|
HC CHROMOSOME ANALYSIS CHORIONIC VILLUS
|
Facility
|
OP
|
$383.09
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
31000021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$383.09 |
| Rate for Payer: Aetna Commercial |
$344.78
|
| Rate for Payer: Aetna Medicare |
$188.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.71
|
| Rate for Payer: ASR ASR |
$371.60
|
| Rate for Payer: BCBS Complete |
$103.56
|
| Rate for Payer: BCBS MAPPO |
$188.57
|
| Rate for Payer: BCBS Trust/PPO |
$315.86
|
| Rate for Payer: BCN Commercial |
$315.86
|
| Rate for Payer: BCN Medicare Advantage |
$188.57
|
| Rate for Payer: Cash Price |
$306.47
|
| Rate for Payer: Cash Price |
$306.47
|
| Rate for Payer: Cofinity Commercial |
$360.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.57
|
| Rate for Payer: Healthscope Commercial |
$371.60
|
| Rate for Payer: Healthscope Whirlpool |
$383.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$188.57
|
| Rate for Payer: Mclaren Commercial |
$344.78
|
| Rate for Payer: Mclaren Medicaid |
$188.57
|
| Rate for Payer: Mclaren Medicare |
$188.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.00
|
| Rate for Payer: Meridian Medicaid |
$103.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.63
|
| Rate for Payer: Nomi Health Commercial |
$314.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.32
|
| Rate for Payer: PACE Medicare |
$179.14
|
| Rate for Payer: PACE SWMI |
$188.57
|
| Rate for Payer: PHP Commercial |
$207.43
|
| Rate for Payer: PHP Medicaid |
$101.07
|
| Rate for Payer: PHP Medicare Advantage |
$188.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$335.66
|
| Rate for Payer: Priority Health Medicare |
$188.57
|
| Rate for Payer: Priority Health Narrow Network |
$268.55
|
| Rate for Payer: Railroad Medicare Medicare |
$188.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.57
|
| Rate for Payer: UHC Exchange |
$292.28
|
| Rate for Payer: UHC Medicaid |
$98.62
|
| Rate for Payer: UHCCP DNSP |
$188.57
|
| Rate for Payer: UHCCP Medicaid |
$98.62
|
| Rate for Payer: VA VA |
$188.57
|
|
|
HC CHROMOSOME ANALYSIS CHORIONIC VILLUS
|
Facility
|
IP
|
$383.09
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
31000021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$287.32 |
| Max. Negotiated Rate |
$383.09 |
| Rate for Payer: Aetna Commercial |
$344.78
|
| Rate for Payer: ASR ASR |
$371.60
|
| Rate for Payer: BCBS Trust/PPO |
$314.59
|
| Rate for Payer: BCN Commercial |
$314.59
|
| Rate for Payer: Cash Price |
$306.47
|
| Rate for Payer: Cofinity Commercial |
$360.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.47
|
| Rate for Payer: Healthscope Commercial |
$371.60
|
| Rate for Payer: Healthscope Whirlpool |
$383.09
|
| Rate for Payer: Mclaren Commercial |
$344.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.63
|
| Rate for Payer: Nomi Health Commercial |
$314.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.12
|
|
|
HC CHROMOSOME ANALYSIS CONGENITAL
|
Facility
|
IP
|
$226.04
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
31000013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$226.04 |
| Rate for Payer: Aetna Commercial |
$203.44
|
| Rate for Payer: ASR ASR |
$219.26
|
| Rate for Payer: BCBS Trust/PPO |
$185.62
|
| Rate for Payer: BCN Commercial |
$185.62
|
| Rate for Payer: Cash Price |
$180.83
|
| Rate for Payer: Cofinity Commercial |
$212.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.83
|
| Rate for Payer: Healthscope Commercial |
$219.26
|
| Rate for Payer: Healthscope Whirlpool |
$226.04
|
| Rate for Payer: Mclaren Commercial |
$203.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.13
|
| Rate for Payer: Nomi Health Commercial |
$185.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.92
|
|
|
HC CHROMOSOME ANALYSIS CONGENITAL
|
Facility
|
OP
|
$226.04
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
31000013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$226.04 |
| Rate for Payer: Aetna Commercial |
$203.44
|
| Rate for Payer: Aetna Medicare |
$116.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.61
|
| Rate for Payer: ASR ASR |
$219.26
|
| Rate for Payer: BCBS Complete |
$63.98
|
| Rate for Payer: BCBS MAPPO |
$116.49
|
| Rate for Payer: BCBS Trust/PPO |
$186.37
|
| Rate for Payer: BCN Commercial |
$186.37
|
| Rate for Payer: BCN Medicare Advantage |
$116.49
|
| Rate for Payer: Cash Price |
$180.83
|
| Rate for Payer: Cash Price |
$180.83
|
| Rate for Payer: Cofinity Commercial |
$212.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.49
