|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
IP
|
$201.63
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$151.22 |
| Max. Negotiated Rate |
$201.63 |
| Rate for Payer: Aetna Commercial |
$181.47
|
| Rate for Payer: ASR ASR |
$195.58
|
| Rate for Payer: BCBS Trust/PPO |
$165.58
|
| Rate for Payer: BCN Commercial |
$165.58
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cofinity Commercial |
$189.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.30
|
| Rate for Payer: Healthscope Commercial |
$195.58
|
| Rate for Payer: Healthscope Whirlpool |
$201.63
|
| Rate for Payer: Mclaren Commercial |
$181.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.39
|
| Rate for Payer: Nomi Health Commercial |
$165.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.43
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
IP
|
$267.37
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$200.53 |
| Max. Negotiated Rate |
$267.37 |
| Rate for Payer: Aetna Commercial |
$240.63
|
| Rate for Payer: ASR ASR |
$259.35
|
| Rate for Payer: BCBS Trust/PPO |
$219.56
|
| Rate for Payer: BCN Commercial |
$219.56
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$251.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$259.35
|
| Rate for Payer: Healthscope Whirlpool |
$267.37
|
| Rate for Payer: Mclaren Commercial |
$240.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Nomi Health Commercial |
$219.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.29
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
OP
|
$267.37
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$267.37 |
| Rate for Payer: Aetna Commercial |
$240.63
|
| Rate for Payer: Aetna Medicare |
$71.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: ASR ASR |
$259.35
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$220.45
|
| Rate for Payer: BCN Commercial |
$220.45
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$251.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$259.35
|
| Rate for Payer: Healthscope Whirlpool |
$267.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.74
|
| Rate for Payer: Mclaren Commercial |
$240.63
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.26
|
| Rate for Payer: Nomi Health Commercial |
$219.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.53
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$78.91
|
| Rate for Payer: PHP Medicaid |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.04
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Narrow Network |
$96.84
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$111.20
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP DNSP |
$71.74
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
OP
|
$993.45
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$993.45 |
| Rate for Payer: Aetna Commercial |
$894.11
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$963.65
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$819.10
|
| Rate for Payer: BCN Commercial |
$819.10
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$794.76
|
| Rate for Payer: Cash Price |
$794.76
|
| Rate for Payer: Cofinity Commercial |
$933.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$794.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$963.65
|
| Rate for Payer: Healthscope Whirlpool |
$993.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$894.11
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.43
|
| Rate for Payer: Nomi Health Commercial |
$814.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.09
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$532.65
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$426.12
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$874.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
IP
|
$993.45
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$745.09 |
| Max. Negotiated Rate |
$993.45 |
| Rate for Payer: Aetna Commercial |
$894.11
|
| Rate for Payer: ASR ASR |
$963.65
|
| Rate for Payer: BCBS Trust/PPO |
$815.82
|
| Rate for Payer: BCN Commercial |
$815.82
|
| Rate for Payer: Cash Price |
$794.76
|
| Rate for Payer: Cofinity Commercial |
$933.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$794.76
|
| Rate for Payer: Healthscope Commercial |
$963.65
|
| Rate for Payer: Healthscope Whirlpool |
$993.45
|
| Rate for Payer: Mclaren Commercial |
$894.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.43
|
| Rate for Payer: Nomi Health Commercial |
$814.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$874.24
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
IP
|
$900.20
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$675.15 |
| Max. Negotiated Rate |
$900.20 |
| Rate for Payer: Aetna Commercial |
$810.18
|
| Rate for Payer: ASR ASR |
$873.19
|
| Rate for Payer: BCBS Trust/PPO |
$739.24
|
| Rate for Payer: BCN Commercial |
$739.24
|
| Rate for Payer: Cash Price |
$720.16
|
| Rate for Payer: Cofinity Commercial |
$846.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.16
|
| Rate for Payer: Healthscope Commercial |
$873.19
|
| Rate for Payer: Healthscope Whirlpool |
$900.20
|
| Rate for Payer: Mclaren Commercial |
$810.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.17
|
| Rate for Payer: Nomi Health Commercial |
$738.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.18
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
OP
|
$900.20
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$900.20 |
| Rate for Payer: Aetna Commercial |
$810.18
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$873.19
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$742.21
|
| Rate for Payer: BCN Commercial |
$742.21
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$720.16
|
| Rate for Payer: Cash Price |
$720.16
|
