|
HC CRITIC AID 6.5 OZ
|
Facility
|
IP
|
$39.21
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$39.21 |
| Rate for Payer: Aetna Commercial |
$35.29
|
| Rate for Payer: ASR ASR |
$38.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: Cofinity Commercial |
$36.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.37
|
| Rate for Payer: Healthscope Commercial |
$39.21
|
| Rate for Payer: Healthscope Whirlpool |
$38.03
|
| Rate for Payer: Mclaren Commercial |
$35.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.50
|
|
|
HC CRITICAL CARE R&B
|
Facility
|
IP
|
$6,213.20
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,349.24 |
| Max. Negotiated Rate |
$6,213.20 |
| Rate for Payer: Aetna Commercial |
$5,591.88
|
| Rate for Payer: ASR ASR |
$6,026.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,817.09
|
| Rate for Payer: BCN Commercial |
$4,817.09
|
| Rate for Payer: Cash Price |
$4,970.56
|
| Rate for Payer: Cofinity Commercial |
$5,840.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,970.56
|
| Rate for Payer: Healthscope Commercial |
$6,213.20
|
| Rate for Payer: Healthscope Whirlpool |
$6,026.80
|
| Rate for Payer: Mclaren Commercial |
$5,591.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,281.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,349.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,467.62
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: BCBS Trust/PPO |
$121.72
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| 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 |
$152.29
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$121.72
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.21
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| 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 |
$133.45
|
| 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 |
$109.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.87
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health Narrow Network |
$111.47
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
| Rate for Payer: UHC Medicare Advantage |
$30.09
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$180.61 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$150.35
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$120.17
|
| Rate for Payer: BCN Commercial |
$120.17
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$145.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$155.00
|
| Rate for Payer: Healthscope Whirlpool |
$150.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$139.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.61
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.40
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: ASR ASR |
$150.35
|
| Rate for Payer: BCBS Trust/PPO |
$120.17
|
| Rate for Payer: BCN Commercial |
$120.17
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$145.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$155.00
|
| Rate for Payer: Healthscope Whirlpool |
$150.35
|
| Rate for Payer: Mclaren Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.40
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$175.57
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$140.33
|
| Rate for Payer: BCN Commercial |
$140.33
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$170.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$181.00
|
| Rate for Payer: Healthscope Whirlpool |
$175.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$162.90
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.82
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$41.46
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.28
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: ASR ASR |
$175.57
|
| Rate for Payer: BCBS Trust/PPO |
$140.33
|
| Rate for Payer: BCN Commercial |
$140.33
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$170.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.80
|
| Rate for Payer: Healthscope Commercial |
$181.00
|
| Rate for Payer: Healthscope Whirlpool |
$175.57
|
| Rate for Payer: Mclaren Commercial |
$162.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.28
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.69
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$43.45
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
OP
|
$90.07
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$87.37
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$69.83
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$84.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Healthscope Whirlpool |
$87.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$81.06
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.61
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$82.09
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.26
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
IP
|
$90.07
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: ASR ASR |
$87.37
|
| Rate for Payer: BCBS Trust/PPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$69.83
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$84.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Healthscope Whirlpool |
$87.37
|
| Rate for Payer: Mclaren Commercial |
$81.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.26
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
IP
|
$228.50
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.95 |
| Max. Negotiated Rate |
$228.50 |
| Rate for Payer: Aetna Commercial |
$205.65
|
| Rate for Payer: ASR ASR |
$221.64
|
| Rate for Payer: BCBS Trust/PPO |
$177.16
|
| Rate for Payer: BCN Commercial |
$177.16
|
| Rate for Payer: Cash Price |
$182.80
|
| Rate for Payer: Cofinity Commercial |
$214.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.80
|
| Rate for Payer: Healthscope Commercial |
$228.50
|
| Rate for Payer: Healthscope Whirlpool |
$221.64
|
| Rate for Payer: Mclaren Commercial |
$205.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.08
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
OP
|
$228.50
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$228.50 |
| Rate for Payer: Aetna Commercial |
$205.65
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$221.64
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$177.16
|
| Rate for Payer: BCN Commercial |
$177.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$182.80
|
| Rate for Payer: Cash Price |
$182.80
|
| Rate for Payer: Cofinity Commercial |
$214.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$228.50
