HC CORTISOL URINE RANDOM
|
Facility
|
IP
|
$73.42
|
|
Service Code
|
CPT 82530
|
Hospital Charge Code |
30100473
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$51.39 |
Max. Negotiated Rate |
$73.42 |
Rate for Payer: Aetna Commercial |
$66.08
|
Rate for Payer: ASR ASR |
$71.22
|
Rate for Payer: BCBS Trust/PPO |
$56.92
|
Rate for Payer: BCN Commercial |
$56.92
|
Rate for Payer: Cash Price |
$58.74
|
Rate for Payer: Cofinity Commercial |
$69.01
|
Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
Rate for Payer: Healthscope Commercial |
$73.42
|
Rate for Payer: Healthscope Whirlpool |
$71.22
|
Rate for Payer: Mclaren Commercial |
$66.08
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.39
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.61
|
|
HC CORTISOL URINE RANDOM CMPT
|
Facility
|
IP
|
$26.93
|
|
Service Code
|
CPT 82542
|
Hospital Charge Code |
30100289
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$18.85 |
Max. Negotiated Rate |
$26.93 |
Rate for Payer: Aetna Commercial |
$24.24
|
Rate for Payer: ASR ASR |
$26.12
|
Rate for Payer: BCBS Trust/PPO |
$20.88
|
Rate for Payer: BCN Commercial |
$20.88
|
Rate for Payer: Cash Price |
$21.54
|
Rate for Payer: Cofinity Commercial |
$25.31
|
Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
Rate for Payer: Healthscope Commercial |
$26.93
|
Rate for Payer: Healthscope Whirlpool |
$26.12
|
Rate for Payer: Mclaren Commercial |
$24.24
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.89
|
Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.70
|
|
HC CORTISOL URINE RANDOM CMPT
|
Facility
|
OP
|
$26.93
|
|
Service Code
|
CPT 82542
|
Hospital Charge Code |
30100289
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$13.18 |
Max. Negotiated Rate |
$30.11 |
Rate for Payer: Aetna Commercial |
$24.24
|
Rate for Payer: Aetna Medicare |
$24.09
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
Rate for Payer: ASR ASR |
$26.12
|
Rate for Payer: BCBS Complete |
$13.84
|
Rate for Payer: BCBS MAPPO |
$24.09
|
Rate for Payer: BCBS Trust/PPO |
$20.88
|
Rate for Payer: BCN Commercial |
$20.88
|
Rate for Payer: BCN Medicare Advantage |
$24.09
|
Rate for Payer: Cash Price |
$21.54
|
Rate for Payer: Cash Price |
$21.54
|
Rate for Payer: Cofinity Commercial |
$25.31
|
Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
Rate for Payer: Healthscope Commercial |
$26.93
|
Rate for Payer: Healthscope Whirlpool |
$26.12
|
Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
Rate for Payer: Mclaren Commercial |
$24.24
|
Rate for Payer: Mclaren Medicaid |
$13.18
|
Rate for Payer: Mclaren Medicare |
$24.09
|
Rate for Payer: Meridian Medicaid |
$13.84
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.89
|
Rate for Payer: PACE Medicare |
$22.89
|
Rate for Payer: PACE SWMI |
$24.09
|
Rate for Payer: PHP Commercial |
$26.50
|
Rate for Payer: PHP Medicaid |
$13.18
|
Rate for Payer: PHP Medicare Advantage |
$24.09
|
Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.51
|
Rate for Payer: Priority Health Medicare |
$24.09
|
Rate for Payer: Priority Health Narrow Network |
$19.12
|
Rate for Payer: Railroad Medicare Medicare |
$24.09
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.70
|
Rate for Payer: UHC Medicare Advantage |
$24.81
|
Rate for Payer: VA VA |
$24.09
|
|
HC COTTONWOOD IGE
|
Facility
|
OP
|
$24.89
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
30200082
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.86 |
Max. Negotiated Rate |
$24.89 |
Rate for Payer: Aetna Commercial |
$22.40
|
Rate for Payer: Aetna Medicare |
$5.22
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
Rate for Payer: ASR ASR |
$24.14
|
Rate for Payer: BCBS Complete |
$3.00
|
Rate for Payer: BCBS MAPPO |
