|
HC BB-COMP-FRESH-FROZEN PLASMA EA
|
Facility
|
IP
|
$224.21
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
39000041
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna Commercial |
$201.79
|
| Rate for Payer: ASR ASR |
$217.48
|
| Rate for Payer: ASR Commercial |
$217.48
|
| Rate for Payer: BCBS Trust/PPO |
$182.71
|
| Rate for Payer: BCN Commercial |
$173.83
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Healthscope Whirlpool |
$217.48
|
| Rate for Payer: Mclaren Commercial |
$201.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
|
|
HC BB-COMP-FRESH-FROZEN PLASMA EA
|
Facility
|
OP
|
$224.21
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
39000041
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna Commercial |
$201.79
|
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.06
|
| Rate for Payer: ASR ASR |
$217.48
|
| Rate for Payer: ASR Commercial |
$217.48
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS MAPPO |
$69.65
|
| Rate for Payer: BCBS Trust/PPO |
$183.61
|
| Rate for Payer: BCN Commercial |
$173.83
|
| Rate for Payer: BCN Medicare Advantage |
$69.65
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.65
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Healthscope Whirlpool |
$217.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$69.65
|
| Rate for Payer: Mclaren Commercial |
$201.79
|
| Rate for Payer: Mclaren Medicaid |
$37.33
|
| Rate for Payer: Mclaren Medicare |
$69.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.13
|
| Rate for Payer: Meridian Medicaid |
$39.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: PACE Medicare |
$66.17
|
| Rate for Payer: PACE SWMI |
$69.65
|
| Rate for Payer: PHP Commercial |
$76.62
|
| Rate for Payer: PHP Medicaid |
$37.33
|
| Rate for Payer: PHP Medicare Advantage |
$69.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.06
|
| Rate for Payer: Priority Health Medicare |
$69.65
|
| Rate for Payer: Priority Health Narrow Network |
$132.85
|
| Rate for Payer: Railroad Medicare Medicare |
$69.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.65
|
| Rate for Payer: UHC Exchange |
$107.96
|
| Rate for Payer: UHC Medicare Advantage |
$69.65
|
| Rate for Payer: UHCCP DNSP |
$69.65
|
| Rate for Payer: UHCCP Medicaid |
$37.33
|
| Rate for Payer: VA VA |
$69.65
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$85.21
|
| Rate for Payer: ASR ASR |
$91.84
|
| Rate for Payer: ASR Commercial |
$91.84
|
| Rate for Payer: BCBS Trust/PPO |
$77.15
|
| Rate for Payer: BCN Commercial |
$73.41
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$89.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Healthscope Whirlpool |
$91.84
|
| Rate for Payer: Mclaren Commercial |
$85.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.32
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$85.21
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$91.84
|
| Rate for Payer: ASR Commercial |
$91.84
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$73.41
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$89.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Healthscope Whirlpool |
$91.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$85.21
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$77.64
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.96
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$66.37
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$94.57
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$101.93
|
| Rate for Payer: ASR Commercial |
$101.93
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$86.05
|
| Rate for Payer: BCN Commercial |
$81.47
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$101.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$94.57
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.07
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$73.66
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$94.57
|
| Rate for Payer: ASR ASR |
$101.93
|
| Rate for Payer: ASR Commercial |
$101.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.63
|
| Rate for Payer: BCN Commercial |
$81.47
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$101.93
|
| Rate for Payer: Mclaren Commercial |
$94.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.47
|
|
|
HC B CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000041
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$85.21
|
| Rate for Payer: ASR ASR |
$91.84
|
| Rate for Payer: ASR Commercial |
$91.84
|
| Rate for Payer: BCBS Trust/PPO |
$77.15
|
| Rate for Payer: BCN Commercial |
$73.41
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$89.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Healthscope Whirlpool |
$91.84
|
| Rate for Payer: Mclaren Commercial |
$85.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$77.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.32
|
|
|
HC B CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000041
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$85.21
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$91.84
|
| Rate for Payer: ASR Commercial |
$91.84
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$73.41
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$89.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Healthscope Whirlpool |
