|
HC CBC NO DIFF INCLUDES PLATELETS
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
30500008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$34.89 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: ASR ASR |
$17.81
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Whirlpool |
$17.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren Commercial |
$16.52
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.12
|
| Rate for Payer: PHP Medicaid |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.16
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC C DIFFICILE PCR
|
Facility
|
OP
|
$137.90
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
30600183
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna Commercial |
$124.11
|
| Rate for Payer: Aetna Medicare |
$37.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.59
|
| Rate for Payer: ASR ASR |
$133.76
|
| Rate for Payer: BCBS Complete |
$21.41
|
| Rate for Payer: BCBS MAPPO |
$37.27
|
| Rate for Payer: BCBS Trust/PPO |
$106.91
|
| Rate for Payer: BCN Commercial |
$106.91
|
| Rate for Payer: BCN Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$110.32
|
| Rate for Payer: Cash Price |
$110.32
|
| Rate for Payer: Cofinity Commercial |
$129.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.27
|
| Rate for Payer: Healthscope Commercial |
$137.90
|
| Rate for Payer: Healthscope Whirlpool |
$133.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.27
|
| Rate for Payer: Mclaren Commercial |
$124.11
|
| Rate for Payer: Mclaren Medicaid |
$20.39
|
| Rate for Payer: Mclaren Medicare |
$37.27
|
| Rate for Payer: Meridian Medicaid |
$21.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.22
|
| Rate for Payer: PACE Medicare |
$35.41
|
| Rate for Payer: PACE SWMI |
$37.27
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Medicaid |
$20.39
|
| Rate for Payer: PHP Medicare Advantage |
$37.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.49
|
| Rate for Payer: Priority Health Medicare |
$37.27
|
| Rate for Payer: Priority Health Narrow Network |
$97.91
|
| Rate for Payer: Railroad Medicare Medicare |
$37.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.35
|
| Rate for Payer: UHC Medicare Advantage |
$38.39
|
| Rate for Payer: VA VA |
$37.27
|
|
|
HC C DIFFICILE PCR
|
Facility
|
IP
|
$137.90
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
30600183
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna Commercial |
$124.11
|
| Rate for Payer: ASR ASR |
$133.76
|
| Rate for Payer: BCBS Trust/PPO |
$106.91
|
| Rate for Payer: BCN Commercial |
$106.91
|
| Rate for Payer: Cash Price |
$110.32
|
| Rate for Payer: Cofinity Commercial |
$129.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.32
|
| Rate for Payer: Healthscope Commercial |
$137.90
|
| Rate for Payer: Healthscope Whirlpool |
$133.76
|
| Rate for Payer: Mclaren Commercial |
$124.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.35
|
|
|
HC C DIFF TOXIN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
30600327
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC C DIFF TOXIN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
30600327
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$127.76 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.76
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$102.21
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
OP
|
$128.20
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$128.20 |
| Rate for Payer: Aetna Commercial |
$115.38
|
| Rate for Payer: Aetna Medicare |
$18.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.70
|
| Rate for Payer: ASR ASR |
$124.35
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$99.39
|
| Rate for Payer: BCN Commercial |
$99.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.96
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$128.20
|
| Rate for Payer: Healthscope Whirlpool |
$124.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.96
|
| Rate for Payer: Mclaren Commercial |
$115.38
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: PACE Medicare |
$18.01
|
| Rate for Payer: PACE SWMI |
$18.96
|
| Rate for Payer: PHP Commercial |
$20.86
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$18.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.82
|
| Rate for Payer: UHC Medicare Advantage |
$19.53
|
| Rate for Payer: VA VA |
$18.96
|
|
|
HC CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
IP
|
$128.20
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$128.20 |
| Rate for Payer: Aetna Commercial |
$115.38
|
| Rate for Payer: ASR ASR |
$124.35
|
| Rate for Payer: BCBS Trust/PPO |
$99.39
|
| Rate for Payer: BCN Commercial |
$99.39
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.56
|
| Rate for Payer: Healthscope Commercial |
$128.20
|
| Rate for Payer: Healthscope Whirlpool |
$124.35
|
| Rate for Payer: Mclaren Commercial |
$115.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.82
|
|
|
HC CEA PANCREATIC CYST
|
Facility
|
OP
|
$180.75
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Aetna Commercial |
$162.68
|
| Rate for Payer: Aetna Medicare |
$18.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.70
|
| Rate for Payer: ASR ASR |
$175.33
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$140.14
|
| Rate for Payer: BCN Commercial |
$140.14
|
| Rate for Payer: BCN Medicare Advantage |
$18.96
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cofinity Commercial |
$169.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$180.75
|
| Rate for Payer: Healthscope Whirlpool |
$175.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.96
|
| Rate for Payer: Mclaren Commercial |
$162.68
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.64
|
| Rate for Payer: PACE Medicare |