$5.22
|
Rate for Payer: BCBS Trust/PPO |
$19.30
|
Rate for Payer: BCN Commercial |
$19.30
|
Rate for Payer: BCN Medicare Advantage |
$5.22
|
Rate for Payer: Cash Price |
$19.91
|
Rate for Payer: Cash Price |
$19.91
|
Rate for Payer: Cofinity Commercial |
$23.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
Rate for Payer: Healthscope Commercial |
$24.89
|
Rate for Payer: Healthscope Whirlpool |
$24.14
|
Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
Rate for Payer: Mclaren Commercial |
$22.40
|
Rate for Payer: Mclaren Medicaid |
$2.86
|
Rate for Payer: Mclaren Medicare |
$5.22
|
Rate for Payer: Meridian Medicaid |
$3.00
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
Rate for Payer: PACE Medicare |
$4.96
|
Rate for Payer: PACE SWMI |
$5.22
|
Rate for Payer: PHP Commercial |
$5.74
|
Rate for Payer: PHP Medicaid |
$2.86
|
Rate for Payer: PHP Medicare Advantage |
$5.22
|
Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
Rate for Payer: Priority Health Medicare |
$5.22
|
Rate for Payer: Priority Health Narrow Network |
$17.67
|
Rate for Payer: Railroad Medicare Medicare |
$5.22
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
Rate for Payer: UHC Medicare Advantage |
$5.38
|
Rate for Payer: VA VA |
$5.22
|
|
HC COTTONWOOD IGE
|
Facility
|
IP
|
$24.89
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
30200082
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$17.42 |
Max. Negotiated Rate |
$24.89 |
Rate for Payer: Aetna Commercial |
$22.40
|
Rate for Payer: ASR ASR |
$24.14
|
Rate for Payer: BCBS Trust/PPO |
$19.30
|
Rate for Payer: BCN Commercial |
$19.30
|
Rate for Payer: Cash Price |
$19.91
|
Rate for Payer: Cofinity Commercial |
$23.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
Rate for Payer: Healthscope Commercial |
$24.89
|
Rate for Payer: Healthscope Whirlpool |
$24.14
|
Rate for Payer: Mclaren Commercial |
$22.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
HC COUNSELING LUNG CA SCREENING
|
Facility
|
OP
|
$215.00
|
|
Service Code
|
HCPCS G0296
|
Hospital Charge Code |
77000011
|
Hospital Revenue Code
|
770
|
Min. Negotiated Rate |
$43.34 |
Max. Negotiated Rate |
$215.00 |
Rate for Payer: Aetna Commercial |
$193.50
|
Rate for Payer: Aetna Medicare |
$79.23
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.04
|
Rate for Payer: Amish Plain Church Group Commercial |
$99.04
|
Rate for Payer: ASR ASR |
$208.55
|
Rate for Payer: BCBS Complete |
$45.51
|
Rate for Payer: BCBS MAPPO |
$79.23
|
Rate for Payer: BCBS Trust/PPO |
$166.69
|
Rate for Payer: BCN Commercial |
$166.69
|
Rate for Payer: BCN Medicare Advantage |
$79.23
|
Rate for Payer: Cash Price |
$172.00
|
Rate for Payer: Cash Price |
$172.00
|
Rate for Payer: Cofinity Commercial |
$202.10
|
Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
Rate for Payer: Healthscope Commercial |
$215.00
|
Rate for Payer: Healthscope Whirlpool |
$208.55
|
Rate for Payer: Humana Choice PPO Medicare |
$79.23
|
Rate for Payer: Mclaren Commercial |
$193.50
|
Rate for Payer: Mclaren Medicaid |
$43.34
|
Rate for Payer: Mclaren Medicare |
$79.23
|
Rate for Payer: Meridian Medicaid |
$45.51
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.19
|
Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.75
|
Rate for Payer: PACE Medicare |
$75.27
|
Rate for Payer: PACE SWMI |
$79.23
|
Rate for Payer: PHP Commercial |
$87.15
|
Rate for Payer: PHP Medicaid |
$43.34
|
Rate for Payer: PHP Medicare Advantage |
$79.23
|
Rate for Payer: Priority Health Choice Medicaid |
$43.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$150.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.65
|
Rate for Payer: Priority Health Medicare |
$79.23
|
Rate for Payer: Priority Health Narrow Network |
