|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
IP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$199.93 |
| Rate for Payer: Aetna Commercial |
$179.94
|
| Rate for Payer: ASR ASR |
$193.93
|
| Rate for Payer: ASR Commercial |
$193.93
|
| Rate for Payer: BCBS Trust/PPO |
$162.92
|
| Rate for Payer: BCN Commercial |
$155.01
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$187.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$199.93
|
| Rate for Payer: Healthscope Whirlpool |
$193.93
|
| Rate for Payer: Mclaren Commercial |
$179.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: Nomi Health Commercial |
$163.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.94
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
IP
|
$1,211.27
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$787.33 |
| Max. Negotiated Rate |
$1,211.27 |
| Rate for Payer: Aetna Commercial |
$1,090.14
|
| Rate for Payer: ASR ASR |
$1,174.93
|
| Rate for Payer: ASR Commercial |
$1,174.93
|
| Rate for Payer: BCBS Trust/PPO |
$987.06
|
| Rate for Payer: BCN Commercial |
$939.10
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cofinity Commercial |
$1,138.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.02
|
| Rate for Payer: Healthscope Commercial |
$1,211.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.93
|
| Rate for Payer: Mclaren Commercial |
$1,090.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.58
|
| Rate for Payer: Nomi Health Commercial |
$993.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.92
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
OP
|
$1,211.27
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$1,090.14
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,174.93
|
| Rate for Payer: ASR Commercial |
$1,174.93
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$991.91
|
| Rate for Payer: BCN Commercial |
$939.10
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cofinity Commercial |
$1,138.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,211.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,090.14
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.58
|
| Rate for Payer: Nomi Health Commercial |
$993.24
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,061.31
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$849.10
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.58
|
| Rate for Payer: ASR ASR |
$166.22
|
| Rate for Payer: ASR Commercial |
$166.22
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS MAPPO |
$12.46
|
| Rate for Payer: BCBS Trust/PPO |
$140.33
|
| Rate for Payer: BCN Commercial |
$132.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.46
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.46
|
| Rate for Payer: Healthscope Commercial |
$171.36
|
| Rate for Payer: Healthscope Whirlpool |
$166.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.46
|
| Rate for Payer: Mclaren Commercial |
$154.22
|
| Rate for Payer: Mclaren Medicaid |
$6.68
|
| Rate for Payer: Mclaren Medicare |
$12.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.08
|
| Rate for Payer: Meridian Medicaid |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.66
|
| Rate for Payer: Nomi Health Commercial |
$140.52
|
| Rate for Payer: PACE Medicare |
$11.84
|
| Rate for Payer: PACE SWMI |
$12.46
|
| Rate for Payer: PHP Commercial |
$13.71
|
| Rate for Payer: PHP Medicaid |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$12.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.15
|
| Rate for Payer: Priority Health Medicare |
$12.46
|
| Rate for Payer: Priority Health Narrow Network |
$120.12
|
| Rate for Payer: Railroad Medicare Medicare |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.46
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicare Advantage |
$12.46
|
| Rate for Payer: UHCCP DNSP |
$12.46
|
| Rate for Payer: UHCCP Medicaid |
$6.68
|
| Rate for Payer: VA VA |
$12.46
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: ASR ASR |
$166.22
|
| Rate for Payer: ASR Commercial |
$166.22
|
| Rate for Payer: BCBS Trust/PPO |
$139.64
|
| Rate for Payer: BCN Commercial |
$132.86
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$171.36
|
| Rate for Payer: Healthscope Whirlpool |
$166.22
|
| Rate for Payer: Mclaren Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.66
|
| Rate for Payer: Nomi Health Commercial |
$140.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.80
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.00
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: BCBS MAPPO |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$75.51
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: BCN Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.60
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$3.00
|
| Rate for Payer: Mclaren Medicare |
$5.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.88
|
| Rate for Payer: Meridian Medicaid |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PACE Medicare |
$5.32
|
| Rate for Payer: PACE SWMI |
$5.60
|
| Rate for Payer: PHP Commercial |
