|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: Aetna Medicare |
$20.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.19
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$11.34
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.15
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| Rate for Payer: Mclaren Medicare |
$20.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.16
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Medicare |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PHP Commercial |
$22.16
|
| Rate for Payer: PHP Medicaid |
$10.80
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.82
|
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Priority Health Narrow Network |
$20.66
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.15
|
| Rate for Payer: UHC Exchange |
$31.23
|
| Rate for Payer: UHC Medicare Advantage |
$20.15
|
| Rate for Payer: UHCCP DNSP |
$20.15
|
| Rate for Payer: UHCCP Medicaid |
$10.80
|
| Rate for Payer: VA VA |
$20.15
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$501.17
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.23
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$429.01
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.82 |
| Max. Negotiated Rate |
$635.11 |
| Rate for Payer: Aetna Commercial |
$571.60
|
| Rate for Payer: ASR ASR |
$616.06
|
| Rate for Payer: ASR Commercial |
$616.06
|
| Rate for Payer: BCBS Trust/PPO |
$517.55
|
| Rate for Payer: BCN Commercial |
$492.40
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$597.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$635.11
|
| Rate for Payer: Healthscope Whirlpool |
$616.06
|
| Rate for Payer: Mclaren Commercial |
$571.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$520.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.90
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$635.11 |
| Rate for Payer: Aetna Commercial |
$571.60
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$616.06
|
| Rate for Payer: ASR Commercial |
$616.06
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$520.09
|
| Rate for Payer: BCN Commercial |
$492.40
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$597.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$635.11
|
| Rate for Payer: Healthscope Whirlpool |
$616.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$571.60
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$520.79
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.82 |
| Max. Negotiated Rate |
$635.11 |
| Rate for Payer: Aetna Commercial |
$571.60
|
| Rate for Payer: ASR ASR |
$616.06
|
| Rate for Payer: ASR Commercial |
$616.06
|
| Rate for Payer: BCBS Trust/PPO |
$517.55
|
| Rate for Payer: BCN Commercial |
$492.40
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$597.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$635.11
|
| Rate for Payer: Healthscope Whirlpool |
$616.06
|
| Rate for Payer: Mclaren Commercial |
$571.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$520.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.90
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$635.11 |
| Rate for Payer: Aetna Commercial |
$571.60
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$616.06
|
| Rate for Payer: ASR Commercial |
$616.06
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$520.09
|
| Rate for Payer: BCN Commercial |
$492.40
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$597.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$635.11
|
| Rate for Payer: Healthscope Whirlpool |
$616.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$571.60
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$520.79
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.48
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$445.21
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
OP
|
$328.51
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$295.66
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$318.65
|
| Rate for Payer: ASR Commercial |
$318.65
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$269.02
|
| Rate for Payer: BCN Commercial |
$254.69
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$262.81
|
| Rate for Payer: Cash Price |
$262.81
|
| Rate for Payer: Cofinity Commercial |
$308.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$328.51
|
| Rate for Payer: Healthscope Whirlpool |
$318.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$295.66
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.23
|
| Rate for Payer: Nomi Health Commercial |
$269.38
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.84
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$230.29
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
IP
|
$328.51
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.53 |
| Max. Negotiated Rate |
$328.51 |
| Rate for Payer: Aetna Commercial |
$295.66
|
| Rate for Payer: ASR ASR |
$318.65
|
| Rate for Payer: ASR Commercial |
$318.65
|
| Rate for Payer: BCBS Trust/PPO |
$267.70
|
| Rate for Payer: BCN Commercial |
$254.69
|
| Rate for Payer: Cash Price |
$262.81
|
| Rate for Payer: Cofinity Commercial |
$308.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.81
|
| Rate for Payer: Healthscope Commercial |
$328.51
|
| Rate for Payer: Healthscope Whirlpool |
$318.65
|
