|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$213.98
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.01
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$79.21
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$213.98
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOT BIOPSY
|
Facility
|
OP
|
$479.16
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.66 |
| Max. Negotiated Rate |
$479.16 |
| Rate for Payer: Aetna Commercial |
$431.24
|
| Rate for Payer: ASR ASR |
$464.79
|
| Rate for Payer: BCBS Complete |
$191.66
|
| Rate for Payer: BCBS Trust/PPO |
$371.49
|
| Rate for Payer: BCN Commercial |
$371.49
|
| Rate for Payer: Cash Price |
$383.33
|
| Rate for Payer: Cofinity Commercial |
$450.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.33
|
| Rate for Payer: Healthscope Commercial |
$479.16
|
| Rate for Payer: Healthscope Whirlpool |
$464.79
|
| Rate for Payer: Mclaren Commercial |
$431.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.04
|
| Rate for Payer: Priority Health Narrow Network |
$340.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.66
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$479.16
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$335.41 |
| Max. Negotiated Rate |
$479.16 |
| Rate for Payer: Aetna Commercial |
$431.24
|
| Rate for Payer: ASR ASR |
$464.79
|
| Rate for Payer: BCBS Trust/PPO |
$371.49
|
| Rate for Payer: BCN Commercial |
$371.49
|
| Rate for Payer: Cash Price |
$383.33
|
| Rate for Payer: Cofinity Commercial |
$450.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.33
|
| Rate for Payer: Healthscope Commercial |
$479.16
|
| Rate for Payer: Healthscope Whirlpool |
$464.79
|
| Rate for Payer: Mclaren Commercial |
$431.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.66
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
OP
|
$189.72
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$189.72 |
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: ASR ASR |
$184.03
|
| Rate for Payer: BCBS Complete |
$75.89
|
| Rate for Payer: BCBS Trust/PPO |
$147.09
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cofinity Commercial |
$178.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.78
|
| Rate for Payer: Healthscope Commercial |
$189.72
|
| Rate for Payer: Healthscope Whirlpool |
$184.03
|
| Rate for Payer: Mclaren Commercial |
$170.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.65
|
| Rate for Payer: Priority Health Narrow Network |
$134.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.95
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
IP
|
$189.72
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$189.72 |
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: ASR ASR |
$184.03
|
| Rate for Payer: BCBS Trust/PPO |
$147.09
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cofinity Commercial |
$178.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.78
|
| Rate for Payer: Healthscope Commercial |
$189.72
|
| Rate for Payer: Healthscope Whirlpool |
$184.03
|
| Rate for Payer: Mclaren Commercial |
$170.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.95
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
OP
|
$208.69
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.48 |
| Max. Negotiated Rate |
$208.69 |
| Rate for Payer: Aetna Commercial |
$187.82
|
| Rate for Payer: ASR ASR |
$202.43
|
| Rate for Payer: BCBS Complete |
$83.48
|
| Rate for Payer: BCBS Trust/PPO |
$161.80
|
| Rate for Payer: BCN Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cofinity Commercial |
$196.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.95
|
| Rate for Payer: Healthscope Commercial |
$208.69
|
| Rate for Payer: Healthscope Whirlpool |
$202.43
|
| Rate for Payer: Mclaren Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.91
|
| Rate for Payer: Priority Health Narrow Network |
$148.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.65
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
IP
|
$208.69
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.08 |
| Max. Negotiated Rate |
$208.69 |
| Rate for Payer: Aetna Commercial |
$187.82
|
| Rate for Payer: ASR ASR |
$202.43
|
| Rate for Payer: BCBS Trust/PPO |
$161.80
|
| Rate for Payer: BCN Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cofinity Commercial |
$196.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.95
|
| Rate for Payer: Healthscope Commercial |
$208.69
|
| Rate for Payer: Healthscope Whirlpool |
$202.43
|
| Rate for Payer: Mclaren Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.65
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
OP
|
$117.90
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$142.64 |
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: Aetna Medicare |
$14.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.98
|
| Rate for Payer: ASR ASR |
$114.36
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS MAPPO |
$14.38
|
| Rate for Payer: BCBS Trust/PPO |
$91.41
|
| Rate for Payer: BCN Commercial |
$91.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$110.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$117.90
|
| Rate for Payer: Healthscope Whirlpool |
$114.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.38
|
| Rate for Payer: Mclaren Commercial |
$106.11
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.38
|
| Rate for Payer: Meridian Medicaid |
$8.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: PACE Medicare |
$13.66
|
| Rate for Payer: PACE SWMI |
$14.38
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: PHP Medicaid |
$7.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.64
|
| Rate for Payer: Priority Health Medicare |
$14.38
|
| Rate for Payer: Priority Health Narrow Network |
$114.11
|
| Rate for Payer: Railroad Medicare Medicare |
$14.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.75
|
| Rate for Payer: UHC Medicare Advantage |
$14.81
|
| Rate for Payer: VA VA |
$14.38
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
IP
|
$117.90
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.53 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: ASR ASR |
$114.36
|
| Rate for Payer: BCBS Trust/PPO |
$91.41
|
| Rate for Payer: BCN Commercial |
$91.41
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$110.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Healthscope Commercial |
