|
HC URINE PRESUMPTIVE ID
|
Facility
|
IP
|
$65.08
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$65.08 |
| Rate for Payer: Aetna Commercial |
$58.57
|
| Rate for Payer: ASR ASR |
$63.13
|
| Rate for Payer: ASR Commercial |
$63.13
|
| Rate for Payer: BCBS Trust/PPO |
$53.03
|
| Rate for Payer: BCN Commercial |
$50.46
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$61.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.06
|
| Rate for Payer: Healthscope Commercial |
$65.08
|
| Rate for Payer: Healthscope Whirlpool |
$63.13
|
| Rate for Payer: Mclaren Commercial |
$58.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.32
|
| Rate for Payer: Nomi Health Commercial |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.27
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$31.66
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.36
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.16
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
|
|
HC URIN MDMA
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$96.32 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$91.69
|
| Rate for Payer: ASR Commercial |
$91.69
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCN Commercial |
$73.29
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$88.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$94.53
|
| Rate for Payer: Healthscope Whirlpool |
$91.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$77.51
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.83
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$66.27
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URIN MDMA
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.44 |
| Max. Negotiated Rate |
$94.53 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: ASR ASR |
$91.69
|
| Rate for Payer: ASR Commercial |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$77.03
|
| Rate for Payer: BCN Commercial |
$73.29
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$88.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$94.53
|
| Rate for Payer: Healthscope Whirlpool |
$91.69
|
| Rate for Payer: Mclaren Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$77.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.19
|
|
|
HC URN COTININE.
|
Facility
|
OP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna Commercial |
$91.75
|
| 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 |
$98.89
|
| Rate for Payer: ASR Commercial |
$98.89
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$83.49
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$95.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$101.95
|
| Rate for Payer: Healthscope Whirlpool |
$98.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.75
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.33
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$71.47
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URN COTININE.
|
Facility
|
IP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$101.95 |
| Rate for Payer: Aetna Commercial |
$91.75
|
| Rate for Payer: ASR ASR |
$98.89
|
| Rate for Payer: ASR Commercial |
$98.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.08
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$95.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Healthscope Commercial |
$101.95
|
| Rate for Payer: Healthscope Whirlpool |
$98.89
|
| Rate for Payer: Mclaren Commercial |
$91.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC URN MDMA
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN MDMA
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC URN TRICYCLIC
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: ASR Commercial |
$46.33
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$39.11
|
| Rate for Payer: BCN Commercial |
$37.03
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$47.76
|
| Rate for Payer: Healthscope Whirlpool |
$46.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.85
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.48
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN TRICYCLIC
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: ASR Commercial |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$38.92
|
| Rate for Payer: BCN Commercial |
$37.03
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$47.76
|
| Rate for Payer: Healthscope Whirlpool |
$46.33
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
OP
|
$1,963.76
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$785.50 |
| Max. Negotiated Rate |
$1,963.76 |
| Rate for Payer: Aetna Commercial |
$1,767.38
|
| Rate for Payer: Aetna Medicare |
$981.88
|
| Rate for Payer: ASR ASR |
$1,904.85
|
| Rate for Payer: ASR Commercial |
$1,904.85
|
| Rate for Payer: BCBS Complete |
$785.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,608.12
|
| Rate for Payer: BCN Commercial |
$1,522.50
|
| Rate for Payer: Cash Price |
$1,571.01
|
| Rate for Payer: Cofinity Commercial |
$1,845.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.01
|
| Rate for Payer: Healthscope Commercial |
$1,963.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.85
|
| Rate for Payer: Mclaren Commercial |
$1,767.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.20
|
| Rate for Payer: Nomi Health Commercial |
$1,610.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,720.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.11
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
IP
|
$1,963.76
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.44 |
| Max. Negotiated Rate |
$1,963.76 |
| Rate for Payer: Aetna Commercial |
$1,767.38
|
| Rate for Payer: ASR ASR |
$1,904.85
|
| Rate for Payer: ASR Commercial |
$1,904.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,600.27
|
| Rate for Payer: BCN Commercial |
$1,522.50
|
| Rate for Payer: Cash Price |
$1,571.01
|
| Rate for Payer: Cofinity Commercial |
$1,845.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.01
|
| Rate for Payer: Healthscope Commercial |
$1,963.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.85
|
| Rate for Payer: Mclaren Commercial |
$1,767.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.20
|
| Rate for Payer: Nomi Health Commercial |
$1,610.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.11
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
OP
|
$16.37
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$16.37 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: ASR ASR |
$15.88
|
| Rate for Payer: ASR Commercial |
$15.88
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$16.37
|
| Rate for Payer: Healthscope Whirlpool |
$15.88
|
| Rate for Payer: Mclaren Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.41
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
IP
|
$16.37
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$16.37 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: ASR ASR |
$15.88
|
| Rate for Payer: ASR Commercial |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.34
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$16.37
|
| Rate for Payer: Healthscope Whirlpool |
$15.88
|
| Rate for Payer: Mclaren Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.41
|
|
|
HC US AAA SCREENING
|
Facility
|
OP
|
$367.02
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$367.02 |
| Rate for Payer: Aetna Commercial |
$330.32
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$356.01
|
| Rate for Payer: ASR Commercial |
$356.01
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$284.55
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cofinity Commercial |
$345.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$367.02