| Rate for Payer: Mclaren Commercial |
$295.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.23
|
| Rate for Payer: Nomi Health Commercial |
$269.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.09
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$501.17
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.23
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$429.01
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
|
|
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: ASR ASR |
$645.05
|
| Rate for Payer: ASR Commercial |
$645.05
|
| Rate for Payer: BCBS Trust/PPO |
$541.91
|
| Rate for Payer: BCN Commercial |
$515.57
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.00
|
| Rate for Payer: Healthscope Commercial |
$665.00
|
| Rate for Payer: Healthscope Whirlpool |
$645.05
|
| Rate for Payer: Mclaren Commercial |
$598.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.25
|
| Rate for Payer: Nomi Health Commercial |
$545.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$585.20
|
|
|
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$645.05
|
| Rate for Payer: ASR Commercial |
$645.05
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$544.57
|
| Rate for Payer: BCN Commercial |
$515.57
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$665.00
|
| Rate for Payer: Healthscope Whirlpool |
$645.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$598.50
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.25
|
| Rate for Payer: Nomi Health Commercial |
$545.30
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$585.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
OP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.41 |
| Max. Negotiated Rate |
$211.92 |
| Rate for Payer: Aetna Commercial |
$126.93
|
| Rate for Payer: Aetna Medicare |
$70.52
|
| Rate for Payer: ASR ASR |
$136.80
|
| Rate for Payer: ASR Commercial |
$136.80
|
| Rate for Payer: BCBS Complete |
$56.41
|
| Rate for Payer: BCBS Trust/PPO |
$115.49
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$109.34
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Commercial |
$132.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.82
|
| Rate for Payer: Healthscope Commercial |
$141.03
|
| Rate for Payer: Healthscope Whirlpool |
$136.80
|
| Rate for Payer: Mclaren Commercial |
$126.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.88
|
| Rate for Payer: Nomi Health Commercial |
$115.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.92
|
| Rate for Payer: Priority Health Narrow Network |
$169.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.11
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
IP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.67 |
| Max. Negotiated Rate |
$141.03 |
| Rate for Payer: Aetna Commercial |
$126.93
|
| Rate for Payer: ASR ASR |
$136.80
|
| Rate for Payer: ASR Commercial |
$136.80
|
| Rate for Payer: BCBS Trust/PPO |
$114.93
|
| Rate for Payer: BCN Commercial |
$109.34
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Commercial |
$132.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.82
|
| Rate for Payer: Healthscope Commercial |
$141.03
|
| Rate for Payer: Healthscope Whirlpool |
$136.80
|
| Rate for Payer: Mclaren Commercial |
$126.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.88
|
| Rate for Payer: Nomi Health Commercial |
$115.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.11
|
|
|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$80.52
|
| Rate for Payer: ASR ASR |
$86.79
|
| Rate for Payer: ASR Commercial |
$86.79
|
| Rate for Payer: BCBS Trust/PPO |
$72.91
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$89.47
|
| Rate for Payer: Healthscope Whirlpool |
$86.79
|
| Rate for Payer: Mclaren Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.73
|
|
|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$80.52
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$86.79
|
| Rate for Payer: ASR Commercial |
$86.79
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$73.27
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$89.47
|
| Rate for Payer: Healthscope Whirlpool |
$86.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$80.52
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.39
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$62.72
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC CMV DNA PCR QUANTITATIVE
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
30600152
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$503.98 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$168.20
|
| Rate for Payer: ASR Commercial |
$168.20
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$142.00
|
| Rate for Payer: BCN Commercial |
$134.44
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$173.40
|
| Rate for Payer: Healthscope Whirlpool |
$168.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: Nomi Health Commercial |
$142.19
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$47.12
|
| Rate for Payer: PHP Medicaid |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$503.98
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$403.18
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.96
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC CMV DNA PCR QUANTITATIVE
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