$152.65
|
Rate for Payer: Railroad Medicare Medicare |
$79.23
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
Rate for Payer: UHC Medicare Advantage |
$81.61
|
Rate for Payer: VA VA |
$79.23
|
|
HC COUNSELING LUNG CA SCREENING
|
Facility
|
IP
|
$215.00
|
|
Service Code
|
HCPCS G0296
|
Hospital Charge Code |
77000011
|
Hospital Revenue Code
|
770
|
Min. Negotiated Rate |
$150.50 |
Max. Negotiated Rate |
$215.00 |
Rate for Payer: Aetna Commercial |
$193.50
|
Rate for Payer: ASR ASR |
$208.55
|
Rate for Payer: BCBS Trust/PPO |
$166.69
|
Rate for Payer: BCN Commercial |
$166.69
|
Rate for Payer: Cash Price |
$172.00
|
Rate for Payer: Cofinity Commercial |
$202.10
|
Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
Rate for Payer: Healthscope Commercial |
$215.00
|
Rate for Payer: Healthscope Whirlpool |
$208.55
|
Rate for Payer: Mclaren Commercial |
$193.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$150.50
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.20
|
|
HC COURT ORDERED BLOOD ALCOHOL
|
Facility
|
IP
|
$75.00
|
|
Service Code
|
CPT 80320
|
Hospital Charge Code |
30100733
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$52.50 |
Max. Negotiated Rate |
$75.00 |
Rate for Payer: Aetna Commercial |
$67.50
|
Rate for Payer: ASR ASR |
$72.75
|
Rate for Payer: BCBS Trust/PPO |
$58.15
|
Rate for Payer: BCN Commercial |
$58.15
|
Rate for Payer: Cash Price |
$60.00
|
Rate for Payer: Cofinity Commercial |
$70.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
Rate for Payer: Healthscope Commercial |
$75.00
|
Rate for Payer: Healthscope Whirlpool |
$72.75
|
Rate for Payer: Mclaren Commercial |
$67.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
HC COURT ORDERED BLOOD ALCOHOL
|
Facility
|
OP
|
$75.00
|
|
Service Code
|
CPT 80320
|
Hospital Charge Code |
30100733
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$30.00 |
Max. Negotiated Rate |
$75.00 |
Rate for Payer: Aetna Commercial |
$67.50
|
Rate for Payer: ASR ASR |
$72.75
|
Rate for Payer: BCBS Complete |
$30.00
|
Rate for Payer: BCBS Trust/PPO |
$58.15
|
Rate for Payer: BCN Commercial |
$58.15
|
Rate for Payer: Cash Price |
$60.00
|
Rate for Payer: Cofinity Commercial |
$70.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
Rate for Payer: Healthscope Commercial |
$75.00
|
Rate for Payer: Healthscope Whirlpool |
$72.75
|
Rate for Payer: Mclaren Commercial |
$67.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.25
|
Rate for Payer: Priority Health Narrow Network |
$53.25
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
HC COVERED STENT GRAFT
|
Facility
|
OP
|
$6,397.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
27800009
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,558.80 |
Max. Negotiated Rate |
$6,397.00 |
Rate for Payer: Aetna Commercial |
$5,757.30
|
Rate for Payer: ASR ASR |
$6,205.09
|
Rate for Payer: BCBS Complete |
$2,558.80
|
Rate for Payer: BCBS Trust/PPO |
$4,959.59
|
Rate for Payer: BCN Commercial |
$4,959.59
|
Rate for Payer: Cash Price |
$5,117.60
|
Rate for Payer: Cofinity Commercial |
$6,013.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$5,117.60
|
Rate for Payer: Healthscope Commercial |
$6,397.00
|
Rate for Payer: Healthscope Whirlpool |
$6,205.09
|
Rate for Payer: Mclaren Commercial |
$5,757.30
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,437.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,477.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,821.27
|
Rate for Payer: Priority Health Narrow Network |
$4,541.87
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,629.36
|
|
HC COVERED STENT GRAFT
|
Facility
|
IP
|
$6,397.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
27800009