|
| Rate for Payer: Healthscope Commercial |
$219.26
|
| Rate for Payer: Healthscope Whirlpool |
$226.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$116.49
|
| Rate for Payer: Mclaren Commercial |
$203.44
|
| Rate for Payer: Mclaren Medicaid |
$116.49
|
| Rate for Payer: Mclaren Medicare |
$116.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.31
|
| Rate for Payer: Meridian Medicaid |
$63.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.13
|
| Rate for Payer: Nomi Health Commercial |
$185.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.53
|
| Rate for Payer: PACE Medicare |
$110.67
|
| Rate for Payer: PACE SWMI |
$116.49
|
| Rate for Payer: PHP Commercial |
$128.14
|
| Rate for Payer: PHP Medicaid |
$62.44
|
| Rate for Payer: PHP Medicare Advantage |
$116.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$198.06
|
| Rate for Payer: Priority Health Medicare |
$116.49
|
| Rate for Payer: Priority Health Narrow Network |
$158.45
|
| Rate for Payer: Railroad Medicare Medicare |
$116.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$116.49
|
| Rate for Payer: UHC Exchange |
$180.56
|
| Rate for Payer: UHC Medicaid |
$60.92
|
| Rate for Payer: UHCCP DNSP |
$116.49
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
| Rate for Payer: VA VA |
$116.49
|
|
|
HC CHROMOSOME ANALYSIS HEMATOLOGIAL
|
Facility
|
OP
|
$233.97
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$233.97 |
| Rate for Payer: Aetna Commercial |
$210.57
|
| Rate for Payer: Aetna Medicare |
$143.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.69
|
| Rate for Payer: ASR ASR |
$226.95
|
| Rate for Payer: BCBS Complete |
$78.95
|
| Rate for Payer: BCBS MAPPO |
$143.75
|
| Rate for Payer: BCBS Trust/PPO |
$192.91
|
| Rate for Payer: BCN Commercial |
$192.91
|
| Rate for Payer: BCN Medicare Advantage |
$143.75
|
| Rate for Payer: Cash Price |
$187.18
|
| Rate for Payer: Cash Price |
$187.18
|
| Rate for Payer: Cofinity Commercial |
$219.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.75
|
| Rate for Payer: Healthscope Commercial |
$226.95
|
| Rate for Payer: Healthscope Whirlpool |
$233.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$143.75
|
| Rate for Payer: Mclaren Commercial |
$210.57
|
| Rate for Payer: Mclaren Medicaid |
$143.75
|
| Rate for Payer: Mclaren Medicare |
$143.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.94
|
| Rate for Payer: Meridian Medicaid |
$78.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$158.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.87
|
| Rate for Payer: Nomi Health Commercial |
$191.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.48
|
| Rate for Payer: PACE Medicare |
$136.56
|
| Rate for Payer: PACE SWMI |
$143.75
|
| Rate for Payer: PHP Commercial |
$158.12
|
| Rate for Payer: PHP Medicaid |
$77.05
|
| Rate for Payer: PHP Medicare Advantage |
$143.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.00
|
| Rate for Payer: Priority Health Medicare |
$143.75
|
| Rate for Payer: Priority Health Narrow Network |
$164.01
|
| Rate for Payer: Railroad Medicare Medicare |
$143.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$143.75
|
| Rate for Payer: UHC Exchange |
$222.81
|
| Rate for Payer: UHC Medicaid |
$75.18
|
| Rate for Payer: UHCCP DNSP |
$143.75
|
| Rate for Payer: UHCCP Medicaid |
$75.18
|
| Rate for Payer: VA VA |
$143.75
|
|
|
HC CHROMOSOME ANALYSIS HEMATOLOGIAL
|
Facility
|
IP
|
$233.97
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.48 |
| Max. Negotiated Rate |
$233.97 |
| Rate for Payer: Aetna Commercial |
$210.57
|
| Rate for Payer: ASR ASR |
$226.95
|
| Rate for Payer: BCBS Trust/PPO |
$192.14
|
| Rate for Payer: BCN Commercial |
$192.14
|
| Rate for Payer: Cash Price |
$187.18
|
| Rate for Payer: Cofinity Commercial |
$219.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.18
|
| Rate for Payer: Healthscope Commercial |
$226.95
|
| Rate for Payer: Healthscope Whirlpool |
$233.97
|
| Rate for Payer: Mclaren Commercial |
$210.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.87
|
| Rate for Payer: Nomi Health Commercial |
$191.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.89
|
|
|
HC CHROMOSOME ANALYSIS MARROW
|
Facility
|
IP
|
$257.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$192.99 |
| Max. Negotiated Rate |
$257.32 |
| Rate for Payer: Aetna Commercial |
$231.59
|
| Rate for Payer: ASR ASR |
$249.60
|
| Rate for Payer: BCBS Trust/PPO |
$211.31
|
| Rate for Payer: BCN Commercial |
$211.31
|