$18.01
|
| Rate for Payer: PACE SWMI |
$18.96
|
| Rate for Payer: PHP Commercial |
$20.86
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$18.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.06
|
| Rate for Payer: UHC Medicare Advantage |
$19.53
|
| Rate for Payer: VA VA |
$18.96
|
|
|
HC CEA PANCREATIC CYST
|
Facility
|
IP
|
$180.75
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Aetna Commercial |
$162.68
|
| Rate for Payer: ASR ASR |
$175.33
|
| Rate for Payer: BCBS Trust/PPO |
$140.14
|
| Rate for Payer: BCN Commercial |
$140.14
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cofinity Commercial |
$169.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.60
|
| Rate for Payer: Healthscope Commercial |
$180.75
|
| Rate for Payer: Healthscope Whirlpool |
$175.33
|
| Rate for Payer: Mclaren Commercial |
$162.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.06
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
IP
|
$193.07
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000097
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$193.07 |
| Rate for Payer: Aetna Commercial |
$173.76
|
| Rate for Payer: ASR ASR |
$187.28
|
| Rate for Payer: BCBS Trust/PPO |
$149.69
|
| Rate for Payer: BCN Commercial |
$149.69
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$181.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.46
|
| Rate for Payer: Healthscope Commercial |
$193.07
|
| Rate for Payer: Healthscope Whirlpool |
$187.28
|
| Rate for Payer: Mclaren Commercial |
$173.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.90
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: ASR ASR |
$181.39
|
| Rate for Payer: BCBS Trust/PPO |
$144.98
|
| Rate for Payer: BCN Commercial |
$144.98
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$175.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.60
|
| Rate for Payer: Healthscope Commercial |
$187.00
|
| Rate for Payer: Healthscope Whirlpool |
$181.39
|
| Rate for Payer: Mclaren Commercial |
$168.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.56
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
OP
|
$193.07
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000097
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$193.07 |
| Rate for Payer: Aetna Commercial |
$173.76
|
| Rate for Payer: Aetna Medicare |
$122.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.78
|
| Rate for Payer: ASR ASR |
$187.28
|
| Rate for Payer: BCBS Complete |
$70.20
|
| Rate for Payer: BCBS MAPPO |
$122.22
|
| Rate for Payer: BCBS Trust/PPO |
$149.69
|
| Rate for Payer: BCN Commercial |
$149.69
|
| Rate for Payer: BCN Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$181.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$193.07
|
| Rate for Payer: Healthscope Whirlpool |
$187.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$122.22
|
| Rate for Payer: Mclaren Commercial |
$173.76
|
| Rate for Payer: Mclaren Medicaid |
$66.85
|
| Rate for Payer: Mclaren Medicare |
$122.22
|
| Rate for Payer: Meridian Medicaid |
$70.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.11
|
| Rate for Payer: PACE Medicare |
$116.11
|
| Rate for Payer: PACE SWMI |
$122.22
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: PHP Medicaid |
$66.85
|
| Rate for Payer: PHP Medicare Advantage |
$122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.45
|
| Rate for Payer: Priority Health Medicare |
$122.22
|
| Rate for Payer: Priority Health Narrow Network |
$73.96
|
| Rate for Payer: Railroad Medicare Medicare |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.90
|
| Rate for Payer: UHC Medicare Advantage |
$125.89
|
| Rate for Payer: VA VA |
$122.22
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: ASR ASR |
$181.39
|
| Rate for Payer: BCBS Complete |
$14.83
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$144.98
|
| Rate for Payer: BCN Commercial |
$144.98
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$175.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$187.00
|
| Rate for Payer: Healthscope Whirlpool |
$181.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$168.30
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Medicaid |
$14.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.95
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$28.39
|
| Rate for Payer: PHP Medicaid |
$14.12
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.46
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$77.17
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.56
|
| Rate for Payer: UHC Medicare Advantage |
$26.58
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
IP
|
$193.07
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$193.07 |
| Rate for Payer: Aetna Commercial |
$173.76
|
| Rate for Payer: ASR ASR |
$187.28
|
| Rate for Payer: BCBS Trust/PPO |
$149.69
|
| Rate for Payer: BCN Commercial |
$149.69
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$181.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.46
|
| Rate for Payer: Healthscope Commercial |
$193.07
|
| Rate for Payer: Healthscope Whirlpool |
$187.28
|
| Rate for Payer: Mclaren Commercial |
$173.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.90
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
OP
|
$193.07
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$193.07 |
| Rate for Payer: Aetna Commercial |
$173.76
|
| Rate for Payer: Aetna Medicare |
$122.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.78
|
| Rate for Payer: ASR ASR |
$187.28
|
| Rate for Payer: BCBS Complete |
$70.20
|
| Rate for Payer: BCBS MAPPO |
$122.22
|
| Rate for Payer: BCBS Trust/PPO |
$149.69
|
| Rate for Payer: BCN Commercial |
$149.69
|
