|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
IP
|
$4,566.80
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,196.76 |
| Max. Negotiated Rate |
$4,566.80 |
| Rate for Payer: Aetna Commercial |
$4,110.12
|
| Rate for Payer: ASR ASR |
$4,429.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,540.64
|
| Rate for Payer: BCN Commercial |
$3,540.64
|
| Rate for Payer: Cash Price |
$3,653.44
|
| Rate for Payer: Cofinity Commercial |
$4,292.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.44
|
| Rate for Payer: Healthscope Commercial |
$4,566.80
|
| Rate for Payer: Healthscope Whirlpool |
$4,429.80
|
| Rate for Payer: Mclaren Commercial |
$4,110.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,881.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,196.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,018.78
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: ASR ASR |
$35.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.69
|
| Rate for Payer: BCN Commercial |
$28.69
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$34.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$37.00
|
| Rate for Payer: Healthscope Whirlpool |
$35.89
|
| Rate for Payer: Mclaren Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.56
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: ASR ASR |
$35.89
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.69
|
| Rate for Payer: BCN Commercial |
$28.69
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$34.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$37.00
|
| Rate for Payer: Healthscope Whirlpool |
$35.89
|
| Rate for Payer: Mclaren Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.67
|
| Rate for Payer: Priority Health Narrow Network |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.56
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| 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 |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.34
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$65.80
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: ASR ASR |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$31.00
|
| Rate for Payer: Healthscope Whirlpool |
$30.07
|
| Rate for Payer: Mclaren Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.28
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: ASR ASR |
$30.07
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$31.00
|
| Rate for Payer: Healthscope Whirlpool |
$30.07
|
| Rate for Payer: Mclaren Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.21
|
| Rate for Payer: Priority Health Narrow Network |
$22.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.28
|
|
|
HC AMPHIPHYSIN WESTERN BLOT
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Trust/PPO |
$220.96
|
| Rate for Payer: BCN Commercial |
$220.96
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$285.00
|
| Rate for Payer: Healthscope Whirlpool |
$276.45
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
HC AMPHIPHYSIN WESTERN BLOT
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Medicare |
$29.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$220.96
|
| Rate for Payer: BCN Commercial |
$220.96
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$285.00
|
| Rate for Payer: Healthscope Whirlpool |
$276.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.21
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$32.13
|
| Rate for Payer: PHP Medicaid |
$15.98
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.35
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health Narrow Network |
$202.35
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
| Rate for Payer: UHC Medicare Advantage |
$30.09
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC AMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC AMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC AMYLASE FLUID
|
Facility
|
IP
|
$60.40
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$60.40 |
| Rate for Payer: Aetna Commercial |
$54.36
|
| Rate for Payer: ASR ASR |
$58.59
|
| Rate for Payer: BCBS Trust/PPO |
$46.83
|
| Rate for Payer: BCN Commercial |
$46.83
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$56.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.32
|
| Rate for Payer: Healthscope Commercial |
$60.40
|
| Rate for Payer: Healthscope Whirlpool |
$58.59
|
| Rate for Payer: Mclaren Commercial |
$54.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.15
|
|
|
HC AMYLASE FLUID
|
Facility
|
OP
|
$60.40
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna Commercial |
$54.36
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$58.59
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$46.83
|
| Rate for Payer: BCN Commercial |
$46.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$56.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$60.40
|
| Rate for Payer: Healthscope Whirlpool |
$58.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$54.36
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.64
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$82.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.15
|
| Rate for Payer: UHC Medicare Advantage |
$6.67
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC AMYLASE PANCREATIC CYST FLUID
|
Facility
|
OP
|
$209.30
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$188.37
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$203.02
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$162.27
|
| Rate for Payer: BCN Commercial |
$162.27
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$167.44
|
| Rate for Payer: Cash Price |
$167.44
|
| Rate for Payer: Cofinity Commercial |
$196.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$209.30
|
| Rate for Payer: Healthscope Whirlpool |
$203.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$188.37
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.90
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.64
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$82.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.18
|
| Rate for Payer: UHC Medicare Advantage |
$6.67
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC AMYLASE PANCREATIC CYST FLUID
|
Facility
|
IP
|
$209.30
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$188.37
|
| Rate for Payer: ASR ASR |
$203.02
|
| Rate for Payer: BCBS Trust/PPO |
$162.27
|
| Rate for Payer: BCN Commercial |
$162.27
|
| Rate for Payer: Cash Price |
$167.44
|
| Rate for Payer: Cofinity Commercial |
$196.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.44
|