| Rate for Payer: Cash Price |
$205.86
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.86
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$257.32
|
| Rate for Payer: Mclaren Commercial |
$231.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.72
|
| Rate for Payer: Nomi Health Commercial |
$211.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.44
|
|
|
HC CHROMOSOME ANALYSIS MARROW
|
Facility
|
OP
|
$257.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$257.32 |
| Rate for Payer: Aetna Commercial |
$231.59
|
| Rate for Payer: Aetna Medicare |
$143.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.69
|
| Rate for Payer: ASR ASR |
$249.60
|
| Rate for Payer: BCBS Complete |
$78.95
|
| Rate for Payer: BCBS MAPPO |
$143.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$212.16
|
| Rate for Payer: BCN Medicare Advantage |
$143.75
|
| Rate for Payer: Cash Price |
$205.86
|
| Rate for Payer: Cash Price |
$205.86
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.75
|
| Rate for Payer: Healthscope Commercial |
$249.60
|
| Rate for Payer: Healthscope Whirlpool |
$257.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$143.75
|
| Rate for Payer: Mclaren Commercial |
$231.59
|
| Rate for Payer: Mclaren Medicaid |
$143.75
|
| Rate for Payer: Mclaren Medicare |
$143.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.94
|
| Rate for Payer: Meridian Medicaid |
$78.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$158.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.72
|
| Rate for Payer: Nomi Health Commercial |
$211.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.99
|
| Rate for Payer: PACE Medicare |
$136.56
|
| Rate for Payer: PACE SWMI |
$143.75
|
| Rate for Payer: PHP Commercial |
$158.12
|
| Rate for Payer: PHP Medicaid |
$77.05
|
| Rate for Payer: PHP Medicare Advantage |
$143.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.46
|
| Rate for Payer: Priority Health Medicare |
$143.75
|
| Rate for Payer: Priority Health Narrow Network |
$180.38
|
| Rate for Payer: Railroad Medicare Medicare |
$143.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$143.75
|
| Rate for Payer: UHC Exchange |
$222.81
|
| Rate for Payer: UHC Medicaid |
$75.18
|
| Rate for Payer: UHCCP DNSP |
$143.75
|
| Rate for Payer: UHCCP Medicaid |
$75.18
|
| Rate for Payer: VA VA |
$143.75
|
|
|
HC CHROMOSOME CELL COUNT 15 TO 20
|
Facility
|
IP
|
$224.65
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
31000019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$168.49 |
| Max. Negotiated Rate |
$224.65 |
| Rate for Payer: Aetna Commercial |
$202.19
|
| Rate for Payer: ASR ASR |
$217.91
|
| Rate for Payer: BCBS Trust/PPO |
$184.48
|
| Rate for Payer: BCN Commercial |
$184.48
|
| Rate for Payer: Cash Price |
$179.72
|
| Rate for Payer: Cofinity Commercial |
$211.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.72
|
| Rate for Payer: Healthscope Commercial |
$217.91
|
| Rate for Payer: Healthscope Whirlpool |
$224.65
|
| Rate for Payer: Mclaren Commercial |
$202.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.95
|
| Rate for Payer: Nomi Health Commercial |
$184.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.69
|
|
|
HC CHROMOSOME CELL COUNT 15 TO 20
|
Facility
|
OP
|
$224.65
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
31000019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$1,153.67 |
| Rate for Payer: Aetna Commercial |
$202.19
|
| Rate for Payer: Aetna Medicare |
$125.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.86
|
| Rate for Payer: ASR ASR |
$217.91
|
| Rate for Payer: BCBS Complete |
$68.92
|
| Rate for Payer: BCBS MAPPO |
$125.49
|
| Rate for Payer: BCBS Trust/PPO |
$185.22
|
| Rate for Payer: BCN Commercial |
$185.22
|
| Rate for Payer: BCN Medicare Advantage |
$125.49
|
| Rate for Payer: Cash Price |
$179.72
|
| Rate for Payer: Cash Price |
$179.72
|
| Rate for Payer: Cofinity Commercial |
$211.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.49
|
| Rate for Payer: Healthscope Commercial |
$217.91
|
| Rate for Payer: Healthscope Whirlpool |
$224.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.49
|
| Rate for Payer: Mclaren Commercial |
$202.19
|
| Rate for Payer: Mclaren Medicaid |
$125.49
|
| Rate for Payer: Mclaren Medicare |
$125.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.76
|
| Rate for Payer: Meridian Medicaid |
$68.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.95
|
| Rate for Payer: Nomi Health Commercial |
$184.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.49