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,477.90 |
Max. Negotiated Rate |
$6,397.00 |
Rate for Payer: Aetna Commercial |
$5,757.30
|
Rate for Payer: ASR ASR |
$6,205.09
|
Rate for Payer: BCBS Trust/PPO |
$4,959.59
|
Rate for Payer: BCN Commercial |
$4,959.59
|
Rate for Payer: Cash Price |
$5,117.60
|
Rate for Payer: Cofinity Commercial |
$6,013.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$5,117.60
|
Rate for Payer: Healthscope Commercial |
$6,397.00
|
Rate for Payer: Healthscope Whirlpool |
$6,205.09
|
Rate for Payer: Mclaren Commercial |
$5,757.30
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,437.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,477.90
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,629.36
|
|
HC COVID 19 ANTIBODY TEST
|
Facility
|
OP
|
$69.36
|
|
Service Code
|
CPT 86769
|
Hospital Charge Code |
30200478
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$23.05 |
Max. Negotiated Rate |
$69.36 |
Rate for Payer: Aetna Commercial |
$62.42
|
Rate for Payer: Aetna Medicare |
$42.13
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.66
|
Rate for Payer: Amish Plain Church Group Commercial |
$52.66
|
Rate for Payer: ASR ASR |
$67.28
|
Rate for Payer: BCBS Complete |
$24.20
|
Rate for Payer: BCBS MAPPO |
$42.13
|
Rate for Payer: BCBS Trust/PPO |
$53.77
|
Rate for Payer: BCN Commercial |
$53.77
|
Rate for Payer: BCN Medicare Advantage |
$42.13
|
Rate for Payer: Cash Price |
$55.49
|
Rate for Payer: Cash Price |
$55.49
|
Rate for Payer: Cofinity Commercial |
$65.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.13
|
Rate for Payer: Healthscope Commercial |
$69.36
|
Rate for Payer: Healthscope Whirlpool |
$67.28
|
Rate for Payer: Humana Choice PPO Medicare |
$42.13
|
Rate for Payer: Mclaren Commercial |
$62.42
|
Rate for Payer: Mclaren Medicaid |
$23.05
|
Rate for Payer: Mclaren Medicare |
$42.13
|
Rate for Payer: Meridian Medicaid |
$24.20
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.24
|
Rate for Payer: MI Amish Medical Board Commercial |
$48.45
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
Rate for Payer: PACE Medicare |
$40.02
|
Rate for Payer: PACE SWMI |
$42.13
|
Rate for Payer: PHP Commercial |
$46.34
|
Rate for Payer: PHP Medicaid |
$23.05
|
Rate for Payer: PHP Medicare Advantage |
$42.13
|
Rate for Payer: Priority Health Choice Medicaid |
$23.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.08
|
Rate for Payer: Priority Health Medicare |
$42.13
|
Rate for Payer: Priority Health Narrow Network |
$36.06
|
Rate for Payer: Railroad Medicare Medicare |
$42.13
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
Rate for Payer: UHC Medicare Advantage |
$43.39
|
Rate for Payer: VA VA |
$42.13
|
|
HC COVID 19 ANTIBODY TEST
|
Facility
|
IP
|
$69.36
|
|
Service Code
|
CPT 86769
|
Hospital Charge Code |
30200478
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$48.55 |
Max. Negotiated Rate |
$69.36 |
Rate for Payer: Aetna Commercial |
$62.42
|
Rate for Payer: ASR ASR |
$67.28
|
Rate for Payer: BCBS Trust/PPO |
$53.77
|
Rate for Payer: BCN Commercial |
$53.77
|
Rate for Payer: Cash Price |
$55.49
|
Rate for Payer: Cofinity Commercial |
$65.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
Rate for Payer: Healthscope Commercial |
$69.36
|
Rate for Payer: Healthscope Whirlpool |
$67.28
|
Rate for Payer: Mclaren Commercial |
$62.42
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
HC COVID 19 PCR
|
Facility
|
IP
|
$122.40
|
|
Service Code
|
HCPCS U0002
|
Hospital Charge Code |
30600307
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$85.68 |
Max. Negotiated Rate |
$122.40 |
Rate for Payer: Aetna Commercial |
$110.16
|
Rate for Payer: ASR ASR |
$118.73
|
Rate for Payer: BCBS Trust/PPO |