$6.16
|
| Rate for Payer: PHP Medicaid |
$3.00
|
| Rate for Payer: PHP Medicare Advantage |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health Narrow Network |
$52.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.60
|
| Rate for Payer: UHC Exchange |
$8.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.60
|
| Rate for Payer: UHCCP DNSP |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$3.00
|
| Rate for Payer: VA VA |
$5.60
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
IP
|
$262.96
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$170.92 |
| Max. Negotiated Rate |
$262.96 |
| Rate for Payer: Aetna Commercial |
$236.66
|
| Rate for Payer: ASR ASR |
$255.07
|
| Rate for Payer: ASR Commercial |
$255.07
|
| Rate for Payer: BCBS Trust/PPO |
$214.29
|
| Rate for Payer: BCN Commercial |
$203.87
|
| Rate for Payer: Cash Price |
$210.37
|
| Rate for Payer: Cofinity Commercial |
$247.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.37
|
| Rate for Payer: Healthscope Commercial |
$262.96
|
| Rate for Payer: Healthscope Whirlpool |
$255.07
|
| Rate for Payer: Mclaren Commercial |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.52
|
| Rate for Payer: Nomi Health Commercial |
$215.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.40
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
OP
|
$262.96
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.82 |
| Max. Negotiated Rate |
$262.96 |
| Rate for Payer: Aetna Commercial |
$236.66
|
| Rate for Payer: Aetna Medicare |
$135.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.82
|
| Rate for Payer: ASR ASR |
$255.07
|
| Rate for Payer: ASR Commercial |
$255.07
|
| Rate for Payer: BCBS Complete |
$76.46
|
| Rate for Payer: BCBS MAPPO |
$135.86
|
| Rate for Payer: BCBS Trust/PPO |
$215.34
|
| Rate for Payer: BCN Commercial |
$203.87
|
| Rate for Payer: BCN Medicare Advantage |
$135.86
|
| Rate for Payer: Cash Price |
$210.37
|
| Rate for Payer: Cash Price |
$210.37
|
| Rate for Payer: Cofinity Commercial |
$247.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.86
|
| Rate for Payer: Healthscope Commercial |
$262.96
|
| Rate for Payer: Healthscope Whirlpool |
$255.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$135.86
|
| Rate for Payer: Mclaren Commercial |
$236.66
|
| Rate for Payer: Mclaren Medicaid |
$72.82
|
| Rate for Payer: Mclaren Medicare |
$135.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.65
|
| Rate for Payer: Meridian Medicaid |
$76.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.52
|
| Rate for Payer: Nomi Health Commercial |
$215.63
|
| Rate for Payer: PACE Medicare |
$129.07
|
| Rate for Payer: PACE SWMI |
$135.86
|
| Rate for Payer: PHP Commercial |
$149.45
|
| Rate for Payer: PHP Medicaid |
$72.82
|
| Rate for Payer: PHP Medicare Advantage |
$135.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.41
|
| Rate for Payer: Priority Health Medicare |
$135.86
|
| Rate for Payer: Priority Health Narrow Network |
$184.33
|
| Rate for Payer: Railroad Medicare Medicare |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.86
|
| Rate for Payer: UHC Exchange |
$210.58
|
| Rate for Payer: UHC Medicare Advantage |
$135.86
|
| Rate for Payer: UHCCP DNSP |
$135.86
|
| Rate for Payer: UHCCP Medicaid |
$72.82
|
| Rate for Payer: VA VA |
$135.86
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: Aetna Medicare |
$74.10
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: ASR Commercial |
$143.74
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$121.35
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: ASR Commercial |
$143.74
|
| Rate for Payer: BCBS Trust/PPO |
$120.76
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$153.73 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$122.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$204.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$175.18
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$76.45
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Trust/PPO |
$203.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
OP
|
$4,135.96
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,654.38 |
| Max. Negotiated Rate |
$4,135.96 |
| Rate for Payer: Aetna Commercial |
$3,722.36
|
| Rate for Payer: Aetna Medicare |
$2,067.98
|
| Rate for Payer: ASR ASR |
$4,011.88
|
| Rate for Payer: ASR Commercial |
$4,011.88
|
| Rate for Payer: BCBS Complete |
$1,654.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,386.94
|
| Rate for Payer: BCN Commercial |
$3,206.61
|
| Rate for Payer: Cash Price |
$3,308.77
|
| Rate for Payer: Cofinity Commercial |
$3,887.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,308.77
|
| Rate for Payer: Healthscope Commercial |
$4,135.96
|
| Rate for Payer: Healthscope Whirlpool |
$4,011.88
|
| Rate for Payer: Mclaren Commercial |
$3,722.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,515.57
|
| Rate for Payer: Nomi Health Commercial |
$3,391.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,623.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,899.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,639.64