|
| Rate for Payer: PACE Medicare |
$119.22
|
| Rate for Payer: PACE SWMI |
$125.49
|
| Rate for Payer: PHP Commercial |
$138.04
|
| Rate for Payer: PHP Medicaid |
$67.26
|
| Rate for Payer: PHP Medicare Advantage |
$125.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,153.67
|
| Rate for Payer: Priority Health Medicare |
$125.49
|
| Rate for Payer: Priority Health Narrow Network |
$922.93
|
| Rate for Payer: Railroad Medicare Medicare |
$125.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.49
|
| Rate for Payer: UHC Exchange |
$194.51
|
| Rate for Payer: UHC Medicaid |
$65.63
|
| Rate for Payer: UHCCP DNSP |
$125.49
|
| Rate for Payer: UHCCP Medicaid |
$65.63
|
| Rate for Payer: VA VA |
$125.49
|
|
|
HC CHROMOSOME CULTURE
|
Facility
|
IP
|
$310.94
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$233.21 |
| Max. Negotiated Rate |
$310.94 |
| Rate for Payer: Aetna Commercial |
$279.85
|
| Rate for Payer: ASR ASR |
$301.61
|
| Rate for Payer: BCBS Trust/PPO |
$255.34
|
| Rate for Payer: BCN Commercial |
$255.34
|
| Rate for Payer: Cash Price |
$248.75
|
| Rate for Payer: Cofinity Commercial |
$292.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.75
|
| Rate for Payer: Healthscope Commercial |
$301.61
|
| Rate for Payer: Healthscope Whirlpool |
$310.94
|
| Rate for Payer: Mclaren Commercial |
$279.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.30
|
| Rate for Payer: Nomi Health Commercial |
$254.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.63
|
|
|
HC CHROMOSOME CULTURE
|
Facility
|
OP
|
$310.94
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.61 |
| Max. Negotiated Rate |
$310.94 |
| Rate for Payer: Aetna Commercial |
$279.85
|
| Rate for Payer: Aetna Medicare |
$150.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.88
|
| Rate for Payer: ASR ASR |
$301.61
|
| Rate for Payer: BCBS Complete |
$82.54
|
| Rate for Payer: BCBS MAPPO |
$150.30
|
| Rate for Payer: BCBS Trust/PPO |
$256.37
|
| Rate for Payer: BCN Commercial |
$256.37
|
| Rate for Payer: BCN Medicare Advantage |
$150.30
|
| Rate for Payer: Cash Price |
$248.75
|
| Rate for Payer: Cash Price |
$248.75
|
| Rate for Payer: Cofinity Commercial |
$292.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.30
|
| Rate for Payer: Healthscope Commercial |
$301.61
|
| Rate for Payer: Healthscope Whirlpool |
$310.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$150.30
|
| Rate for Payer: Mclaren Commercial |
$279.85
|
| Rate for Payer: Mclaren Medicaid |
$150.30
|
| Rate for Payer: Mclaren Medicare |
$150.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.81
|
| Rate for Payer: Meridian Medicaid |
$82.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.30
|
| Rate for Payer: Nomi Health Commercial |
$254.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.21
|
| Rate for Payer: PACE Medicare |
$142.78
|
| Rate for Payer: PACE SWMI |
$150.30
|
| Rate for Payer: PHP Commercial |
$165.33
|
| Rate for Payer: PHP Medicaid |
$80.56
|
| Rate for Payer: PHP Medicare Advantage |
$150.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.45
|
| Rate for Payer: Priority Health Medicare |
$150.30
|
| Rate for Payer: Priority Health Narrow Network |
$217.97
|
| Rate for Payer: Railroad Medicare Medicare |
$150.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$150.30
|
| Rate for Payer: UHC Exchange |
$232.97
|
| Rate for Payer: UHC Medicaid |
$78.61
|
| Rate for Payer: UHCCP DNSP |
$150.30
|
| Rate for Payer: UHCCP Medicaid |
$78.61
|
| Rate for Payer: VA VA |
$150.30
|
|
|
HC CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MO
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: Aetna Medicare |
$59.57
|
| Rate for Payer: ASR ASR |
$156.17
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS Trust/PPO |
$132.74
|
| Rate for Payer: BCN Commercial |
$132.74
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$151.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$156.17
|
| Rate for Payer: Healthscope Whirlpool |
$161.00
|
| Rate for Payer: Mclaren Commercial |
$144.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Nomi Health Commercial |
$132.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141.07
|
| Rate for Payer: Priority Health Narrow Network |
$112.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.68
|
|
|
HC CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MO
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: ASR ASR |
$156.17
|
| Rate for Payer: BCBS Trust/PPO |
$132.21
|
