|
HC CANNULA VENOUS RT PVC
|
Facility
|
IP
|
$85.68
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: ASR ASR |
$83.11
|
| Rate for Payer: ASR Commercial |
$83.11
|
| Rate for Payer: BCBS Trust/PPO |
$69.82
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Healthscope Whirlpool |
$83.11
|
| Rate for Payer: Mclaren Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Nomi Health Commercial |
$70.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.40
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
IP
|
$73.44
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$59.85
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
OP
|
$73.44
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.14
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Narrow Network |
$51.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
OP
|
$97.92
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$88.13
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: ASR ASR |
$94.98
|
| Rate for Payer: ASR Commercial |
$94.98
|
| Rate for Payer: BCBS Complete |
$39.17
|
| Rate for Payer: BCBS Trust/PPO |
$80.19
|
| Rate for Payer: BCN Commercial |
$75.92
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$97.92
|
| Rate for Payer: Healthscope Whirlpool |
$94.98
|
| Rate for Payer: Mclaren Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: Nomi Health Commercial |
$80.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.80
|
| Rate for Payer: Priority Health Narrow Network |
$68.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.17
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
IP
|
$97.92
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$88.13
|
| Rate for Payer: ASR ASR |
$94.98
|
| Rate for Payer: ASR Commercial |
$94.98
|
| Rate for Payer: BCBS Trust/PPO |
$79.80
|
| Rate for Payer: BCN Commercial |
$75.92
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$97.92
|
| Rate for Payer: Healthscope Whirlpool |
$94.98
|
| Rate for Payer: Mclaren Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: Nomi Health Commercial |
$80.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.17
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
OP
|
$73.44
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.14
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Narrow Network |
$51.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
IP
|
$73.44
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$59.85
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
IP
|
$44.76
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.09 |
| Max. Negotiated Rate |
$44.76 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: ASR ASR |
$43.42
|
| Rate for Payer: ASR Commercial |
$43.42
|
| Rate for Payer: BCBS Trust/PPO |
$36.47
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cofinity Commercial |
$42.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.81
|
| Rate for Payer: Healthscope Commercial |
$44.76
|
| Rate for Payer: Healthscope Whirlpool |
$43.42
|
| Rate for Payer: Mclaren Commercial |
$40.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.05
|
| Rate for Payer: Nomi Health Commercial |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.39
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
OP
|
$44.76
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$44.76 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$43.42
|
| Rate for Payer: ASR Commercial |
$43.42
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$36.65
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cofinity Commercial |
$42.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$44.76
|
| Rate for Payer: Healthscope Whirlpool |
$43.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$40.28
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.05
|
| Rate for Payer: Nomi Health Commercial |
$36.70
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.22
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$31.38
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicaid |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.11
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$32.09
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: ASR Commercial |
$43.40
|
| Rate for Payer: BCBS Trust/PPO |
$36.46
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: ASR Commercial |
$43.40
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$36.64
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: ASR ASR |
$20.99
|
| Rate for Payer: ASR Commercial |
$20.99
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$17.72
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.88
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$5.37
|
| Rate for Payer: PHP Medicaid |
$2.62
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.96
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.17
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$7.56
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP DNSP |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: ASR ASR |
$20.99
|
| Rate for Payer: ASR Commercial |
$20.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.99
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.04
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: ASR Commercial |
$76.10
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$64.24
|
| Rate for Payer: BCN Commercial |
$60.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$78.45
|
| Rate for Payer: Healthscope Whirlpool |
$76.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.32
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$13.55
|
| Rate for Payer: PHP Medicaid |
$6.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.74
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$54.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.32
|
| Rate for Payer: UHC Exchange |
$19.10
|
| Rate for Payer: UHC Medicare Advantage |
$12.32
|
| Rate for Payer: UHCCP DNSP |
$12.32
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: ASR Commercial |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$63.93