|
| Rate for Payer: Healthscope Whirlpool |
$356.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$330.32
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.97
|
| Rate for Payer: Nomi Health Commercial |
$300.96
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.58
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$257.28
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC US AAA SCREENING
|
Facility
|
IP
|
$367.02
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$367.02 |
| Rate for Payer: Aetna Commercial |
$330.32
|
| Rate for Payer: ASR ASR |
$356.01
|
| Rate for Payer: ASR Commercial |
$356.01
|
| Rate for Payer: BCBS Trust/PPO |
$299.08
|
| Rate for Payer: BCN Commercial |
$284.55
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cofinity Commercial |
$345.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.62
|
| Rate for Payer: Healthscope Commercial |
$367.02
|
| Rate for Payer: Healthscope Whirlpool |
$356.01
|
| Rate for Payer: Mclaren Commercial |
$330.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.97
|
| Rate for Payer: Nomi Health Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.98
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
IP
|
$950.92
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$618.10 |
| Max. Negotiated Rate |
$950.92 |
| Rate for Payer: Aetna Commercial |
$855.83
|
| Rate for Payer: ASR ASR |
$922.39
|
| Rate for Payer: ASR Commercial |
$922.39
|
| Rate for Payer: BCBS Trust/PPO |
$774.90
|
| Rate for Payer: BCN Commercial |
$737.25
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cofinity Commercial |
$893.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.74
|
| Rate for Payer: Healthscope Commercial |
$950.92
|
| Rate for Payer: Healthscope Whirlpool |
$922.39
|
| Rate for Payer: Mclaren Commercial |
$855.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.28
|
| Rate for Payer: Nomi Health Commercial |
$779.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.81
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
OP
|
$950.92
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$950.92 |
| Rate for Payer: Aetna Commercial |
$855.83
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$922.39
|
| Rate for Payer: ASR Commercial |
$922.39
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$778.71
|
| Rate for Payer: BCN Commercial |
$737.25
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cofinity Commercial |
$893.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$950.92
|
| Rate for Payer: Healthscope Whirlpool |
$922.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$855.83
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.28
|
| Rate for Payer: Nomi Health Commercial |
$779.75
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$833.20
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$666.59
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
OP
|
$816.66
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$816.66 |
| Rate for Payer: Aetna Commercial |
$734.99
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$792.16
|
| Rate for Payer: ASR Commercial |
$792.16
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$668.76
|
| Rate for Payer: BCN Commercial |
$633.16
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$767.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$816.66
|
| Rate for Payer: Healthscope Whirlpool |
$792.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$734.99
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: Nomi Health Commercial |
$669.66
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.56
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$572.48
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
IP
|
$816.66
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$530.83 |
| Max. Negotiated Rate |
$816.66 |
| Rate for Payer: Aetna Commercial |
$734.99
|
| Rate for Payer: ASR ASR |
$792.16
|
| Rate for Payer: ASR Commercial |
$792.16
|
| Rate for Payer: BCBS Trust/PPO |
$665.50
|
| Rate for Payer: BCN Commercial |
$633.16
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$767.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Healthscope Commercial |
$816.66
|
| Rate for Payer: Healthscope Whirlpool |
$792.16
|
| Rate for Payer: Mclaren Commercial |
$734.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: Nomi Health Commercial |
$669.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.66
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
IP
|
$602.20
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$391.43 |
| Max. Negotiated Rate |
$602.20 |
| Rate for Payer: Aetna Commercial |
$541.98
|
| Rate for Payer: ASR ASR |
$584.13
|
| Rate for Payer: ASR Commercial |
$584.13
|
| Rate for Payer: BCBS Trust/PPO |
$490.73
|
| Rate for Payer: BCN Commercial |
$466.89
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Healthscope Commercial |
$602.20
|
| Rate for Payer: Healthscope Whirlpool |
$584.13
|
| Rate for Payer: Mclaren Commercial |
$541.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: Nomi Health Commercial |
$493.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.94
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
OP
|
$602.20
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$602.20 |
| Rate for Payer: Aetna Commercial |
$541.98
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$584.13
|
| Rate for Payer: ASR Commercial |
$584.13
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$493.14
|
| Rate for Payer: BCN Commercial |
$466.89
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$602.20
|
| Rate for Payer: Healthscope Whirlpool |
$584.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$541.98
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: Nomi Health Commercial |
$493.80
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.65
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$422.14
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
IP
|
$562.45
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$365.59 |
| Max. Negotiated Rate |
$562.45 |
| Rate for Payer: Aetna Commercial |
$506.20
|
| Rate for Payer: ASR ASR |
$545.58
|
| Rate for Payer: ASR Commercial |
$545.58
|
| Rate for Payer: BCBS Trust/PPO |
$458.34
|
| Rate for Payer: BCN Commercial |
$436.07
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cofinity Commercial |
$528.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.96
|
| Rate for Payer: Healthscope Commercial |
$562.45
|
| Rate for Payer: Healthscope Whirlpool |
$545.58
|
| Rate for Payer: Mclaren Commercial |
$506.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.08
|
| Rate for Payer: Nomi Health Commercial |
$461.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.96
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
OP
|
$562.45
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$562.45 |
| Rate for Payer: Aetna Commercial |
$506.20
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$545.58
|
| Rate for Payer: ASR Commercial |
$545.58
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$460.59
|
| Rate for Payer: BCN Commercial |
$436.07
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cofinity Commercial |
$528.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$562.45
|
| Rate for Payer: Healthscope Whirlpool |
$545.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$506.20
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.08
|
| Rate for Payer: Nomi Health Commercial |
$461.21
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.82
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$394.28
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
