|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.26
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$11.59
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
| Rate for Payer: UHC Medicare Advantage |
$8.01
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$49.25 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$5.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$15.91 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: PHP Medicaid |
$2.71
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$12.73
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.10
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$439.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$161.10 |
| Max. Negotiated Rate |
$439.22 |
| Rate for Payer: Aetna Commercial |
$395.30
|
| Rate for Payer: Aetna Medicare |
$294.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.15
|
| Rate for Payer: ASR ASR |
$426.04
|
| Rate for Payer: BCBS Complete |
$169.17
|
| Rate for Payer: BCBS MAPPO |
$294.52
|
| Rate for Payer: BCBS Trust/PPO |
$340.53
|
| Rate for Payer: BCN Commercial |
$340.53
|
| Rate for Payer: BCN Medicare Advantage |
$294.52
|
| Rate for Payer: Cash Price |
$351.38
|
| Rate for Payer: Cash Price |
$351.38
|
| Rate for Payer: Cofinity Commercial |
$412.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$439.22
|
| Rate for Payer: Healthscope Whirlpool |
$426.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$294.52
|
| Rate for Payer: Mclaren Commercial |
$395.30
|
| Rate for Payer: Mclaren Medicaid |
$161.10
|
| Rate for Payer: Mclaren Medicare |
$294.52
|
| Rate for Payer: Meridian Medicaid |
$169.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.34
|
| Rate for Payer: PACE Medicare |
$279.79
|
| Rate for Payer: PACE SWMI |
$294.52
|
| Rate for Payer: PHP Commercial |
$323.97
|
| Rate for Payer: PHP Medicaid |
$161.10
|
| Rate for Payer: PHP Medicare Advantage |
$294.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.32
|
| Rate for Payer: Priority Health Medicare |
$294.52
|
| Rate for Payer: Priority Health Narrow Network |
$200.26
|
| Rate for Payer: Railroad Medicare Medicare |
$294.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.51
|
| Rate for Payer: UHC Medicare Advantage |
$303.36
|
| Rate for Payer: VA VA |
$294.52
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$439.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$307.45 |
| Max. Negotiated Rate |
$439.22 |
| Rate for Payer: Aetna Commercial |
$395.30
|
| Rate for Payer: ASR ASR |
$426.04
|
| Rate for Payer: BCBS Trust/PPO |
$340.53
|
| Rate for Payer: BCN Commercial |
$340.53
|
| Rate for Payer: Cash Price |
$351.38
|
| Rate for Payer: Cofinity Commercial |
$412.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.38
|
| Rate for Payer: Healthscope Commercial |
$439.22
|
| Rate for Payer: Healthscope Whirlpool |
$426.04
|
| Rate for Payer: Mclaren Commercial |
$395.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.51
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,263.54
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$905.42 |
| Max. Negotiated Rate |
$2,263.54 |
| Rate for Payer: Aetna Commercial |
$2,037.19
|
| Rate for Payer: ASR ASR |
$2,195.63
|
| Rate for Payer: BCBS Complete |
$905.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,754.92
|
| Rate for Payer: BCN Commercial |
$1,754.92
|
| Rate for Payer: Cash Price |
$1,810.83
|
| Rate for Payer: Cofinity Commercial |
$2,127.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.83
|
| Rate for Payer: Healthscope Commercial |
$2,263.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,195.63
|
| Rate for Payer: Mclaren Commercial |
$2,037.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,924.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,059.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,607.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,991.92
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,263.54
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,584.48 |
| Max. Negotiated Rate |
$2,263.54 |
| Rate for Payer: Aetna Commercial |
$2,037.19
|
| Rate for Payer: ASR ASR |
$2,195.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,754.92
|
| Rate for Payer: BCN Commercial |
$1,754.92
|
| Rate for Payer: Cash Price |
$1,810.83
|
| Rate for Payer: Cofinity Commercial |
$2,127.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.83
|
| Rate for Payer: Healthscope Commercial |
$2,263.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,195.63
|
| Rate for Payer: Mclaren Commercial |
$2,037.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,924.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,991.92
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,701.70
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,080.68 |
| Max. Negotiated Rate |
$2,701.70 |
| Rate for Payer: Aetna Commercial |
$2,431.53
|
| Rate for Payer: ASR ASR |
$2,620.65
|
| Rate for Payer: BCBS Complete |
$1,080.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.63
|
| Rate for Payer: BCN Commercial |
$2,094.63
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,539.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Healthscope Commercial |
$2,701.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,620.65
|
| Rate for Payer: Mclaren Commercial |
$2,431.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,458.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,918.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,377.50
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,701.70
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,891.19 |
| Max. Negotiated Rate |
$2,701.70 |
| Rate for Payer: Aetna Commercial |
$2,431.53
|
| Rate for Payer: ASR ASR |
$2,620.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.63
|
| Rate for Payer: BCN Commercial |
$2,094.63
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,539.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Healthscope Commercial |
$2,701.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,620.65
|
| Rate for Payer: Mclaren Commercial |
$2,431.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,377.50
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$136.65
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$122.98
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$132.55
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$105.94
|
| Rate for Payer: BCN Commercial |
$105.94
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cofinity Commercial |
$128.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$136.65
|
| Rate for Payer: Healthscope Whirlpool |
$132.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$122.98
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.15
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.35
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$97.02
