|
HC CREATE TEAR SAC DRAIN
|
Facility
|
OP
|
$5,261.47
|
|
|
Service Code
|
CPT 68720
|
| Hospital Charge Code |
76100308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,048.73 |
| Max. Negotiated Rate |
$6,071.75 |
| Rate for Payer: Aetna Commercial |
$4,735.32
|
| Rate for Payer: Aetna Medicare |
$3,917.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,896.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,896.57
|
| Rate for Payer: ASR ASR |
$5,103.63
|
| Rate for Payer: BCBS Complete |
$2,151.36
|
| Rate for Payer: BCBS MAPPO |
$3,917.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,338.08
|
| Rate for Payer: BCN Commercial |
$4,338.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,917.26
|
| Rate for Payer: Cash Price |
$4,209.18
|
| Rate for Payer: Cash Price |
$4,209.18
|
| Rate for Payer: Cofinity Commercial |
$4,945.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,209.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,917.26
|
| Rate for Payer: Healthscope Commercial |
$5,103.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,261.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,917.26
|
| Rate for Payer: Mclaren Commercial |
$4,735.32
|
| Rate for Payer: Mclaren Medicaid |
$3,917.26
|
| Rate for Payer: Mclaren Medicare |
$3,917.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,113.12
|
| Rate for Payer: Meridian Medicaid |
$2,151.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,504.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,308.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,472.25
|
| Rate for Payer: Nomi Health Commercial |
$4,314.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,946.10
|
| Rate for Payer: PACE Medicare |
$3,721.40
|
| Rate for Payer: PACE SWMI |
$3,917.26
|
| Rate for Payer: PHP Commercial |
$4,308.99
|
| Rate for Payer: PHP Medicaid |
$2,099.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,917.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,048.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,610.10
|
| Rate for Payer: Priority Health Medicare |
$3,917.26
|
| Rate for Payer: Priority Health Narrow Network |
$3,688.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3,917.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,630.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,917.26
|
| Rate for Payer: UHC Exchange |
$6,071.75
|
| Rate for Payer: UHC Medicaid |
$2,048.73
|
| Rate for Payer: UHCCP DNSP |
$3,917.26
|
| Rate for Payer: UHCCP Medicaid |
$2,048.73
|
| Rate for Payer: VA VA |
$3,917.26
|
|
|
HC CREATE TEAR SAC DRAIN
|
Facility
|
IP
|
$5,261.47
|
|
|
Service Code
|
CPT 68720
|
| Hospital Charge Code |
76100308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,946.10 |
| Max. Negotiated Rate |
$5,261.47 |
| Rate for Payer: Aetna Commercial |
$4,735.32
|
| Rate for Payer: ASR ASR |
$5,103.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,320.72
|
| Rate for Payer: BCN Commercial |
$4,320.72
|
| Rate for Payer: Cash Price |
$4,209.18
|
| Rate for Payer: Cofinity Commercial |
$4,945.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,209.18
|
| Rate for Payer: Healthscope Commercial |
$5,103.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,261.47
|
| Rate for Payer: Mclaren Commercial |
$4,735.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,472.25
|
| Rate for Payer: Nomi Health Commercial |
$4,314.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,946.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,630.09
|
|
|
HC CREATININE CLEARANCE
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
30100182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$64.42
|
| Rate for Payer: BCN Commercial |
$64.42
|
| 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 |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| 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: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC CREATININE CLEARANCE
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
30100182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.82
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS MAPPO |
$9.46
|
| Rate for Payer: BCBS Trust/PPO |
$64.68
|
| Rate for Payer: BCN Commercial |
$64.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.46
|
| 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 |
$9.46
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.46
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$9.46
|
| Rate for Payer: Mclaren Medicare |
$9.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.93
|
| Rate for Payer: Meridian Medicaid |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$8.99
|
| Rate for Payer: PACE SWMI |
$9.46
|
| Rate for Payer: PHP Commercial |
$10.41
|
| Rate for Payer: PHP Medicaid |
$5.07
|
| Rate for Payer: PHP Medicare Advantage |
$9.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health Narrow Network |
$29.05
|
| Rate for Payer: Railroad Medicare Medicare |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.46
|
| Rate for Payer: UHC Exchange |
$14.66
|
| Rate for Payer: UHC Medicaid |
$4.95
|
| Rate for Payer: UHCCP DNSP |
$9.46
|
| Rate for Payer: UHCCP Medicaid |
$4.95
|
| Rate for Payer: VA VA |
$9.46
|
|
|
HC CREATININE SERUM
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.12
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$5.12
|
| Rate for Payer: Mclaren Medicare |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: Meridian Medicaid |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.63
|
| Rate for Payer: PHP Medicaid |
$2.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.25
|
| Rate for Payer: Priority Health Medicare |
$5.12
|
| Rate for Payer: Priority Health Narrow Network |
$21.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.12
|
| Rate for Payer: UHC Exchange |
$7.94
|
| Rate for Payer: UHC Medicaid |
$2.68
|
| Rate for Payer: UHCCP DNSP |
$5.12
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$5.12