|
| Rate for Payer: Healthscope Whirlpool |
$221.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$205.65
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.22
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.94
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$162.24
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.08
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| 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 |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$7.08
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Medicaid |
$7.08
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.90
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health Narrow Network |
$43.92
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
| Rate for Payer: UHC Medicare Advantage |
$13.34
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| 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 CRP-SF
|
Facility
|
OP
|
$29.38
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$48.74 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$28.50
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$22.78
|
| Rate for Payer: BCN Commercial |
$22.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Commercial |
$27.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Healthscope Whirlpool |
$28.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$26.44
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.97
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.74
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$38.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.85
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CRP-SF
|
Facility
|
IP
|
$29.38
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: ASR ASR |
$28.50
|
| Rate for Payer: BCBS Trust/PPO |
$22.78
|
| Rate for Payer: BCN Commercial |
$22.78
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cofinity Commercial |
$27.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Healthscope Whirlpool |
$28.50
|
| Rate for Payer: Mclaren Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.85
|
|
|
HC CRRT INITIAL
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$630.00
|
| Rate for Payer: ASR ASR |
$679.00
|
| Rate for Payer: BCBS Trust/PPO |
$542.71
|
| Rate for Payer: BCN Commercial |
$542.71
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$658.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Healthscope Commercial |
$700.00
|
| Rate for Payer: Healthscope Whirlpool |
$679.00
|
| Rate for Payer: Mclaren Commercial |
$630.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.00
|
|
|
HC CRRT INITIAL
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$630.00
|
| Rate for Payer: ASR ASR |
$679.00
|
| Rate for Payer: BCBS Complete |
$280.00
|
| Rate for Payer: BCBS Trust/PPO |
$542.71
|
| Rate for Payer: BCN Commercial |
$542.71
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$658.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Healthscope Commercial |
$700.00
|
| Rate for Payer: Healthscope Whirlpool |
$679.00
|
| Rate for Payer: Mclaren Commercial |
$630.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.00
|
| Rate for Payer: Priority Health Narrow Network |
$497.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.00
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
IP
|
$1,112.82
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$778.97 |
| Max. Negotiated Rate |
$1,112.82 |
| Rate for Payer: Aetna Commercial |
$1,001.54
|
| Rate for Payer: ASR ASR |
$1,079.44
|
| Rate for Payer: BCBS Trust/PPO |
$862.77
|
| Rate for Payer: BCN Commercial |
$862.77
|
| Rate for Payer: Cash Price |
$890.26
|
| Rate for Payer: Cofinity Commercial |
$1,046.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.26
|
| Rate for Payer: Healthscope Commercial |
$1,112.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,079.44
|
| Rate for Payer: Mclaren Commercial |
$1,001.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$979.28
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
OP
|
$1,112.82
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$215.35 |
| Max. Negotiated Rate |
$1,112.82 |
| Rate for Payer: Aetna Commercial |
$1,001.54
|
| Rate for Payer: Aetna Medicare |
$393.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.11
|
| Rate for Payer: ASR ASR |
$1,079.44
|
| Rate for Payer: BCBS Complete |
$226.14
|
| Rate for Payer: BCBS MAPPO |
$393.69
|
| Rate for Payer: BCBS Trust/PPO |
$862.77
|
| Rate for Payer: BCN Commercial |
$862.77
|
| Rate for Payer: BCN Medicare Advantage |
$393.69
|
| Rate for Payer: Cash Price |
$890.26
|
| Rate for Payer: Cash Price |
$890.26
|
| Rate for Payer: Cofinity Commercial |
$1,046.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.69
|
| Rate for Payer: Healthscope Commercial |
$1,112.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,079.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.69
|
| Rate for Payer: Mclaren Commercial |
$1,001.54
|
| Rate for Payer: Mclaren Medicaid |
$215.35
|
| Rate for Payer: Mclaren Medicare |
$393.69
|
| Rate for Payer: Meridian Medicaid |
$226.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$413.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.90
|
| Rate for Payer: PACE Medicare |
$374.01
|
| Rate for Payer: PACE SWMI |
$393.69
|
| Rate for Payer: PHP Commercial |
$433.06
|
| Rate for Payer: PHP Medicaid |
$215.35
|
| Rate for Payer: PHP Medicare Advantage |
$393.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.67
|
| Rate for Payer: Priority Health Medicare |
$393.69
|
| Rate for Payer: Priority Health Narrow Network |
$790.10
|
| Rate for Payer: Railroad Medicare Medicare |
$393.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$979.28
|
| Rate for Payer: UHC Medicare Advantage |
$405.50
|
| Rate for Payer: VA VA |
$393.69
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.75
|
| Rate for Payer: Priority Health Narrow Network |
$88.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$286.07 |
| Max. Negotiated Rate |
$408.67 |
| Rate for Payer: Aetna Commercial |
$367.80
|
| Rate for Payer: ASR ASR |
$396.41
|
| Rate for Payer: BCBS Trust/PPO |
$316.84
|
| Rate for Payer: BCN Commercial |
$316.84
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$384.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$408.67
|
| Rate for Payer: Healthscope Whirlpool |
$396.41
|
| Rate for Payer: Mclaren Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.63
|
|