$94.90
|
Rate for Payer: BCN Commercial |
$94.90
|
Rate for Payer: Cash Price |
$97.92
|
Rate for Payer: Cofinity Commercial |
$115.06
|
Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
Rate for Payer: Healthscope Commercial |
$122.40
|
Rate for Payer: Healthscope Whirlpool |
$118.73
|
Rate for Payer: Mclaren Commercial |
$110.16
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.71
|
|
HC COVID 19 PCR
|
Facility
|
OP
|
$122.40
|
|
Service Code
|
HCPCS U0002
|
Hospital Charge Code |
30600307
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$28.07 |
Max. Negotiated Rate |
$122.40 |
Rate for Payer: Aetna Commercial |
$110.16
|
Rate for Payer: Aetna Medicare |
$51.31
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
Rate for Payer: ASR ASR |
$118.73
|
Rate for Payer: BCBS Complete |
$29.47
|
Rate for Payer: BCBS MAPPO |
$51.31
|
Rate for Payer: BCBS Trust/PPO |
$94.90
|
Rate for Payer: BCN Commercial |
$94.90
|
Rate for Payer: BCN Medicare Advantage |
$51.31
|
Rate for Payer: Cash Price |
$97.92
|
Rate for Payer: Cash Price |
$97.92
|
Rate for Payer: Cofinity Commercial |
$115.06
|
Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
Rate for Payer: Healthscope Commercial |
$122.40
|
Rate for Payer: Healthscope Whirlpool |
$118.73
|
Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
Rate for Payer: Mclaren Commercial |
$110.16
|
Rate for Payer: Mclaren Medicaid |
$28.07
|
Rate for Payer: Mclaren Medicare |
$51.31
|
Rate for Payer: Meridian Medicaid |
$29.47
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
Rate for Payer: PACE Medicare |
$48.74
|
Rate for Payer: PACE SWMI |
$51.31
|
Rate for Payer: PHP Commercial |
$56.44
|
Rate for Payer: PHP Medicaid |
$28.07
|
Rate for Payer: PHP Medicare Advantage |
$51.31
|
Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.90
|
Rate for Payer: Priority Health Medicare |
$51.31
|
Rate for Payer: Priority Health Narrow Network |
$43.92
|
Rate for Payer: Railroad Medicare Medicare |
$51.31
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.71
|
Rate for Payer: UHC Medicare Advantage |
$52.85
|
Rate for Payer: VA VA |
$51.31
|
|
HC COVID ABBOTT ID NOW
|
Facility
|
OP
|
$147.90
|
|
Service Code
|
CPT 87635
|
Hospital Charge Code |
30600310
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$25.00 |
Max. Negotiated Rate |
$147.90 |
Rate for Payer: Aetna Commercial |
$133.11
|
Rate for Payer: Aetna Medicare |
$51.31
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
Rate for Payer: ASR ASR |
$143.46
|
Rate for Payer: BCBS Complete |
$29.47
|
Rate for Payer: BCBS MAPPO |
$51.31
|
Rate for Payer: BCBS Trust/PPO |
$114.67
|
Rate for Payer: BCCCP Commercial |
$25.00
|
Rate for Payer: BCN Commercial |
$114.67
|
Rate for Payer: BCN Medicare Advantage |
$51.31
|
Rate for Payer: Cash Price |
$118.32
|
Rate for Payer: Cash Price |
$118.32
|
Rate for Payer: Cofinity Commercial |
$139.03
|
Rate for Payer: Encore Health Key Benefits Commercial |
$118.32
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
Rate for Payer: Healthscope Commercial |
$147.90
|
Rate for Payer: Healthscope Whirlpool |
$143.46
|
Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
Rate for Payer: Mclaren Commercial |
$133.11
|
Rate for Payer: Mclaren Medicaid |
$28.07
|
Rate for Payer: Mclaren Medicare |
$51.31
|
Rate for Payer: Meridian Medicaid |
$29.47
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
Rate for Payer: PACE Medicare |
$48.74
|
Rate for Payer: PACE SWMI |
$51.31
|
Rate for Payer: PHP Commercial |
$56.44
|
Rate for Payer: PHP Medicaid |
$28.07
|
Rate for Payer: PHP Medicare Advantage |
$51.31
|
Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.90
|
Rate for Payer: Priority Health Medicare |
