|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$9,202.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,446.74 |
| Max. Negotiated Rate |
$16,142.34 |
| Rate for Payer: Aetna Commercial |
$8,282.30
|
| Rate for Payer: Aetna Medicare |
$10,414.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: ASR ASR |
$8,926.48
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$7,587.51
|
| Rate for Payer: BCN Commercial |
$7,587.51
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cofinity Commercial |
$8,650.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,362.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$8,926.48
|
| Rate for Payer: Healthscope Whirlpool |
$9,202.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,414.41
|
| Rate for Payer: Mclaren Commercial |
$8,282.30
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$5,719.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,822.18
|
| Rate for Payer: Nomi Health Commercial |
$7,546.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,901.92
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$11,455.85
|
| Rate for Payer: PHP Medicaid |
$5,582.12
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,063.28
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health Narrow Network |
$6,450.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,098.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Exchange |
$16,142.34
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP DNSP |
$10,414.41
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: VA VA |
$10,414.41
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,880.19
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,421.01 |
| Max. Negotiated Rate |
$16,142.34 |
| Rate for Payer: Aetna Commercial |
$4,392.17
|
| Rate for Payer: Aetna Medicare |
$10,414.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: ASR ASR |
$4,733.78
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,023.72
|
| Rate for Payer: BCN Commercial |
$4,023.72
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cofinity Commercial |
$4,587.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,904.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$4,733.78
|
| Rate for Payer: Healthscope Whirlpool |
$4,880.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,414.41
|
| Rate for Payer: Mclaren Commercial |
$4,392.17
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$5,719.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,148.16
|
| Rate for Payer: Nomi Health Commercial |
$4,001.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.14
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$11,455.85
|
| Rate for Payer: PHP Medicaid |
$5,582.12
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,276.02
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health Narrow Network |
$3,421.01
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,294.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Exchange |
$16,142.34
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP DNSP |
$10,414.41
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: VA VA |
$10,414.41
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,880.19
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,660.14 |
| Max. Negotiated Rate |
$4,880.19 |
| Rate for Payer: Aetna Commercial |
$4,392.17
|
| Rate for Payer: ASR ASR |
$4,733.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,007.61
|
| Rate for Payer: BCN Commercial |
$4,007.61
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cofinity Commercial |
$4,587.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,904.15
|
| Rate for Payer: Healthscope Commercial |
$4,733.78
|
| Rate for Payer: Healthscope Whirlpool |
$4,880.19
|
| Rate for Payer: Mclaren Commercial |
$4,392.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,148.16
|
| Rate for Payer: Nomi Health Commercial |
$4,001.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,294.57
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.95
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$3.95
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicaid |
$2.12
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.18
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.94
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.95
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Medicaid |
$2.07
|
| Rate for Payer: UHCCP DNSP |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.07
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
OP
|
$40.22
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Aetna Commercial |
$36.20
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: ASR ASR |
$39.01
|
| Rate for Payer: BCBS Complete |
$3.05
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$33.16
|
| Rate for Payer: BCN Commercial |
$33.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$32.18
|
| Rate for Payer: Cash Price |
$32.18
|
| Rate for Payer: Cofinity Commercial |
$37.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$39.01
|
| Rate for Payer: Healthscope Whirlpool |
$40.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.56
|
| Rate for Payer: Mclaren Commercial |
$36.20
|
| Rate for Payer: Mclaren Medicaid |
$5.56
|
| Rate for Payer: Mclaren Medicare |
$5.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: Meridian Medicaid |
$3.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.19
|
| Rate for Payer: Nomi Health Commercial |
$32.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.16
|