|
|
|
HC CREATININE SERUM
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC CREATININE URINE/OTHER SOURCE
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$32.51
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CREATININE URINE/OTHER SOURCE
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.57 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: Aetna Commercial |
$35.49
|
| Rate for Payer: ASR ASR |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$39.43
|
| Rate for Payer: Mclaren Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.70
|
|
|
HC CREATININE, WHOLE BLOOD
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.12
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$5.12
|
| Rate for Payer: Mclaren Medicare |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: Meridian Medicaid |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PACE Medicare |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.63
|
| Rate for Payer: PHP Medicaid |
$2.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.25
|
| Rate for Payer: Priority Health Medicare |
$5.12
|
| Rate for Payer: Priority Health Narrow Network |
$21.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.12
|
| Rate for Payer: UHC Exchange |
$7.94
|
| Rate for Payer: UHC Medicaid |
$2.68
|
| Rate for Payer: UHCCP DNSP |
$5.12
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$5.12
|
|
|
HC CREATININE, WHOLE BLOOD
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC CRITIC AID 6.5 OZ
|
Facility
|
IP
|
$40.79
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$40.79 |
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: ASR ASR |
$39.57
|
| Rate for Payer: BCBS Trust/PPO |
$33.50
|
| Rate for Payer: BCN Commercial |
$33.50
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Cofinity Commercial |
$38.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.63
|
| Rate for Payer: Healthscope Commercial |
$39.57
|
| Rate for Payer: Healthscope Whirlpool |
$40.79
|
| Rate for Payer: Mclaren Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.67
|
| Rate for Payer: Nomi Health Commercial |
$33.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC CRITIC AID 6.5 OZ
|
Facility
|
OP
|
$40.79
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$40.79 |
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Medicare |
$15.09
|
| Rate for Payer: ASR ASR |
$39.57
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$33.63
|
| Rate for Payer: BCN Commercial |
$33.63
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Cofinity Commercial |
$38.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.63
|
| Rate for Payer: Healthscope Commercial |
$39.57
|
| Rate for Payer: Healthscope Whirlpool |
$40.79
|
| Rate for Payer: Mclaren Commercial |
$36.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.67
|
| Rate for Payer: Nomi Health Commercial |
$33.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.74
|
| Rate for Payer: Priority Health Narrow Network |
$28.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC CRITICAL CARE R&B
|
Facility
|
IP
|
$6,464.21
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,848.16 |
| Max. Negotiated Rate |
$6,464.21 |
| Rate for Payer: Aetna Commercial |
$5,817.79
|
| Rate for Payer: ASR ASR |
$6,270.28
|
| Rate for Payer: BCBS Trust/PPO |
$5,308.41
|
| Rate for Payer: BCN Commercial |
$5,308.41
|
| Rate for Payer: Cash Price |
$5,171.37
|
| Rate for Payer: Cofinity Commercial |
$6,076.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,171.37
|
| Rate for Payer: Healthscope Commercial |
$6,270.28
|
| Rate for Payer: Healthscope Whirlpool |
$6,464.21
|
| Rate for Payer: Mclaren Commercial |
$5,817.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,494.58
|
| Rate for Payer: Nomi Health Commercial |
$5,300.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,848.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,688.50
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
OP
|
$163.34
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$163.34 |
| Rate for Payer: Aetna Commercial |
$147.01
|
| Rate for Payer: Aetna Medicare |
$29.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: ASR ASR |
$158.44
|
| Rate for Payer: BCBS Complete |
$16.04
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$134.67
|
| Rate for Payer: BCN Commercial |
$134.67
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$158.44
|
| Rate for Payer: Healthscope Whirlpool |
$163.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.21
|
| Rate for Payer: Mclaren Commercial |
$147.01
|
| Rate for Payer: Mclaren Medicaid |
$29.21
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Meridian Medicaid |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.84
|
| Rate for Payer: Nomi Health Commercial |
$133.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.50
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$32.13
|
| Rate for Payer: PHP Medicaid |
$15.66
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.12
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health Narrow Network |
$114.50
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.21
|
| Rate for Payer: UHC Exchange |
$45.28
|
| Rate for Payer: UHC Medicaid |
$15.28
|
| Rate for Payer: UHCCP DNSP |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$15.28
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
IP
|
$163.34
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$163.34 |
| Rate for Payer: Aetna Commercial |
$147.01
|
| Rate for Payer: ASR ASR |
$158.44
|
| Rate for Payer: BCBS Trust/PPO |
$134.13
|
| Rate for Payer: BCN Commercial |
$134.13
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.67
|
| Rate for Payer: Healthscope Commercial |
$158.44
|
| Rate for Payer: Healthscope Whirlpool |
$163.34
|
| Rate for Payer: Mclaren Commercial |
$147.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.84
|
| Rate for Payer: Nomi Health Commercial |
$133.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.74