$91.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$85.21
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$77.64
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.96
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$66.37
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC BCR / ABL FISH
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000024
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$107.35
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.86
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$91.89
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC BCR / ABL FISH
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000024
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$106.83
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
HC BCR / ABL FISH CMPT1
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000112
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$94.57
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$101.93
|
| Rate for Payer: ASR Commercial |
$101.93
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$86.05
|
| Rate for Payer: BCN Commercial |
$81.47
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$101.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$94.57
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.07
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$73.66
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC BCR / ABL FISH CMPT1
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000112
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$94.57
|
| Rate for Payer: ASR ASR |
$101.93
|
| Rate for Payer: ASR Commercial |
$101.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.63
|
| Rate for Payer: BCN Commercial |
$81.47
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$101.93
|
| Rate for Payer: Mclaren Commercial |
$94.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.47
|
|
|
HC BCR/ABL FISH CMPT 2
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$77.87 |
| Rate for Payer: Aetna Commercial |
$70.08
|
| Rate for Payer: ASR ASR |
$75.53
|
| Rate for Payer: ASR Commercial |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$63.46
|
| Rate for Payer: BCN Commercial |
$60.37
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$73.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$77.87
|
| Rate for Payer: Healthscope Whirlpool |
$75.53
|
| Rate for Payer: Mclaren Commercial |
$70.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$63.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.53
|
|
|
HC BCR/ABL FISH CMPT 2
|
Facility
|
OP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$70.08
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$75.53
|
| Rate for Payer: ASR Commercial |
$75.53
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.77
|
| Rate for Payer: BCN Commercial |
$60.37
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$73.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$77.87
|
| Rate for Payer: Healthscope Whirlpool |
$75.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$70.08
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$63.85
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.23
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$54.59
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC BCR/ABL P210 QUANT
|
Facility
|
OP
|
$390.15
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000096
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.34 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$351.14
|
| Rate for Payer: Aetna Medicare |
$163.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.95
|
| Rate for Payer: ASR ASR |
$378.45
|
| Rate for Payer: ASR Commercial |
$378.45
|
| Rate for Payer: BCBS Complete |
$92.28
|
| Rate for Payer: BCBS MAPPO |
$163.96
|
| Rate for Payer: BCBS Trust/PPO |
$319.49
|
| Rate for Payer: BCN Commercial |
$302.48
|
| Rate for Payer: BCN Medicare Advantage |
$163.96
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Healthscope Whirlpool |
$378.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.96
|
| Rate for Payer: Mclaren Commercial |
$351.14
|
| Rate for Payer: Mclaren Medicaid |
$87.88
|
| Rate for Payer: Mclaren Medicare |
$163.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.16
|
| Rate for Payer: Meridian Medicaid |
$92.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: PACE Medicare |
$155.76
|
| Rate for Payer: PACE SWMI |
$163.96
|
| Rate for Payer: PHP Commercial |
$180.36
|
| Rate for Payer: PHP Medicaid |
$87.88
|
| Rate for Payer: PHP Medicare Advantage |
$163.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.93
|
| Rate for Payer: Priority Health Medicare |
$163.96
|
| Rate for Payer: Priority Health Narrow Network |
$82.34
|
| Rate for Payer: Railroad Medicare Medicare |
$163.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.96
|
| Rate for Payer: UHC Exchange |
$254.14
|
| Rate for Payer: UHC Medicare Advantage |
$163.96
|
| Rate for Payer: UHCCP DNSP |
$163.96
|
| Rate for Payer: UHCCP Medicaid |
$87.88
|
| Rate for Payer: VA VA |
$163.96
|
|
|
HC BCR/ABL P210 QUANT
|
Facility
|
IP
|
$390.15
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000096