| Rate for Payer: Cofinity Commercial |
$846.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$873.19
|
| Rate for Payer: Healthscope Whirlpool |
$900.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$810.18
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.17
|
| Rate for Payer: Nomi Health Commercial |
$738.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.15
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$788.76
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$631.04
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
OP
|
$449.04
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Aetna Commercial |
$404.14
|
| Rate for Payer: Aetna Medicare |
$71.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: ASR ASR |
$435.57
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$370.23
|
| Rate for Payer: BCN Commercial |
$370.23
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$359.23
|
| Rate for Payer: Cash Price |
$359.23
|
| Rate for Payer: Cofinity Commercial |
$422.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$435.57
|
| Rate for Payer: Healthscope Whirlpool |
$449.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.74
|
| Rate for Payer: Mclaren Commercial |
$404.14
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.68
|
| Rate for Payer: Nomi Health Commercial |
$368.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.78
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$78.91
|
| Rate for Payer: PHP Medicaid |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.81
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Narrow Network |
$146.24
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$111.20
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP DNSP |
$71.74
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
IP
|
$449.04
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$336.78 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Aetna Commercial |
$404.14
|
| Rate for Payer: ASR ASR |
$435.57
|
| Rate for Payer: BCBS Trust/PPO |
$368.75
|
| Rate for Payer: BCN Commercial |
$368.75
|
| Rate for Payer: Cash Price |
$359.23
|
| Rate for Payer: Cofinity Commercial |
$422.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.23
|
| Rate for Payer: Healthscope Commercial |
$435.57
|
| Rate for Payer: Healthscope Whirlpool |
$449.04
|
| Rate for Payer: Mclaren Commercial |
$404.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.68
|
| Rate for Payer: Nomi Health Commercial |
$368.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.16
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
OP
|
$447.42
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$510.14 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$434.00
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$368.90
|
| Rate for Payer: BCN Commercial |
$368.90
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$434.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$402.68
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$366.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$392.03
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$313.64
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
IP
|
$447.42
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$335.56 |
| Max. Negotiated Rate |
$447.42 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: ASR ASR |
$434.00
|
| Rate for Payer: BCBS Trust/PPO |
$367.42
|
| Rate for Payer: BCN Commercial |
$367.42
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Healthscope Commercial |
$434.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.42
|
| Rate for Payer: Mclaren Commercial |
$402.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$366.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
|
|
HC CHEMO INTO PLEURA W THORACENTESIS
|
Facility
|
OP
|
$447.42
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
33500006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$510.14 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$434.00
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$368.90
|
| Rate for Payer: BCN Commercial |
$368.90
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$434.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$402.68
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$366.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$392.03
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$313.64
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC CHEMO INTO PLEURA W THORACENTESIS
|
Facility
|
IP
|
$447.42
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
33500006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$335.56 |
| Max. Negotiated Rate |
$447.42 |
| Rate for Payer: Aetna Commercial |
$402.68
|
| Rate for Payer: ASR ASR |
$434.00
|
| Rate for Payer: BCBS Trust/PPO |
$367.42
|
| Rate for Payer: BCN Commercial |
$367.42
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Commercial |
$420.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Healthscope Commercial |
$434.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.42
|
| Rate for Payer: Mclaren Commercial |
$402.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$366.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.73
|
|
|
HC CHEST TUBE PROCEDURE
|
Facility
|
IP
|
$1,591.81
|
|
| Hospital Charge Code |
45000035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,193.86 |
| Max. Negotiated Rate |
$1,591.81 |
| Rate for Payer: Aetna Commercial |
$1,432.63
|
| Rate for Payer: ASR ASR |
$1,544.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.19
|
| Rate for Payer: BCN Commercial |
$1,307.19
|
| Rate for Payer: Cash Price |
$1,273.45
|
| Rate for Payer: Cofinity Commercial |
$1,496.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,273.45
|