$117.90
|
| Rate for Payer: Healthscope Whirlpool |
$114.36
|
| Rate for Payer: Mclaren Commercial |
$106.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.75
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$64.16 |
| Rate for Payer: Aetna Commercial |
$57.74
|
| 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 |
$62.24
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$49.74
|
| Rate for Payer: BCN Commercial |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$60.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$64.16
|
| Rate for Payer: Healthscope Whirlpool |
$62.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$57.74
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| 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 |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.39
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$45.55
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.46
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$64.16 |
| Rate for Payer: Aetna Commercial |
$57.74
|
| Rate for Payer: ASR ASR |
$62.24
|
| Rate for Payer: BCBS Trust/PPO |
$49.74
|
| Rate for Payer: BCN Commercial |
$49.74
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$60.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Healthscope Commercial |
$64.16
|
| Rate for Payer: Healthscope Whirlpool |
$62.24
|
| Rate for Payer: Mclaren Commercial |
$57.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.46
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$64.16 |
| Rate for Payer: Aetna Commercial |
$57.74
|
| 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 |
$62.24
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$49.74
|
| Rate for Payer: BCN Commercial |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$60.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$64.16
|
| Rate for Payer: Healthscope Whirlpool |
$62.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$57.74
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| 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 |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.39
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$45.55
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.46
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$64.16 |
| Rate for Payer: Aetna Commercial |
$57.74
|
| Rate for Payer: ASR ASR |
$62.24
|
| Rate for Payer: BCBS Trust/PPO |
$49.74
|
| Rate for Payer: BCN Commercial |
$49.74
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$60.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Healthscope Commercial |
$64.16
|
| Rate for Payer: Healthscope Whirlpool |
$62.24
|
| Rate for Payer: Mclaren Commercial |
$57.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.46
|
|
|
HC H PYLORI W SUSCEPTIBILITIES
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
30600333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
|
|
HC H PYLORI W SUSCEPTIBILITIES
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
30600333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$125.19 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.29
|
| Rate for Payer: ASR ASR |
$87.69
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: BCN Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.63
|
| Rate for Payer: Healthscope Commercial |
$90.40
|
| Rate for Payer: Healthscope Whirlpool |
$87.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.63
|
| Rate for Payer: Mclaren Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$3.63
|
| Rate for Payer: Mclaren Medicare |
$6.63
|
| Rate for Payer: Meridian Medicaid |
$3.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$6.30
|
| Rate for Payer: PACE SWMI |
$6.63
|
| Rate for Payer: PHP Commercial |
$7.29
|
| Rate for Payer: PHP Medicaid |
$3.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.19
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Narrow Network |
$100.15
|
| Rate for Payer: Railroad Medicare Medicare |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.83
|
| Rate for Payer: VA VA |
$6.63
|
|
|
HC HSV 1 IGM TITER
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$51.40
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
HC HSV 1 IGM TITER
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$51.40
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$24.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC HSV 2 IGM TITER
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$51.40
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
HC HSV 2 IGM TITER
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$51.40
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.70
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$53.36
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HSV AB IGM BY IFA
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200279
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC HSV AB IGM BY IFA
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200279
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC HSV CULTURE, NEONATE
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$128.27 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$19.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.45
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.40
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$19.56
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.56
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$10.70
|
| Rate for Payer: Mclaren Medicare |
$19.56
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Medicare |
$18.58
|
| Rate for Payer: PACE SWMI |
$19.56
|
| Rate for Payer: PHP Commercial |
$21.52
|
| Rate for Payer: PHP Medicaid |
$10.70
|
| Rate for Payer: PHP Medicare Advantage |
$19.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$19.56
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Railroad Medicare Medicare |
$19.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Medicare Advantage |
$20.15
|
| Rate for Payer: VA VA |
$19.56
|
|
|
HC HSV CULTURE, NEONATE
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$51.40
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
HC HSV CULTURE, NEONATE CMPT
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