$51.31
|
Rate for Payer: Priority Health Narrow Network |
$43.92
|
Rate for Payer: Railroad Medicare Medicare |
$51.31
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.15
|
Rate for Payer: UHC Medicare Advantage |
$52.85
|
Rate for Payer: VA VA |
$51.31
|
|
HC COVID ABBOTT ID NOW
|
Facility
|
IP
|
$147.90
|
|
Service Code
|
CPT 87635
|
Hospital Charge Code |
30600310
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$103.53 |
Max. Negotiated Rate |
$147.90 |
Rate for Payer: Aetna Commercial |
$133.11
|
Rate for Payer: ASR ASR |
$143.46
|
Rate for Payer: BCBS Trust/PPO |
$114.67
|
Rate for Payer: BCN Commercial |
$114.67
|
Rate for Payer: Cash Price |
$118.32
|
Rate for Payer: Cofinity Commercial |
$139.03
|
Rate for Payer: Encore Health Key Benefits Commercial |
$118.32
|
Rate for Payer: Healthscope Commercial |
$147.90
|
Rate for Payer: Healthscope Whirlpool |
$143.46
|
Rate for Payer: Mclaren Commercial |
$133.11
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.15
|
|
HC COVID FLU AB RSV GENEMARKERS
|
Facility
|
OP
|
$249.90
|
|
Service Code
|
CPT 87637
|
Hospital Charge Code |
30600316
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$78.02 |
Max. Negotiated Rate |
$249.90 |
Rate for Payer: Aetna Commercial |
$224.91
|
Rate for Payer: Aetna Medicare |
$142.63
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
Rate for Payer: ASR ASR |
$242.40
|
Rate for Payer: BCBS Complete |
$81.93
|
Rate for Payer: BCBS MAPPO |
$142.63
|
Rate for Payer: BCBS Trust/PPO |
$193.75
|
Rate for Payer: BCN Commercial |
$193.75
|
Rate for Payer: BCN Medicare Advantage |
$142.63
|
Rate for Payer: Cash Price |
$199.92
|
Rate for Payer: Cash Price |
$199.92
|
Rate for Payer: Cofinity Commercial |
$234.91
|
Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
Rate for Payer: Healthscope Commercial |
$249.90
|
Rate for Payer: Healthscope Whirlpool |
$242.40
|
Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
Rate for Payer: Mclaren Commercial |
$224.91
|
Rate for Payer: Mclaren Medicaid |
$78.02
|
Rate for Payer: Mclaren Medicare |
$142.63
|
Rate for Payer: Meridian Medicaid |
$81.93
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.42
|
Rate for Payer: PACE Medicare |
$135.50
|
Rate for Payer: PACE SWMI |
$142.63
|
Rate for Payer: PHP Commercial |
$156.89
|
Rate for Payer: PHP Medicaid |
$78.02
|
Rate for Payer: PHP Medicare Advantage |
$142.63
|
Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
Rate for Payer: Priority Health Cigna Priority Health |
$174.93
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.41
|
Rate for Payer: Priority Health Medicare |
$142.63
|
Rate for Payer: Priority Health Narrow Network |
$177.43
|
Rate for Payer: Railroad Medicare Medicare |
$142.63
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
Rate for Payer: UHC Medicare Advantage |
$146.91
|
Rate for Payer: VA VA |
$142.63
|
|
HC COVID FLU AB RSV GENEMARKERS
|
Facility
|
IP
|
$249.90
|
|
Service Code
|
CPT 87637
|
Hospital Charge Code |
30600316
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$174.93 |
Max. Negotiated Rate |
$249.90 |
Rate for Payer: Aetna Commercial |
$224.91
|
Rate for Payer: ASR ASR |
$242.40
|
Rate for Payer: BCBS Trust/PPO |
$193.75
|
Rate for Payer: BCN Commercial |
$193.75
|
Rate for Payer: Cash Price |
$199.92
|
Rate for Payer: Cofinity Commercial |
$234.91
|
Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
Rate for Payer: Healthscope Commercial |
$249.90
|
Rate for Payer: Healthscope Whirlpool |
$242.40
|
Rate for Payer: Mclaren Commercial |
$224.91
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$174.93
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
|
HC COXIELLA BURNETTI ANTIBODIES
|
Facility
|
IP
|
$42.84