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$351.14
|
| Rate for Payer: ASR ASR |
$378.45
|
| Rate for Payer: ASR Commercial |
$378.45
|
| Rate for Payer: BCBS Trust/PPO |
$317.93
|
| Rate for Payer: BCN Commercial |
$302.48
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Healthscope Whirlpool |
$378.45
|
| Rate for Payer: Mclaren Commercial |
$351.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.33
|
|
|
HC BCRABL RNA, CMPT 1
|
Facility
|
OP
|
$236.92
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
31000144
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$236.92 |
| Rate for Payer: Aetna Commercial |
$213.23
|
| Rate for Payer: Aetna Medicare |
$144.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.05
|
| Rate for Payer: ASR ASR |
$229.81
|
| Rate for Payer: ASR Commercial |
$229.81
|
| Rate for Payer: BCBS Complete |
$81.52
|
| Rate for Payer: BCBS MAPPO |
$144.84
|
| Rate for Payer: BCBS Trust/PPO |
$194.01
|
| Rate for Payer: BCN Commercial |
$183.68
|
| Rate for Payer: BCN Medicare Advantage |
$144.84
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cofinity Commercial |
$222.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.84
|
| Rate for Payer: Healthscope Commercial |
$236.92
|
| Rate for Payer: Healthscope Whirlpool |
$229.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$144.84
|
| Rate for Payer: Mclaren Commercial |
$213.23
|
| Rate for Payer: Mclaren Medicaid |
$77.63
|
| Rate for Payer: Mclaren Medicare |
$144.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.08
|
| Rate for Payer: Meridian Medicaid |
$81.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.38
|
| Rate for Payer: Nomi Health Commercial |
$194.27
|
| Rate for Payer: PACE Medicare |
$137.60
|
| Rate for Payer: PACE SWMI |
$144.84
|
| Rate for Payer: PHP Commercial |
$159.32
|
| Rate for Payer: PHP Medicaid |
$77.63
|
| Rate for Payer: PHP Medicare Advantage |
$144.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.05
|
| Rate for Payer: Priority Health Medicare |
$144.84
|
| Rate for Payer: Priority Health Narrow Network |
$72.84
|
| Rate for Payer: Railroad Medicare Medicare |
$144.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.84
|
| Rate for Payer: UHC Exchange |
$224.50
|
| Rate for Payer: UHC Medicare Advantage |
$144.84
|
| Rate for Payer: UHCCP DNSP |
$144.84
|
| Rate for Payer: UHCCP Medicaid |
$77.63
|
| Rate for Payer: VA VA |
$144.84
|
|
|
HC BCRABL RNA, CMPT 1
|
Facility
|
IP
|
$236.92
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
31000144
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$236.92 |
| Rate for Payer: Aetna Commercial |
$213.23
|
| Rate for Payer: ASR ASR |
$229.81
|
| Rate for Payer: ASR Commercial |
$229.81
|
| Rate for Payer: BCBS Trust/PPO |
$193.07
|
| Rate for Payer: BCN Commercial |
$183.68
|
| Rate for Payer: Cash Price |
$189.54
|
| Rate for Payer: Cofinity Commercial |
$222.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.54
|
| Rate for Payer: Healthscope Commercial |
$236.92
|
| Rate for Payer: Healthscope Whirlpool |
$229.81
|
| Rate for Payer: Mclaren Commercial |
$213.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.38
|
| Rate for Payer: Nomi Health Commercial |
$194.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.49
|
|
|
HC BCRABL RNA, CMPT 2
|
Facility
|
OP
|
$351.08
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
31000145
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$351.08 |
| Rate for Payer: Aetna Commercial |
$315.97
|
| Rate for Payer: Aetna Medicare |
$214.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.28
|
| Rate for Payer: ASR ASR |
$340.55
|
| Rate for Payer: ASR Commercial |
$340.55
|
| Rate for Payer: BCBS Complete |
$120.79
|
| Rate for Payer: BCBS MAPPO |
$214.62
|
| Rate for Payer: BCBS Trust/PPO |
$287.50
|
| Rate for Payer: BCN Commercial |
$272.19
|
| Rate for Payer: BCN Medicare Advantage |
$214.62
|
| Rate for Payer: Cash Price |
$280.86
|
| Rate for Payer: Cash Price |
$280.86
|
| Rate for Payer: Cofinity Commercial |
$330.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.62
|
| Rate for Payer: Healthscope Commercial |
$351.08
|
| Rate for Payer: Healthscope Whirlpool |
$340.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$214.62
|
| Rate for Payer: Mclaren Commercial |
$315.97
|
| Rate for Payer: Mclaren Medicaid |
$115.04
|
| Rate for Payer: Mclaren Medicare |
$214.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.35
|
| Rate for Payer: Meridian Medicaid |
$120.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.42
|
| Rate for Payer: Nomi Health Commercial |
$287.89
|
| Rate for Payer: PACE Medicare |
$203.89
|
| Rate for Payer: PACE SWMI |
$214.62
|
| Rate for Payer: PHP Commercial |
$236.08
|
| Rate for Payer: PHP Medicaid |
$115.04
|
| Rate for Payer: PHP Medicare Advantage |
$214.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.87
|
| Rate for Payer: Priority Health Medicare |
$214.62
|
| Rate for Payer: Priority Health Narrow Network |
$65.50
|
| Rate for Payer: Railroad Medicare Medicare |
$214.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.62
|
| Rate for Payer: UHC Exchange |
$332.66
|
| Rate for Payer: UHC Medicare Advantage |
$214.62
|
| Rate for Payer: UHCCP DNSP |