| Rate for Payer: BCN Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$181.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$193.07
|
| Rate for Payer: Healthscope Whirlpool |
$187.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$122.22
|
| Rate for Payer: Mclaren Commercial |
$173.76
|
| Rate for Payer: Mclaren Medicaid |
$66.85
|
| Rate for Payer: Mclaren Medicare |
$122.22
|
| Rate for Payer: Meridian Medicaid |
$70.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.11
|
| Rate for Payer: PACE Medicare |
$116.11
|
| Rate for Payer: PACE SWMI |
$122.22
|
| Rate for Payer: PHP Commercial |
$134.44
|
| Rate for Payer: PHP Medicaid |
$66.85
|
| Rate for Payer: PHP Medicare Advantage |
$122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.45
|
| Rate for Payer: Priority Health Medicare |
$122.22
|
| Rate for Payer: Priority Health Narrow Network |
$73.96
|
| Rate for Payer: Railroad Medicare Medicare |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.90
|
| Rate for Payer: UHC Medicare Advantage |
$125.89
|
| Rate for Payer: VA VA |
$122.22
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$27.01
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$27.85
|
| Rate for Payer: Healthscope Whirlpool |
$27.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.51
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$27.85 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: ASR ASR |
$27.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Healthscope Commercial |
$27.85
|
| Rate for Payer: Healthscope Whirlpool |
$27.01
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.51
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$27.01
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$27.85
|
| Rate for Payer: Healthscope Whirlpool |
$27.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.51
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$27.85 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: ASR ASR |
$27.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Healthscope Commercial |
$27.85
|
| Rate for Payer: Healthscope Whirlpool |
$27.01
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.51
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
OP
|
$1,187.52
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,187.52 |
| Rate for Payer: Aetna Commercial |
$1,068.77
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,151.89
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$920.68
|
| Rate for Payer: BCN Commercial |
$920.68
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$950.02
|
| Rate for Payer: Cash Price |
$950.02
|
| Rate for Payer: Cofinity Commercial |
$1,116.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,187.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$1,068.77
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.39
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,080.64
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$843.14
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,045.02
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
IP
|
$1,187.52
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$831.26 |
| Max. Negotiated Rate |
$1,187.52 |
| Rate for Payer: Aetna Commercial |
$1,068.77
|
| Rate for Payer: ASR ASR |
$1,151.89
|
| Rate for Payer: BCBS Trust/PPO |
$920.68
|
| Rate for Payer: BCN Commercial |
$920.68
|
| Rate for Payer: Cash Price |
$950.02
|
| Rate for Payer: Cofinity Commercial |
$1,116.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.02
|
| Rate for Payer: Healthscope Commercial |
$1,187.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.89
|
| Rate for Payer: Mclaren Commercial |
$1,068.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,045.02
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCN Commercial |
$130.25
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$168.00
|
| Rate for Payer: Healthscope Whirlpool |
$162.96
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.58
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS MAPPO |
$12.46
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCN Commercial |
$130.25
|
| Rate for Payer: BCN Medicare Advantage |
$12.46
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.46
|
| Rate for Payer: Healthscope Commercial |
$168.00
|
| Rate for Payer: Healthscope Whirlpool |
$162.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.46
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: Mclaren Medicaid |
$6.82
|
| Rate for Payer: Mclaren Medicare |
$12.46
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PACE Medicare |
$11.84
|
| Rate for Payer: PACE SWMI |
$12.46
|
| Rate for Payer: PHP Commercial |
$13.71
|
| Rate for Payer: PHP Medicaid |
$6.82
|
| Rate for Payer: PHP Medicare Advantage |
$12.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.88
|
| Rate for Payer: Priority Health Medicare |
$12.46
|
| Rate for Payer: Priority Health Narrow Network |
$119.28
|
| Rate for Payer: Railroad Medicare Medicare |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
| Rate for Payer: UHC Medicare Advantage |
$12.83
|
| Rate for Payer: VA VA |
$12.46
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.00
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS MAPPO |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.60
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$3.06
|
| Rate for Payer: Mclaren Medicare |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$5.32
|
| Rate for Payer: PACE SWMI |
$5.60
|
| Rate for Payer: PHP Commercial |
$6.16
|
| Rate for Payer: PHP Medicaid |
$3.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health Narrow Network |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
| Rate for Payer: UHC Medicare Advantage |
$5.77
|
| Rate for Payer: VA VA |
$5.60
|
|
