17
|
| Rate for Payer: Mclaren Commercial |
$89.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.27
|
| Rate for Payer: Nomi Health Commercial |
$81.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.24
|
|
|
HC SWEAT COLLECTION
|
Facility
|
OP
|
$99.14
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$89.23
|
| Rate for Payer: Aetna Medicare |
$52.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.14
|
| Rate for Payer: ASR ASR |
$96.17
|
| Rate for Payer: ASR Commercial |
$96.17
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$52.11
|
| Rate for Payer: BCBS Trust/PPO |
$81.19
|
| Rate for Payer: BCN Commercial |
$76.86
|
| Rate for Payer: BCN Medicare Advantage |
$52.11
|
| Rate for Payer: Cash Price |
$79.31
|
| Rate for Payer: Cash Price |
$79.31
|
| Rate for Payer: Cofinity Commercial |
$93.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Healthscope Whirlpool |
$96.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.11
|
| Rate for Payer: Mclaren Commercial |
$89.23
|
| Rate for Payer: Mclaren Medicaid |
$27.93
|
| Rate for Payer: Mclaren Medicare |
$52.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.72
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.27
|
| Rate for Payer: Nomi Health Commercial |
$81.29
|
| Rate for Payer: PACE Medicare |
$49.50
|
| Rate for Payer: PACE SWMI |
$52.11
|
| Rate for Payer: PHP Commercial |
$57.32
|
| Rate for Payer: PHP Medicaid |
$27.93
|
| Rate for Payer: PHP Medicare Advantage |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.87
|
| Rate for Payer: Priority Health Medicare |
$52.11
|
| Rate for Payer: Priority Health Narrow Network |
$69.50
|
| Rate for Payer: Railroad Medicare Medicare |
$52.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.11
|
| Rate for Payer: UHC Exchange |
$80.77
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
| Rate for Payer: UHCCP DNSP |
$52.11
|
| Rate for Payer: UHCCP Medicaid |
$27.93
|
| Rate for Payer: VA VA |
$52.11
|
|
|
HC SWEET VERNAL IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC SWEET VERNAL IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SYCAMORE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SYCAMORE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC SYPHILIS ANTIBODY CMPT
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| 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 |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$26.41
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| 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 |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| 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 |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.26
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$22.61
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC SYPHILIS ANTIBODY CMPT
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC SYPHILLIS AB TP-PA REFLEX
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC SYPHILLIS AB TP-PA REFLEX
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| 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 |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$66.82
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| 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 |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP DNSP |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC SYPHYLIS NON-TREPONEMAL AB (RPR)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 0065U
|
| Hospital Charge Code |
30200437
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| 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 |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: BCBS MAPPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$9.70
|
| 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 |
$10.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| 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 |
$9.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Medicare |
$18.09
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: Railroad Medicare Medicare |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.09
|
| Rate for Payer: UHC Exchange |
$28.04
|
| Rate for Payer: UHC Medicare Advantage |
$18.09
|
| Rate for Payer: UHCCP DNSP |
$18.09
|
| Rate for Payer: UHCCP Medicaid |
$9.70
|
| Rate for Payer: VA VA |
$18.09
|
|
|
HC SYPHYLIS NON-TREPONEMAL AB (RPR)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 0065U
|
| Hospital Charge Code |
30200437
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC T3 FREE
|
Facility
|
IP
|
$132.19
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
30100448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: ASR ASR |
$128.22
|
| Rate for Payer: ASR Commercial |
$128.22
|
| Rate for Payer: BCBS Trust/PPO |
$107.72
|
| Rate for Payer: BCN Commercial |
$102.49
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$124.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.75
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Healthscope Whirlpool |
$128.22
|
| Rate for Payer: Mclaren Commercial |
$118.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.36
|
| Rate for Payer: Nomi Health Commercial |
$108.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.33
|
|
|
HC T3 FREE
|
Facility
|
OP
|
$132.19
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
30100448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| 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 |
$128.22
|
| Rate for Payer: ASR Commercial |
$128.22
|
| Rate for Payer: BCBS Complete |
$9.53
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$108.25
|
| Rate for Payer: BCN Commercial |
$102.49
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$124.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Healthscope Whirlpool |
$128.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$118.97
|
| Rate for Payer: Mclaren Medicaid |
$9.08
|
| 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 |
$9.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.36
|
| Rate for Payer: Nomi Health Commercial |
$108.40
|
| 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 |
$9.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.82
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health Narrow Network |
$92.67
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.94
|
| Rate for Payer: UHC Exchange |
$26.26
|
| Rate for Payer: UHC Medicare Advantage |
$16.94
|
| Rate for Payer: UHCCP DNSP |
$16.94
|
| Rate for Payer: UHCCP Medicaid |
$9.08
|
| Rate for Payer: VA VA |
$16.94
|
|