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.25
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$136.65
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.66 |
| Max. Negotiated Rate |
$136.65 |
| Rate for Payer: Aetna Commercial |
$122.98
|
| Rate for Payer: ASR ASR |
$132.55
|
| Rate for Payer: BCBS Trust/PPO |
$105.94
|
| Rate for Payer: BCN Commercial |
$105.94
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cofinity Commercial |
$128.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.32
|
| Rate for Payer: Healthscope Commercial |
$136.65
|
| Rate for Payer: Healthscope Whirlpool |
$132.55
|
| Rate for Payer: Mclaren Commercial |
$122.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.25
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$103.91
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.74 |
| Max. Negotiated Rate |
$103.91 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: ASR ASR |
$100.79
|
| Rate for Payer: BCBS Trust/PPO |
$80.56
|
| Rate for Payer: BCN Commercial |
$80.56
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$97.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.13
|
| Rate for Payer: Healthscope Commercial |
$103.91
|
| Rate for Payer: Healthscope Whirlpool |
$100.79
|
| Rate for Payer: Mclaren Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.44
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$103.91
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$103.91 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: ASR ASR |
$100.79
|
| Rate for Payer: BCBS Complete |
$41.56
|
| Rate for Payer: BCBS Trust/PPO |
$80.56
|
| Rate for Payer: BCN Commercial |
$80.56
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$97.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.13
|
| Rate for Payer: Healthscope Commercial |
$103.91
|
| Rate for Payer: Healthscope Whirlpool |
$100.79
|
| Rate for Payer: Mclaren Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.56
|
| Rate for Payer: Priority Health Narrow Network |
$73.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.44
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$59.87
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$59.87 |
| Rate for Payer: Aetna Commercial |
$53.88
|
| Rate for Payer: ASR ASR |
$58.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.42
|
| Rate for Payer: BCN Commercial |
$46.42
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cofinity Commercial |
$56.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.90
|
| Rate for Payer: Healthscope Commercial |
$59.87
|
| Rate for Payer: Healthscope Whirlpool |
$58.07
|
| Rate for Payer: Mclaren Commercial |
$53.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.69
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$59.87
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$59.87 |
| Rate for Payer: Aetna Commercial |
$53.88
|
| Rate for Payer: Aetna Medicare |
$35.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.68
|
| Rate for Payer: ASR ASR |
$58.07
|
| Rate for Payer: BCBS Complete |
$20.53
|
| Rate for Payer: BCBS MAPPO |
$35.74
|
| Rate for Payer: BCBS Trust/PPO |
$46.42
|
| Rate for Payer: BCN Commercial |
$46.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.74
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cofinity Commercial |
$56.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.74
|
| Rate for Payer: Healthscope Commercial |
$59.87
|
| Rate for Payer: Healthscope Whirlpool |
$58.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.74
|
| Rate for Payer: Mclaren Commercial |
$53.88
|
| Rate for Payer: Mclaren Medicaid |
$19.55
|
| Rate for Payer: Mclaren Medicare |
$35.74
|
| Rate for Payer: Meridian Medicaid |
$20.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.89
|
| Rate for Payer: PACE Medicare |
$33.95
|
| Rate for Payer: PACE SWMI |
$35.74
|
| Rate for Payer: PHP Commercial |
$39.31
|
| Rate for Payer: PHP Medicaid |
$19.55
|
| Rate for Payer: PHP Medicare Advantage |
$35.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.48
|
| Rate for Payer: Priority Health Medicare |
$35.74
|
| Rate for Payer: Priority Health Narrow Network |
$42.51
|
| Rate for Payer: Railroad Medicare Medicare |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.69
|
| Rate for Payer: UHC Medicare Advantage |
$36.81
|
| Rate for Payer: VA VA |
$35.74
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.30
|
| Rate for Payer: Priority Health Narrow Network |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: ASR ASR |
$32.01
|
| Rate for Payer: BCBS Trust/PPO |
$25.58
|
| Rate for Payer: BCN Commercial |
$25.58
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$31.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$33.00
|
| Rate for Payer: Healthscope Whirlpool |
$32.01
|
| Rate for Payer: Mclaren Commercial |
$29.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.04
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$32.01
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$25.58
|
| Rate for Payer: BCN Commercial |
$25.58
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$31.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$33.00
|
| Rate for Payer: Healthscope Whirlpool |
$32.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$29.70
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.05
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.18
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$13.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.04
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$33.45
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna Commercial |
$30.10
|
| Rate for Payer: ASR ASR |
$32.45
|
| Rate for Payer: BCBS Trust/PPO |
$25.93
|
| Rate for Payer: BCN Commercial |
$25.93
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$31.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.76
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Healthscope Whirlpool |
$32.45
|
| Rate for Payer: Mclaren Commercial |
$30.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.44
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$33.45
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna Commercial |
$30.10
|
| Rate for Payer: ASR ASR |
$32.45
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$25.93
|
| Rate for Payer: BCN Commercial |
$25.93
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$31.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.76
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Healthscope Whirlpool |
$32.45
|
| Rate for Payer: Mclaren Commercial |
$30.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.18
|
| Rate for Payer: Priority Health Narrow Network |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.44
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.75
|
| Rate for Payer: Priority Health Narrow Network |
$17.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