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
OP
|
$161.26
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Aetna Commercial |
$145.13
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$156.42
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$132.96
|
| Rate for Payer: BCN Commercial |
$132.96
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$156.42
|
| Rate for Payer: Healthscope Whirlpool |
$161.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$145.13
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Nomi Health Commercial |
$132.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.06
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$170.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
IP
|
$161.26
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$161.26 |
| Rate for Payer: Aetna Commercial |
$145.13
|
| Rate for Payer: ASR ASR |
$156.42
|
| Rate for Payer: BCBS Trust/PPO |
$132.43
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Healthscope Commercial |
$156.42
|
| Rate for Payer: Healthscope Whirlpool |
$161.26
|
| Rate for Payer: Mclaren Commercial |
$145.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Nomi Health Commercial |
$132.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.91
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
IP
|
$188.31
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$141.23 |
| Max. Negotiated Rate |
$188.31 |
| Rate for Payer: Aetna Commercial |
$169.48
|
| Rate for Payer: ASR ASR |
$182.66
|
| Rate for Payer: BCBS Trust/PPO |
$154.64
|
| Rate for Payer: BCN Commercial |
$154.64
|
| Rate for Payer: Cash Price |
$150.65
|
| Rate for Payer: Cofinity Commercial |
$177.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.65
|
| Rate for Payer: Healthscope Commercial |
$182.66
|
| Rate for Payer: Healthscope Whirlpool |
$188.31
|
| Rate for Payer: Mclaren Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.06
|
| Rate for Payer: Nomi Health Commercial |
$154.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.71
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
OP
|
$188.31
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$169.48
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$182.66
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$155.26
|
| Rate for Payer: BCN Commercial |
$155.26
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$150.65
|
| Rate for Payer: Cash Price |
$150.65
|
| Rate for Payer: Cofinity Commercial |
$177.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$182.66
|
| Rate for Payer: Healthscope Whirlpool |
$188.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$169.48
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.06
|
| Rate for Payer: Nomi Health Commercial |
$154.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.23
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.13
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$48.90
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.79
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$44.63
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
IP
|
$93.71
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$93.71 |
| Rate for Payer: Aetna Commercial |
$84.34
|
| Rate for Payer: ASR ASR |
$90.90
|
| Rate for Payer: BCBS Trust/PPO |
$76.95
|
| Rate for Payer: BCN Commercial |
$76.95
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$88.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.71
|
| Rate for Payer: Mclaren Commercial |
$84.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$76.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.46
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
OP
|
$93.71
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$84.34
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$90.90
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$77.26
|
| Rate for Payer: BCN Commercial |
$77.26
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$88.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$84.34
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$76.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.04
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$96.84
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
IP
|
$237.73
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$178.30 |
| Max. Negotiated Rate |
$237.73 |
| Rate for Payer: Aetna Commercial |
$213.96
|
| Rate for Payer: ASR ASR |
$230.60
|
| Rate for Payer: BCBS Trust/PPO |
$195.22
|
| Rate for Payer: BCN Commercial |
$195.22
|
| Rate for Payer: Cash Price |
$190.18
|
| Rate for Payer: Cofinity Commercial |
$223.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.18
|
| Rate for Payer: Healthscope Commercial |
$230.60
|
| Rate for Payer: Healthscope Whirlpool |
$237.73
|
| Rate for Payer: Mclaren Commercial |
$213.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.07
|
| Rate for Payer: Nomi Health Commercial |
$194.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.20
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
OP
|
$237.73
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$213.96
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$230.60
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$196.01
|
| Rate for Payer: BCN Commercial |
$196.01
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$190.18
|
| Rate for Payer: Cash Price |
$190.18
|
| Rate for Payer: Cofinity Commercial |
$223.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$230.60
|
| Rate for Payer: Healthscope Whirlpool |
$237.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$213.96
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.07
|
| Rate for Payer: Nomi Health Commercial |
$194.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.30
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$208.30
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$166.65
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