|
|
Service Code
|
CPT 86638
|
Hospital Charge Code |
30200247
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$29.99 |
Max. Negotiated Rate |
$42.84 |
Rate for Payer: Aetna Commercial |
$38.56
|
Rate for Payer: ASR ASR |
$41.55
|
Rate for Payer: BCBS Trust/PPO |
$33.21
|
Rate for Payer: BCN Commercial |
$33.21
|
Rate for Payer: Cash Price |
$34.27
|
Rate for Payer: Cofinity Commercial |
$40.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
Rate for Payer: Healthscope Commercial |
$42.84
|
Rate for Payer: Healthscope Whirlpool |
$41.55
|
Rate for Payer: Mclaren Commercial |
$38.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
HC COXIELLA BURNETTI ANTIBODIES
|
Facility
|
OP
|
$42.84
|
|
Service Code
|
CPT 86638
|
Hospital Charge Code |
30200247
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.63 |
Max. Negotiated Rate |
$42.84 |
Rate for Payer: Aetna Commercial |
$38.56
|
Rate for Payer: Aetna Medicare |
$12.12
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
Rate for Payer: ASR ASR |
$41.55
|
Rate for Payer: BCBS Complete |
$6.96
|
Rate for Payer: BCBS MAPPO |
$12.12
|
Rate for Payer: BCBS Trust/PPO |
$33.21
|
Rate for Payer: BCN Commercial |
$33.21
|
Rate for Payer: BCN Medicare Advantage |
$12.12
|
Rate for Payer: Cash Price |
$34.27
|
Rate for Payer: Cash Price |
$34.27
|
Rate for Payer: Cofinity Commercial |
$40.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
Rate for Payer: Healthscope Commercial |
$42.84
|
Rate for Payer: Healthscope Whirlpool |
$41.55
|
Rate for Payer: Humana Choice PPO Medicare |
$12.12
|
Rate for Payer: Mclaren Commercial |
$38.56
|
Rate for Payer: Mclaren Medicaid |
$6.63
|
Rate for Payer: Mclaren Medicare |
$12.12
|
Rate for Payer: Meridian Medicaid |
$6.96
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.73
|
Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
Rate for Payer: PACE Medicare |
$11.51
|
Rate for Payer: PACE SWMI |
$12.12
|
Rate for Payer: PHP Commercial |
$13.33
|
Rate for Payer: PHP Medicaid |
$6.63
|
Rate for Payer: PHP Medicare Advantage |
$12.12
|
Rate for Payer: Priority Health Choice Medicaid |
$6.63
|
Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.98
|
Rate for Payer: Priority Health Medicare |
$12.12
|
Rate for Payer: Priority Health Narrow Network |
$30.42
|
Rate for Payer: Railroad Medicare Medicare |
$12.12
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
Rate for Payer: UHC Medicare Advantage |
$12.48
|
Rate for Payer: VA VA |
$12.12
|
|
HC COXIELLA BURNETTI ANTIBODY CMP
|
Facility
|
IP
|
$42.84
|
|
Service Code
|
CPT 86638
|
Hospital Charge Code |
30200248
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$29.99 |
Max. Negotiated Rate |
$42.84 |
Rate for Payer: Aetna Commercial |
$38.56
|
Rate for Payer: ASR ASR |
$41.55
|
Rate for Payer: BCBS Trust/PPO |
$33.21
|
Rate for Payer: BCN Commercial |
$33.21
|
Rate for Payer: Cash Price |
$34.27
|
Rate for Payer: Cofinity Commercial |
$40.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
Rate for Payer: Healthscope Commercial |
$42.84
|
Rate for Payer: Healthscope Whirlpool |
$41.55
|
Rate for Payer: Mclaren Commercial |
$38.56
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
HC COXIELLA BURNETTI ANTIBODY CMP
|
Facility
|
OP
|
$42.84
|
|
Service Code
|
CPT 86638
|
Hospital Charge Code |
30200248
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.63 |
Max. Negotiated Rate |
$42.84 |
Rate for Payer: Aetna Commercial |
$38.56
|
Rate for Payer: Aetna Medicare |
$12.12
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
Rate for Payer: ASR ASR |
$41.55
|
Rate for Payer: BCBS Complete |
$6.96
|
Rate for Payer: BCBS MAPPO |
$12.12
|
Rate for Payer: BCBS Trust/PPO |
$33.21
|
Rate for Payer: BCN Commercial |