| Rate for Payer: Healthscope Commercial |
$209.30
|
| Rate for Payer: Healthscope Whirlpool |
$203.02
|
| Rate for Payer: Mclaren Commercial |
$188.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.18
|
|
|
HC AMYLASE SERUM
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.64
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$82.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$6.67
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC AMYLASE SERUM
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC ANAEROBIC CULTURE
|
Facility
|
OP
|
$122.10
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
30600077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna Commercial |
$109.89
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.84
|
| Rate for Payer: ASR ASR |
$118.44
|
| Rate for Payer: BCBS Complete |
$5.44
|
| Rate for Payer: BCBS MAPPO |
$9.47
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$94.66
|
| Rate for Payer: BCN Medicare Advantage |
$9.47
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cofinity Commercial |
$114.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.47
|
| Rate for Payer: Healthscope Commercial |
$122.10
|
| Rate for Payer: Healthscope Whirlpool |
$118.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.47
|
| Rate for Payer: Mclaren Commercial |
$109.89
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicare |
$9.47
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.78
|
| Rate for Payer: PACE Medicare |
$9.00
|
| Rate for Payer: PACE SWMI |
$9.47
|
| Rate for Payer: PHP Commercial |
$10.42
|
| Rate for Payer: PHP Medicaid |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$9.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.39
|
| Rate for Payer: Priority Health Medicare |
$9.47
|
| Rate for Payer: Priority Health Narrow Network |
$121.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.45
|
| Rate for Payer: UHC Medicare Advantage |
$9.75
|
| Rate for Payer: VA VA |
$9.47
|
|
|
HC ANAEROBIC CULTURE
|
Facility
|
IP
|
$122.10
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
30600077
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$122.10 |
| Rate for Payer: Aetna Commercial |
$109.89
|
| Rate for Payer: ASR ASR |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$94.66
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cofinity Commercial |
$114.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.68
|
| Rate for Payer: Healthscope Commercial |
$122.10
|
| Rate for Payer: Healthscope Whirlpool |
$118.44
|
| Rate for Payer: Mclaren Commercial |
$109.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.45
|
|
|
HC ANAEROBIC ID
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
30600286
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$39.78
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
|
|
HC ANAEROBIC ID
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
30600286
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.10
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$8.08
|
| Rate for Payer: BCBS Trust/PPO |
$39.78
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: BCN Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.08
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.08
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$4.42
|
| Rate for Payer: Mclaren Medicare |
$8.08
|
| Rate for Payer: Meridian Medicaid |
$4.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.61
|
| Rate for Payer: PACE Medicare |
$7.68
|
| Rate for Payer: PACE SWMI |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: PHP Medicaid |
$4.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.53
|
| Rate for Payer: Priority Health Medicare |
$8.08
|
| Rate for Payer: Priority Health Narrow Network |
$63.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
| Rate for Payer: UHC Medicare Advantage |
$8.32
|
| Rate for Payer: VA VA |
$8.08
|
|
|
HC ANALYSIS BRAIN NPGT PRGRMG 15 MIN
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$86.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.55
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$86.04
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: BCN Medicare Advantage |
$86.04
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.04
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.04
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Mclaren Medicaid |
$47.06
|
| Rate for Payer: Mclaren Medicare |
$86.04
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Medicare |
$81.74
|
| Rate for Payer: PACE SWMI |
$86.04
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: PHP Medicaid |
$47.06
|
| Rate for Payer: PHP Medicare Advantage |
$86.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.76
|
| Rate for Payer: Priority Health Medicare |
$86.04
|
| Rate for Payer: Priority Health Narrow Network |
$31.81
|
| Rate for Payer: Railroad Medicare Medicare |
$86.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
| Rate for Payer: UHC Medicare Advantage |
$88.62
|
| Rate for Payer: VA VA |
$86.04
|
|
|
HC ANALYSIS BRAIN NPGT PRGRMG 15 MIN
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC ANALYSIS SMPL OR COMPLEX CN NPGT PRGRMG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare |
$33.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.90
|
| Rate for Payer: ASR ASR |
$106.70
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$85.28
|
| Rate for Payer: BCN Commercial |
$85.28
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Healthscope Whirlpool |
$106.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.52
|
| Rate for Payer: Mclaren Commercial |
$99.00
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Mclaren Medicare |
$33.52
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PACE Medicare |
$31.84
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Commercial |
$36.87
|
| Rate for Payer: PHP Medicaid |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.76
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$31.81
|
| Rate for Payer: Railroad Medicare Medicare |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.80
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
| Rate for Payer: VA VA |
$33.52
|
|
|
HC ANALYSIS SMPL OR COMPLEX CN NPGT PRGRMG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: ASR ASR |
$106.70
|
| Rate for Payer: BCBS Trust/PPO |
$85.28
|
| Rate for Payer: BCN Commercial |
$85.28
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Healthscope Whirlpool |
$106.70
|
| Rate for Payer: Mclaren Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.80
|
|