| Rate for Payer: Healthscope Commercial |
$1,544.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,591.81
|
| Rate for Payer: Mclaren Commercial |
$1,432.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,353.04
|
| Rate for Payer: Nomi Health Commercial |
$1,305.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,193.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,400.79
|
|
|
HC CHEST TUBE PROCEDURE
|
Facility
|
OP
|
$1,591.81
|
|
| Hospital Charge Code |
45000035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$588.97 |
| Max. Negotiated Rate |
$1,591.81 |
| Rate for Payer: Aetna Commercial |
$1,432.63
|
| Rate for Payer: Aetna Medicare |
$588.97
|
| Rate for Payer: ASR ASR |
$1,544.06
|
| Rate for Payer: BCBS Complete |
$636.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,312.45
|
| Rate for Payer: BCN Commercial |
$1,312.45
|
| Rate for Payer: Cash Price |
$1,273.45
|
| Rate for Payer: Cofinity Commercial |
$1,496.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,273.45
|
| Rate for Payer: Healthscope Commercial |
$1,544.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,591.81
|
| Rate for Payer: Mclaren Commercial |
$1,432.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,273.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,353.04
|
| Rate for Payer: Nomi Health Commercial |
$1,305.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,193.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,394.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,400.79
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200078
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200078
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC CHILDBIRTH EDUCATION
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
HCPCS S9442
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.13 |
| 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 |
$35.18
|
| Rate for Payer: BCN Commercial |
$35.18
|
| 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 |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC CHILDBIRTH EDUCATION
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
HCPCS S9442
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.32
|
| Rate for Payer: BCN Commercial |
$35.32
|
| 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 |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC CHILDHOOD ALLERGEN PROFILE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200120
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC CHILDHOOD ALLERGEN PROFILE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200120
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CHLAMYDIA AB IGG
|
Facility
|
OP
|
$18.91
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200239
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna Commercial |
$17.02
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: ASR ASR |
$18.34
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.59
|
| Rate for Payer: BCN Commercial |
$15.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$15.13
|
| Rate for Payer: Cash Price |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$18.34
|
| Rate for Payer: Healthscope Whirlpool |
$18.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.82
|
| Rate for Payer: Mclaren Commercial |
$17.02
|
| Rate for Payer: Mclaren Medicaid |
$11.82
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.07
|
| Rate for Payer: Nomi Health Commercial |
$15.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.18
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicaid |
$6.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.57
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow Network |
$13.26
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.82
|
| Rate for Payer: UHC Exchange |
$18.32
|
| Rate for Payer: UHC Medicaid |
$6.18
|
| Rate for Payer: UHCCP DNSP |
$11.82
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC CHLAMYDIA AB IGG
|
Facility
|
IP
|
$18.91
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200239
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna Commercial |
$17.02
|
| Rate for Payer: ASR ASR |
$18.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Commercial |
$15.53
|
| Rate for Payer: Cash Price |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.13
|
| Rate for Payer: Healthscope Commercial |
$18.34
|
| Rate for Payer: Healthscope Whirlpool |
$18.91
|
| Rate for Payer: Mclaren Commercial |
$17.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.07
|
| Rate for Payer: Nomi Health Commercial |
$15.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.64
|
|
|
HC CHLAMYDIA AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
30600149
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$119.86 |
| Rate for Payer: Aetna Commercial |
$62.08
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$66.91
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$56.87
|
| Rate for Payer: BCN Commercial |
$56.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$66.91
|
| Rate for Payer: Healthscope Whirlpool |
$68.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$62.08
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$119.86
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$95.89
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC CHLAMYDIA AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
30600149
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$68.98 |
| Rate for Payer: Aetna Commercial |
$62.08
|
| Rate for Payer: ASR ASR |
$66.91
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$66.91
|
| Rate for Payer: Healthscope Whirlpool |
$68.98
|
| Rate for Payer: Mclaren Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$56.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.70
|
|