| Rate for Payer: PACE Medicare |
$5.28
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.12
|
| Rate for Payer: PHP Medicaid |
$2.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.24
|
| Rate for Payer: Priority Health Medicare |
$5.56
|
| Rate for Payer: Priority Health Narrow Network |
$28.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.56
|
| Rate for Payer: UHC Exchange |
$8.62
|
| Rate for Payer: UHC Medicaid |
$2.91
|
| Rate for Payer: UHCCP DNSP |
$5.56
|
| Rate for Payer: UHCCP Medicaid |
$2.91
|
| Rate for Payer: VA VA |
$5.56
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
IP
|
$40.22
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Aetna Commercial |
$36.20
|
| Rate for Payer: ASR ASR |
$39.01
|
| Rate for Payer: BCBS Trust/PPO |
$33.03
|
| Rate for Payer: BCN Commercial |
$33.03
|
| Rate for Payer: Cash Price |
$32.18
|
| Rate for Payer: Cofinity Commercial |
$37.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.18
|
| Rate for Payer: Healthscope Commercial |
$39.01
|
| Rate for Payer: Healthscope Whirlpool |
$40.22
|
| Rate for Payer: Mclaren Commercial |
$36.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.19
|
| Rate for Payer: Nomi Health Commercial |
$32.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.39
|
|
|
HC UREAPLASMA PCR
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$72.29
|
| Rate for Payer: BCN Commercial |
$72.29
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Healthscope Whirlpool |
$87.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.76
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.83
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$61.46
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC UREAPLASMA PCR
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: BCBS Trust/PPO |
$72.00
|
| Rate for Payer: BCN Commercial |
$72.00
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Healthscope Whirlpool |
$87.68
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
OP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$56.54
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$60.94
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$51.80
|
| Rate for Payer: BCN Commercial |
$51.80
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$59.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.94
|
| Rate for Payer: Healthscope Whirlpool |
$62.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$56.54
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.04
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$44.04
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
IP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$56.54
|
| Rate for Payer: ASR ASR |
$60.94
|
| Rate for Payer: BCBS Trust/PPO |
$51.59
|
| Rate for Payer: BCN Commercial |
$51.59
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$59.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$60.94
|
| Rate for Payer: Healthscope Whirlpool |
$62.82
|
| Rate for Payer: Mclaren Commercial |
$56.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.28
|
|
|
HC URETERAL DILITATION CATH
|
Facility
|
IP
|
$363.86
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
27200077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.89 |
| Max. Negotiated Rate |
$363.86 |
| Rate for Payer: Aetna Commercial |
$327.47
|
| Rate for Payer: ASR ASR |
$352.94
|
| Rate for Payer: BCBS Trust/PPO |
$298.80
|
| Rate for Payer: BCN Commercial |
$298.80
|
| Rate for Payer: Cash Price |
$291.09
|
| Rate for Payer: Cofinity Commercial |
$342.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.09
|
| Rate for Payer: Healthscope Commercial |
$352.94
|
| Rate for Payer: Healthscope Whirlpool |
$363.86
|
| Rate for Payer: Mclaren Commercial |
$327.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.28
|
| Rate for Payer: Nomi Health Commercial |
$298.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.20
|
|
|
HC URETERAL DILITATION CATH
|
Facility
|
OP
|
$363.86
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
27200077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.63 |
| Max. Negotiated Rate |
$363.86 |
| Rate for Payer: Aetna Commercial |
$327.47
|
| Rate for Payer: Aetna Medicare |
$134.63
|
| Rate for Payer: ASR ASR |
$352.94
|
| Rate for Payer: BCBS Complete |
$145.54
|
| Rate for Payer: BCBS Trust/PPO |
$300.00
|
| Rate for Payer: BCN Commercial |
$300.00
|
| Rate for Payer: Cash Price |
$291.09
|
| Rate for Payer: Cofinity Commercial |
$342.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.09
|
| Rate for Payer: Healthscope Commercial |
$352.94
|
| Rate for Payer: Healthscope Whirlpool |
$363.86
|
| Rate for Payer: Mclaren Commercial |
$327.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.28
|
| Rate for Payer: Nomi Health Commercial |
$298.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$318.81
|
| Rate for Payer: Priority Health Narrow Network |
$255.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.20
|
|
|
HC URIC ACID OTHER SOURCE
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
30100453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.35
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$5.08
|
| Rate for Payer: BCBS Trust/PPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$32.51
|
| Rate for Payer: BCN Medicare Advantage |
$5.08
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.08
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Mclaren Medicare |
$5.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.33