|
| Rate for Payer: BCN Commercial |
$60.82
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$78.45
|
| Rate for Payer: Healthscope Whirlpool |
$76.10
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
IP
|
$197.91
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$128.64 |
| Max. Negotiated Rate |
$197.91 |
| Rate for Payer: Aetna Commercial |
$178.12
|
| Rate for Payer: ASR ASR |
$191.97
|
| Rate for Payer: ASR Commercial |
$191.97
|
| Rate for Payer: BCBS Trust/PPO |
$161.28
|
| Rate for Payer: BCN Commercial |
$153.44
|
| Rate for Payer: Cash Price |
$158.33
|
| Rate for Payer: Cofinity Commercial |
$186.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.33
|
| Rate for Payer: Healthscope Commercial |
$197.91
|
| Rate for Payer: Healthscope Whirlpool |
$191.97
|
| Rate for Payer: Mclaren Commercial |
$178.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.22
|
| Rate for Payer: Nomi Health Commercial |
$162.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.16
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
OP
|
$197.91
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$197.91 |
| Rate for Payer: Aetna Commercial |
$178.12
|
| Rate for Payer: Aetna Medicare |
$122.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.50
|
| Rate for Payer: ASR ASR |
$191.97
|
| Rate for Payer: ASR Commercial |
$191.97
|
| Rate for Payer: BCBS Complete |
$69.11
|
| Rate for Payer: BCBS MAPPO |
$122.80
|
| Rate for Payer: BCBS Trust/PPO |
$162.07
|
| Rate for Payer: BCN Commercial |
$153.44
|
| Rate for Payer: BCN Medicare Advantage |
$122.80
|
| Rate for Payer: Cash Price |
$158.33
|
| Rate for Payer: Cash Price |
$158.33
|
| Rate for Payer: Cofinity Commercial |
$186.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.80
|
| Rate for Payer: Healthscope Commercial |
$197.91
|
| Rate for Payer: Healthscope Whirlpool |
$191.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$122.80
|
| Rate for Payer: Mclaren Commercial |
$178.12
|
| Rate for Payer: Mclaren Medicaid |
$65.82
|
| Rate for Payer: Mclaren Medicare |
$122.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.94
|
| Rate for Payer: Meridian Medicaid |
$69.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.22
|
| Rate for Payer: Nomi Health Commercial |
$162.29
|
| Rate for Payer: PACE Medicare |
$116.66
|
| Rate for Payer: PACE SWMI |
$122.80
|
| Rate for Payer: PHP Commercial |
$135.08
|
| Rate for Payer: PHP Medicaid |
$65.82
|
| Rate for Payer: PHP Medicare Advantage |
$122.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.41
|
| Rate for Payer: Priority Health Medicare |
$122.80
|
| Rate for Payer: Priority Health Narrow Network |
$138.73
|
| Rate for Payer: Railroad Medicare Medicare |
$122.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.80
|
| Rate for Payer: UHC Exchange |
$190.34
|
| Rate for Payer: UHC Medicare Advantage |
$122.80
|
| Rate for Payer: UHCCP DNSP |
$122.80
|
| Rate for Payer: UHCCP Medicaid |
$65.82
|
| Rate for Payer: VA VA |
$122.80
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
IP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: ASR ASR |
$49.63
|
| Rate for Payer: ASR Commercial |
$49.63
|
| Rate for Payer: BCBS Trust/PPO |
$41.70
|
| Rate for Payer: BCN Commercial |
$39.67
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.63
|
| Rate for Payer: Mclaren Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
OP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$49.63
|
| Rate for Payer: ASR Commercial |
$49.63
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.90
|
| Rate for Payer: BCN Commercial |
$39.67
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$46.05
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$41.96
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.84
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$35.87
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.64
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
IP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: ASR ASR |
$49.63
|
| Rate for Payer: ASR Commercial |
$49.63
|
| Rate for Payer: BCBS Trust/PPO |
$41.70
|
| Rate for Payer: BCN Commercial |
$39.67
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.63
|
| Rate for Payer: Mclaren Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
OP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$49.63
|
| Rate for Payer: ASR Commercial |
$49.63
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.90
|
| Rate for Payer: BCN Commercial |
$39.67
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$46.05
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$41.96
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.84
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$35.87
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.64
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
OP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200145
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$49.63
|
| Rate for Payer: ASR Commercial |
$49.63
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.90
|
| Rate for Payer: BCN Commercial |
$39.67
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$46.05
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$41.96
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.84
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$35.87
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP DNSP |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$13.64
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
IP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200145
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$51.17 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: ASR ASR |
$49.63
|
| Rate for Payer: ASR Commercial |
$49.63
|
| Rate for Payer: BCBS Trust/PPO |
$41.70
|
| Rate for Payer: BCN Commercial |
$39.67
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$49.63
|
| Rate for Payer: Mclaren Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.03
|
|