| Rate for Payer: BCN Commercial |
$132.21
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$151.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$156.17
|
| Rate for Payer: Healthscope Whirlpool |
$161.00
|
| Rate for Payer: Mclaren Commercial |
$144.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Nomi Health Commercial |
$132.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.68
|
|
|
HC CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: ASR ASR |
$252.20
|
| Rate for Payer: BCBS Trust/PPO |
$213.51
|
| Rate for Payer: BCN Commercial |
$213.51
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$244.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$252.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.00
|
| Rate for Payer: Mclaren Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.80
|
|
|
HC CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$101.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: ASR ASR |
$252.20
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$214.37
|
| Rate for Payer: BCN Commercial |
$214.37
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$244.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$252.20
|
| Rate for Payer: Healthscope Whirlpool |
$260.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.22
|
| Rate for Payer: Mclaren Commercial |
$234.00
|
| Rate for Payer: Mclaren Medicaid |
$101.22
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$55.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$111.34
|
| Rate for Payer: PHP Medicaid |
$54.25
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.81
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health Narrow Network |
$182.26
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$156.89
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP DNSP |
$101.22
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC CIRCUMCISION
|
Facility
|
OP
|
$2,819.98
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$1,043.39 |
| Max. Negotiated Rate |
$2,819.98 |
| Rate for Payer: Aetna Commercial |
$2,537.98
|
| Rate for Payer: Aetna Medicare |
$1,043.39
|
| Rate for Payer: ASR ASR |
$2,735.38
|
| Rate for Payer: BCBS Complete |
$1,127.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,325.07
|
| Rate for Payer: BCN Commercial |
$2,325.07
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,650.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,735.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,819.98
|
| Rate for Payer: Mclaren Commercial |
$2,537.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,255.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,470.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,481.58
|
|
|
HC CIRCUMCISION
|
Facility
|
IP
|
$2,819.98
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$2,114.99 |
| Max. Negotiated Rate |
$2,819.98 |
| Rate for Payer: Aetna Commercial |
$2,537.98
|
| Rate for Payer: ASR ASR |
$2,735.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,315.77
|
| Rate for Payer: BCN Commercial |
$2,315.77
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,650.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,735.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,819.98
|
| Rate for Payer: Mclaren Commercial |
$2,537.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,481.58
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,077.02 |
| Max. Negotiated Rate |
$2,769.36 |
| Rate for Payer: Aetna Commercial |
$2,492.42
|
| Rate for Payer: ASR ASR |
$2,686.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,274.20
|
| Rate for Payer: BCN Commercial |
$2,274.20
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,603.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,686.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,769.36
|
| Rate for Payer: Mclaren Commercial |
$2,492.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,437.04
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$2,492.42
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$2,686.28
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.34
|
| Rate for Payer: BCN Commercial |
$2,283.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,603.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,686.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,769.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$2,492.42
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,426.51
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,941.32