30600152
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$112.71 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: ASR ASR |
$168.20
|
| Rate for Payer: ASR Commercial |
$168.20
|
| Rate for Payer: BCBS Trust/PPO |
$141.30
|
| Rate for Payer: BCN Commercial |
$134.44
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$173.40
|
| Rate for Payer: Healthscope Whirlpool |
$168.20
|
| Rate for Payer: Mclaren Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: Nomi Health Commercial |
$142.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.59
|
|
|
HC COAGULATION INTERPRETATION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
30500075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC COAGULATION INTERPRETATION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
30500075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.35
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: BCBS MAPPO |
$15.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$15.48
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.48
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$8.30
|
| Rate for Payer: Mclaren Medicare |
$15.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.25
|
| Rate for Payer: Meridian Medicaid |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PACE Medicare |
$14.71
|
| Rate for Payer: PACE SWMI |
$15.48
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Medicaid |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Medicare |
$15.48
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: Railroad Medicare Medicare |
$15.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.48
|
| Rate for Payer: UHC Exchange |
$23.99
|
| Rate for Payer: UHC Medicare Advantage |
$15.48
|
| Rate for Payer: UHCCP DNSP |
$15.48
|
| Rate for Payer: UHCCP Medicaid |
$8.30
|
| Rate for Payer: VA VA |
$15.48
|
|
|
HC COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$76.63
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Aetna Commercial |
$68.97
|
| Rate for Payer: ASR ASR |
$74.33
|
| Rate for Payer: ASR Commercial |
$74.33
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$59.41
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cofinity Commercial |
$72.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.30
|
| Rate for Payer: Healthscope Commercial |
$76.63
|
| Rate for Payer: Healthscope Whirlpool |
$74.33
|
| Rate for Payer: Mclaren Commercial |
$68.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.14
|
| Rate for Payer: Nomi Health Commercial |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.43
|
|
|
HC COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$76.63
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Aetna Commercial |
$68.97
|
| Rate for Payer: Aetna Medicare |
$4.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: ASR ASR |
$74.33
|
| Rate for Payer: ASR Commercial |
$74.33
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$62.75
|
| Rate for Payer: BCN Commercial |
$59.41
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cofinity Commercial |
$72.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$76.63
|
| Rate for Payer: Healthscope Whirlpool |
$74.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.28
|
| Rate for Payer: Mclaren Commercial |
$68.97
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.14
|
| Rate for Payer: Nomi Health Commercial |
$62.84
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.14
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$53.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Exchange |
$6.63
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP DNSP |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.28
|
|
|
HC COBALT SERUM
|
Facility
|
OP
|
$88.74
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
30100639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$155.91 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna Medicare |
$21.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.45
|
| Rate for Payer: ASR ASR |
$86.08
|
| Rate for Payer: ASR Commercial |
$86.08
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS MAPPO |
$21.96
|
| Rate for Payer: BCBS Trust/PPO |
$72.67
|
| Rate for Payer: BCN Commercial |
$68.80
|
| Rate for Payer: BCN Medicare Advantage |
$21.96
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.96
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.96
|
| Rate for Payer: Mclaren Commercial |
$79.87
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Mclaren Medicare |
$21.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.06
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: PACE Medicare |
$20.86
|
| Rate for Payer: PACE SWMI |
$21.96
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Medicaid |
$11.77
|
| Rate for Payer: PHP Medicare Advantage |
$21.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.91
|
| Rate for Payer: Priority Health Medicare |
$21.96
|
| Rate for Payer: Priority Health Narrow Network |
$124.73
|
| Rate for Payer: Railroad Medicare Medicare |
$21.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.96
|
| Rate for Payer: UHC Exchange |
$34.04
|
| Rate for Payer: UHC Medicare Advantage |
$21.96
|
| Rate for Payer: UHCCP DNSP |
$21.96
|
| Rate for Payer: UHCCP Medicaid |
$11.77
|
| Rate for Payer: VA VA |
$21.96
|
|