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
IP
|
$4,135.96
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,688.37 |
| Max. Negotiated Rate |
$4,135.96 |
| Rate for Payer: Aetna Commercial |
$3,722.36
|
| Rate for Payer: ASR ASR |
$4,011.88
|
| Rate for Payer: ASR Commercial |
$4,011.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,370.39
|
| Rate for Payer: BCN Commercial |
$3,206.61
|
| Rate for Payer: Cash Price |
$3,308.77
|
| Rate for Payer: Cofinity Commercial |
$3,887.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,308.77
|
| Rate for Payer: Healthscope Commercial |
$4,135.96
|
| Rate for Payer: Healthscope Whirlpool |
$4,011.88
|
| Rate for Payer: Mclaren Commercial |
$3,722.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,515.57
|
| Rate for Payer: Nomi Health Commercial |
$3,391.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,639.64
|
|
|
HC CERETEC PER DOSE
|
Facility
|
IP
|
$2,060.99
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,339.64 |
| Max. Negotiated Rate |
$2,060.99 |
| Rate for Payer: Aetna Commercial |
$1,854.89
|
| Rate for Payer: ASR ASR |
$1,999.16
|
| Rate for Payer: ASR Commercial |
$1,999.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.50
|
| Rate for Payer: BCN Commercial |
$1,597.89
|
| Rate for Payer: Cash Price |
$1,648.79
|
| Rate for Payer: Cofinity Commercial |
$1,937.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,648.79
|
| Rate for Payer: Healthscope Commercial |
$2,060.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,999.16
|
| Rate for Payer: Mclaren Commercial |
$1,854.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,751.84
|
| Rate for Payer: Nomi Health Commercial |
$1,690.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,813.67
|
|
|
HC CERETEC PER DOSE
|
Facility
|
OP
|
$2,060.99
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$2,196.03 |
| Rate for Payer: Aetna Commercial |
$1,854.89
|
| Rate for Payer: Aetna Medicare |
$802.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,002.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,002.92
|
| Rate for Payer: ASR ASR |
$1,999.16
|
| Rate for Payer: ASR Commercial |
$1,999.16
|
| Rate for Payer: BCBS Complete |
$451.56
|
| Rate for Payer: BCBS MAPPO |
$802.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,687.74
|
| Rate for Payer: BCN Commercial |
$1,597.89
|
| Rate for Payer: BCN Medicare Advantage |
$802.34
|
| Rate for Payer: Cash Price |
$1,648.79
|
| Rate for Payer: Cash Price |
$1,648.79
|
| Rate for Payer: Cofinity Commercial |
$1,937.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,648.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.34
|
| Rate for Payer: Healthscope Commercial |
$2,060.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,999.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$802.34
|
| Rate for Payer: Mclaren Commercial |
$1,854.89
|
| Rate for Payer: Mclaren Medicaid |
$430.05
|
| Rate for Payer: Mclaren Medicare |
$802.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$842.46
|
| Rate for Payer: Meridian Medicaid |
$451.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$922.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,751.84
|
| Rate for Payer: Nomi Health Commercial |
$1,690.01
|
| Rate for Payer: PACE Medicare |
$762.22
|
| Rate for Payer: PACE SWMI |
$802.34
|
| Rate for Payer: PHP Commercial |
$882.57
|
| Rate for Payer: PHP Medicaid |
$430.05
|
| Rate for Payer: PHP Medicare Advantage |
$802.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,196.03
|
| Rate for Payer: Priority Health Medicare |
$802.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,756.82
|
| Rate for Payer: Railroad Medicare Medicare |
$802.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,813.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$802.34
|
| Rate for Payer: UHC Exchange |
$1,243.63
|
| Rate for Payer: UHC Medicare Advantage |
$802.34
|
| Rate for Payer: UHCCP DNSP |
$802.34
|
| Rate for Payer: UHCCP Medicaid |
$430.05
|
| Rate for Payer: VA VA |
$802.34
|
|
|
HC CERTOLIZUMAB
|
Facility
|
OP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$161.27
|
| Rate for Payer: ASR Commercial |
$161.27
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$136.15
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$166.26
|
| Rate for Payer: Healthscope Whirlpool |
$161.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$149.63
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC CERTOLIZUMAB
|
Facility
|
IP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Aetna Commercial |
$149.63
|
| Rate for Payer: ASR ASR |
$161.27
|
| Rate for Payer: ASR Commercial |
$161.27
|
| Rate for Payer: BCBS Trust/PPO |
$135.49
|
| Rate for Payer: BCN Commercial |
$128.90
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Healthscope Commercial |
$166.26
|
| Rate for Payer: Healthscope Whirlpool |
$161.27
|
| Rate for Payer: Mclaren Commercial |
$149.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.31
|
|