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,437.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,114.99 |
| Max. Negotiated Rate |
$2,819.98 |
| Rate for Payer: Aetna Commercial |
$2,537.98
|
| Rate for Payer: ASR ASR |
$2,735.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,315.77
|
| Rate for Payer: BCN Commercial |
$2,315.77
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,650.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,735.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,819.98
|
| Rate for Payer: Mclaren Commercial |
$2,537.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,481.58
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$2,537.98
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$2,735.38
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,325.07
|
| Rate for Payer: BCN Commercial |
$2,325.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,650.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,735.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,819.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$2,537.98
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,470.87
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,481.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CITRIC ACID URINE
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$54.12 |
| Rate for Payer: Aetna Commercial |
$48.71
|
| Rate for Payer: Aetna Medicare |
$27.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.75
|
| Rate for Payer: ASR ASR |
$52.50
|
| Rate for Payer: BCBS Complete |
$15.27
|
| Rate for Payer: BCBS MAPPO |
$27.80
|
| Rate for Payer: BCBS Trust/PPO |
$44.62
|
| Rate for Payer: BCN Commercial |
$44.62
|
| Rate for Payer: BCN Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$50.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Whirlpool |
$54.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.80
|
| Rate for Payer: Mclaren Commercial |
$48.71
|
| Rate for Payer: Mclaren Medicaid |
$27.80
|
| Rate for Payer: Mclaren Medicare |
$27.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.19
|
| Rate for Payer: Meridian Medicaid |
$15.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Medicare |
$26.41
|
| Rate for Payer: PACE SWMI |
$27.80
|
| Rate for Payer: PHP Commercial |
$30.58
|
| Rate for Payer: PHP Medicaid |
$14.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.42
|
| Rate for Payer: Priority Health Medicare |
$27.80
|
| Rate for Payer: Priority Health Narrow Network |
$37.94
|
| Rate for Payer: Railroad Medicare Medicare |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.80
|
| Rate for Payer: UHC Exchange |
$43.09
|
| Rate for Payer: UHC Medicaid |
$14.54
|
| Rate for Payer: UHCCP DNSP |
$27.80
|
| Rate for Payer: UHCCP Medicaid |
$14.54
|
| Rate for Payer: VA VA |
$27.80
|
|
|
HC CITRIC ACID URINE
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$54.12 |
| Rate for Payer: Aetna Commercial |
$48.71
|
| Rate for Payer: ASR ASR |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCN Commercial |
$44.44
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$50.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$52.50
|
| Rate for Payer: Healthscope Whirlpool |
$54.12
|
| Rate for Payer: Mclaren Commercial |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.63
|
|
|
HC CK-MB FRACTION
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$179.77 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.55
|
| Rate for Payer: BCBS Trust/PPO |
$85.75
|
| Rate for Payer: BCN Commercial |
$85.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$100.88
|
| Rate for Payer: Healthscope Whirlpool |
$104.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.55
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Mclaren Medicaid |
$11.55
|
| Rate for Payer: Mclaren Medicare |
$11.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.13
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Medicare |
$10.97
|
| Rate for Payer: PACE SWMI |
$11.55
|
| Rate for Payer: PHP Commercial |
$12.71
|
| Rate for Payer: PHP Medicaid |
$6.19
|
| Rate for Payer: PHP Medicare Advantage |
$11.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.77
|
| Rate for Payer: Priority Health Medicare |
$11.55
|
| Rate for Payer: Priority Health Narrow Network |
$143.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.55
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicaid |
$6.04
|
| Rate for Payer: UHCCP DNSP |
$11.55
|
| Rate for Payer: UHCCP Medicaid |
$6.04
|
| Rate for Payer: VA VA |
$11.55
|
|