$214.62
|
| Rate for Payer: UHCCP Medicaid |
$115.04
|
| Rate for Payer: VA VA |
$214.62
|
|
|
HC BCRABL RNA, CMPT 2
|
Facility
|
IP
|
$351.08
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
31000145
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$228.20 |
| Max. Negotiated Rate |
$351.08 |
| Rate for Payer: Aetna Commercial |
$315.97
|
| Rate for Payer: ASR ASR |
$340.55
|
| Rate for Payer: ASR Commercial |
$340.55
|
| Rate for Payer: BCBS Trust/PPO |
$286.10
|
| Rate for Payer: BCN Commercial |
$272.19
|
| Rate for Payer: Cash Price |
$280.86
|
| Rate for Payer: Cofinity Commercial |
$330.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.86
|
| Rate for Payer: Healthscope Commercial |
$351.08
|
| Rate for Payer: Healthscope Whirlpool |
$340.55
|
| Rate for Payer: Mclaren Commercial |
$315.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.42
|
| Rate for Payer: Nomi Health Commercial |
$287.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.95
|
|
|
HC BCRABL RNA, QUAL
|
Facility
|
OP
|
$268.20
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000143
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.34 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna Commercial |
$241.38
|
| Rate for Payer: Aetna Medicare |
$163.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.95
|
| Rate for Payer: ASR ASR |
$260.15
|
| Rate for Payer: ASR Commercial |
$260.15
|
| Rate for Payer: BCBS Complete |
$92.28
|
| Rate for Payer: BCBS MAPPO |
$163.96
|
| Rate for Payer: BCBS Trust/PPO |
$219.63
|
| Rate for Payer: BCN Commercial |
$207.94
|
| Rate for Payer: BCN Medicare Advantage |
$163.96
|
| Rate for Payer: Cash Price |
$214.56
|
| Rate for Payer: Cash Price |
$214.56
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$268.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.96
|
| Rate for Payer: Mclaren Commercial |
$241.38
|
| Rate for Payer: Mclaren Medicaid |
$87.88
|
| Rate for Payer: Mclaren Medicare |
$163.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.16
|
| Rate for Payer: Meridian Medicaid |
$92.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.97
|
| Rate for Payer: Nomi Health Commercial |
$219.92
|
| Rate for Payer: PACE Medicare |
$155.76
|
| Rate for Payer: PACE SWMI |
$163.96
|
| Rate for Payer: PHP Commercial |
$180.36
|
| Rate for Payer: PHP Medicaid |
$87.88
|
| Rate for Payer: PHP Medicare Advantage |
$163.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.93
|
| Rate for Payer: Priority Health Medicare |
$163.96
|
| Rate for Payer: Priority Health Narrow Network |
$82.34
|
| Rate for Payer: Railroad Medicare Medicare |
$163.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.96
|
| Rate for Payer: UHC Exchange |
$254.14
|
| Rate for Payer: UHC Medicare Advantage |
$163.96
|
| Rate for Payer: UHCCP DNSP |
$163.96
|
| Rate for Payer: UHCCP Medicaid |
$87.88
|
| Rate for Payer: VA VA |
$163.96
|
|
|
HC BCRABL RNA, QUAL
|
Facility
|
IP
|
$268.20
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000143
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$174.33 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Aetna Commercial |
$241.38
|
| Rate for Payer: ASR ASR |
$260.15
|
| Rate for Payer: ASR Commercial |
$260.15
|
| Rate for Payer: BCBS Trust/PPO |
$218.56
|
| Rate for Payer: BCN Commercial |
$207.94
|
| Rate for Payer: Cash Price |
$214.56
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.56
|
| Rate for Payer: Healthscope Commercial |
$268.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.15
|
| Rate for Payer: Mclaren Commercial |
$241.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.97
|
| Rate for Payer: Nomi Health Commercial |
$219.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.02
|
|
|
HC BDIAL APTT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500096
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC BDIAL APTT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500096
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.01
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicaid |
$3.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.32
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP DNSP |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$3.22
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC BDIAL DIRM
|
Facility
|
OP
|
$40.32
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
30500088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$36.29
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$39.11
|
| Rate for Payer: ASR Commercial |
$39.11
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$33.02
|
| Rate for Payer: BCN Commercial |
$31.26
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Healthscope Whirlpool |
$39.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$36.29
|
| Rate for Payer: Mclaren Medicaid |
$5.46
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.27
|
| Rate for Payer: Nomi Health Commercial |
$33.06
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.33
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$28.26
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
| Rate for Payer: UHCCP DNSP |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.46
|
| Rate for Payer: VA VA |
$10.18
|
|