$33.21
|
Rate for Payer: BCN Medicare Advantage |
$12.12
|
Rate for Payer: Cash Price |
$34.27
|
Rate for Payer: Cash Price |
$34.27
|
Rate for Payer: Cofinity Commercial |
$40.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
Rate for Payer: Healthscope Commercial |
$42.84
|
Rate for Payer: Healthscope Whirlpool |
$41.55
|
Rate for Payer: Humana Choice PPO Medicare |
$12.12
|
Rate for Payer: Mclaren Commercial |
$38.56
|
Rate for Payer: Mclaren Medicaid |
$6.63
|
Rate for Payer: Mclaren Medicare |
$12.12
|
Rate for Payer: Meridian Medicaid |
$6.96
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.73
|
Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
Rate for Payer: PACE Medicare |
$11.51
|
Rate for Payer: PACE SWMI |
$12.12
|
Rate for Payer: PHP Commercial |
$13.33
|
Rate for Payer: PHP Medicaid |
$6.63
|
Rate for Payer: PHP Medicare Advantage |
$12.12
|
Rate for Payer: Priority Health Choice Medicaid |
$6.63
|
Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.98
|
Rate for Payer: Priority Health Medicare |
$12.12
|
Rate for Payer: Priority Health Narrow Network |
$30.42
|
Rate for Payer: Railroad Medicare Medicare |
$12.12
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
Rate for Payer: UHC Medicare Advantage |
$12.48
|
Rate for Payer: VA VA |
$12.12
|
|
HC COXSACKIE A AB CMPT
|
Facility
|
IP
|
$20.40
|
|
Service Code
|
CPT 86658
|
Hospital Charge Code |
30200266
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$14.28 |
Max. Negotiated Rate |
$20.40 |
Rate for Payer: Aetna Commercial |
$18.36
|
Rate for Payer: ASR ASR |
$19.79
|
Rate for Payer: BCBS Trust/PPO |
$15.82
|
Rate for Payer: BCN Commercial |
$15.82
|
Rate for Payer: Cash Price |
$16.32
|
Rate for Payer: Cofinity Commercial |
$19.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
Rate for Payer: Healthscope Commercial |
$20.40
|
Rate for Payer: Healthscope Whirlpool |
$19.79
|
Rate for Payer: Mclaren Commercial |
$18.36
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
HC COXSACKIE A AB CMPT
|
Facility
|
OP
|
$20.40
|
|
Service Code
|
CPT 86658
|
Hospital Charge Code |
30200266
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$7.13 |
Max. Negotiated Rate |
$20.40 |
Rate for Payer: Aetna Commercial |
$18.36
|
Rate for Payer: Aetna Medicare |
$13.03
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
Rate for Payer: ASR ASR |
$19.79
|
Rate for Payer: BCBS Complete |
$7.48
|
Rate for Payer: BCBS MAPPO |
$13.03
|
Rate for Payer: BCBS Trust/PPO |
$15.82
|
Rate for Payer: BCN Commercial |
$15.82
|
Rate for Payer: BCN Medicare Advantage |
$13.03
|
Rate for Payer: Cash Price |
$16.32
|
Rate for Payer: Cash Price |
$16.32
|
Rate for Payer: Cofinity Commercial |
$19.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
Rate for Payer: Healthscope Commercial |
$20.40
|
Rate for Payer: Healthscope Whirlpool |
$19.79
|
Rate for Payer: Humana Choice PPO Medicare |
$13.03
|
Rate for Payer: Mclaren Commercial |
$18.36
|
Rate for Payer: Mclaren Medicaid |
$7.13
|
Rate for Payer: Mclaren Medicare |
$13.03
|
Rate for Payer: Meridian Medicaid |
$7.48
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
Rate for Payer: PACE Medicare |
$12.38
|
Rate for Payer: PACE SWMI |
$13.03
|
Rate for Payer: PHP Commercial |
$14.33
|
Rate for Payer: PHP Medicaid |
$7.13
|
Rate for Payer: PHP Medicare Advantage |
$13.03
|
Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.56
|
Rate for Payer: Priority Health Medicare |
$13.03
|
Rate for Payer: Priority Health Narrow Network |
$14.48
|
Rate for Payer: Railroad Medicare Medicare |
$13.03
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
Rate for Payer: UHC Medicare Advantage |
$13.42
|
Rate for Payer: VA VA |
$13.03
|
|