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$4.83
|
| Rate for Payer: PACE SWMI |
$5.08
|
| Rate for Payer: PHP Commercial |
$5.59
|
| Rate for Payer: PHP Medicaid |
$2.72
|
| Rate for Payer: PHP Medicare Advantage |
$5.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.85
|
| Rate for Payer: Priority Health Medicare |
$5.08
|
| Rate for Payer: Priority Health Narrow Network |
$40.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.08
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UHC Medicaid |
$2.66
|
| Rate for Payer: UHCCP DNSP |
$5.08
|
| Rate for Payer: UHCCP Medicaid |
$2.66
|
| Rate for Payer: VA VA |
$5.08
|
|
|
HC URIC ACID OTHER SOURCE
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
30100453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.57 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.43
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
|
|
HC URIC ACID SERUM
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
30100452
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC URIC ACID SERUM
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
30100452
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.52
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$4.97
|
| Rate for Payer: PHP Medicaid |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$15.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.52
|
| Rate for Payer: UHC Exchange |
$7.01
|
| Rate for Payer: UHC Medicaid |
$2.36
|
| Rate for Payer: UHCCP DNSP |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$2.36
|
| Rate for Payer: VA VA |
$4.52
|
|
|
HC URINALYSIS
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
30700001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC URINALYSIS
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
30700001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.96
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: BCBS MAPPO |
$3.17
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.17
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$3.17
|
| Rate for Payer: Mclaren Medicare |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.33
|
| Rate for Payer: Meridian Medicaid |
$1.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$3.01
|
| Rate for Payer: PACE SWMI |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.49
|
| Rate for Payer: PHP Medicaid |
$1.70
|
| Rate for Payer: PHP Medicare Advantage |
$3.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$3.17
|
| Rate for Payer: Priority Health Narrow Network |
$28.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.17
|
| Rate for Payer: UHC Exchange |
$4.91
|
| Rate for Payer: UHC Medicaid |
$1.66
|
| Rate for Payer: UHCCP DNSP |
$3.17
|
| Rate for Payer: UHCCP Medicaid |
$1.66
|
| Rate for Payer: VA VA |
$3.17
|
|
|
HC URINALYSIS, MICROSCOPIC ONLY
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.81
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$32.51
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.05
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$3.05
|
| Rate for Payer: Mclaren Medicare |
$3.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$2.90
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: PHP Medicaid |
$1.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.55
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: Priority Health Narrow Network |
$27.64
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.05
|
| Rate for Payer: UHC Exchange |
$4.73
|
| Rate for Payer: UHC Medicaid |
$1.60
|
| Rate for Payer: UHCCP DNSP |
$3.05
|
| Rate for Payer: UHCCP Medicaid |
$1.60
|
| Rate for Payer: VA VA |
$3.05
|
|
|
HC URINALYSIS, MICROSCOPIC ONLY
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$29.57 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.43
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
|
|
HC URINARY 1 PIECE POUCH
|
Facility
|
IP
|
$14.34
|
|
| Hospital Charge Code |
27000167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: ASR ASR |
$13.91
|
| Rate for Payer: BCBS Trust/PPO |
$11.78
|
| Rate for Payer: BCN Commercial |
$11.78
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Healthscope Whirlpool |
$14.34
|
| Rate for Payer: Mclaren Commercial |
$12.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.62
|
|
|
HC URINARY 1 PIECE POUCH
|
Facility
|
OP
|
$14.34
|
|
| Hospital Charge Code |
27000167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: ASR ASR |
$13.91
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Healthscope Whirlpool |
$14.34
|
| Rate for Payer: Mclaren Commercial |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.56
|
| Rate for Payer: Priority Health Narrow Network |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.62
|
|
|
HC URINE ALCOHOL SCRN
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.31 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: ASR ASR |
$93.53
|
| Rate for Payer: BCBS Trust/PPO |
$79.18
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Healthscope Whirlpool |
$96.42
|
| Rate for Payer: Mclaren Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.85
|
|
|
HC URINE ALCOHOL SCRN
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$93.53
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.50
|
| Rate for Payer: BCN Commercial |
$79.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Healthscope Whirlpool |
$96.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$86.78
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.59
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
