|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$216.03
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.02 |
| Max. Negotiated Rate |
$216.03 |
| Rate for Payer: Aetna Commercial |
$194.43
|
| Rate for Payer: ASR ASR |
$209.55
|
| Rate for Payer: BCBS Trust/PPO |
$177.40
|
| Rate for Payer: BCN Commercial |
$177.40
|
| Rate for Payer: Cash Price |
$172.82
|
| Rate for Payer: Cofinity Commercial |
$203.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.82
|
| Rate for Payer: Healthscope Commercial |
$209.55
|
| Rate for Payer: Healthscope Whirlpool |
$216.03
|
| Rate for Payer: Mclaren Commercial |
$194.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.11
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$404.73
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.55 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$364.26
|
| Rate for Payer: ASR ASR |
$392.59
|
| Rate for Payer: BCBS Trust/PPO |
$332.36
|
| Rate for Payer: BCN Commercial |
$332.36
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cofinity Commercial |
$380.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.78
|
| Rate for Payer: Healthscope Commercial |
$392.59
|
| Rate for Payer: Healthscope Whirlpool |
$404.73
|
| Rate for Payer: Mclaren Commercial |
$364.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Nomi Health Commercial |
$331.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.16
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$404.73
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$364.26
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$392.59
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$333.70
|
| Rate for Payer: BCN Commercial |
$333.70
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cash Price |
$323.78
|
| Rate for Payer: Cofinity Commercial |
$380.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$392.59
|
| Rate for Payer: Healthscope Whirlpool |
$404.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$364.26
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.02
|
| Rate for Payer: Nomi Health Commercial |
$331.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.55
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$340.68
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$272.54
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$303.56
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.67 |
| Max. Negotiated Rate |
$303.56 |
| Rate for Payer: Aetna Commercial |
$273.20
|
| Rate for Payer: ASR ASR |
$294.45
|
| Rate for Payer: BCBS Trust/PPO |
$249.28
|
| Rate for Payer: BCN Commercial |
$249.28
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cofinity Commercial |
$285.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.85
|
| Rate for Payer: Healthscope Commercial |
$294.45
|
| Rate for Payer: Healthscope Whirlpool |
$303.56
|
| Rate for Payer: Mclaren Commercial |
$273.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.03
|
| Rate for Payer: Nomi Health Commercial |
$248.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.13
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$303.56
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$340.68 |
| Rate for Payer: Aetna Commercial |
$273.20
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$294.45
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$250.29
|
| Rate for Payer: BCN Commercial |
$250.29
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cash Price |
$242.85
|
| Rate for Payer: Cofinity Commercial |
$285.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$294.45
|
| Rate for Payer: Healthscope Whirlpool |
$303.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$273.20
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.03
|
| Rate for Payer: Nomi Health Commercial |
$248.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.67
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$340.68
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$272.54
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$424.48
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.36 |
| Max. Negotiated Rate |
$424.48 |
| Rate for Payer: Aetna Commercial |
$382.03
|
| Rate for Payer: ASR ASR |
$411.75
|
| Rate for Payer: BCBS Trust/PPO |
$348.58
|
| Rate for Payer: BCN Commercial |
$348.58
|
| Rate for Payer: Cash Price |
$339.58
|
| Rate for Payer: Cofinity Commercial |
$399.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.58
|
| Rate for Payer: Healthscope Commercial |
$411.75
|
| Rate for Payer: Healthscope Whirlpool |
$424.48
|
| Rate for Payer: Mclaren Commercial |
$382.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.81
|
| Rate for Payer: Nomi Health Commercial |
$348.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.54
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$424.48
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.06 |
| Max. Negotiated Rate |
$424.48 |
| Rate for Payer: Aetna Commercial |
$382.03
|
| Rate for Payer: Aetna Medicare |
$157.06
|
| Rate for Payer: ASR ASR |
$411.75
|
| Rate for Payer: BCBS Complete |
$169.79
|
| Rate for Payer: BCBS Trust/PPO |
$349.98
|
| Rate for Payer: BCN Commercial |
$349.98
|
| Rate for Payer: Cash Price |
$339.58
|
| Rate for Payer: Cofinity Commercial |
$399.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.58
|
| Rate for Payer: Healthscope Commercial |
$411.75
|
| Rate for Payer: Healthscope Whirlpool |
$424.48
|
| Rate for Payer: Mclaren Commercial |
$382.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.81
|
| Rate for Payer: Nomi Health Commercial |
$348.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$371.93
|
| Rate for Payer: Priority Health Narrow Network |
$297.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.54
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$953.80
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$715.35 |
| Max. Negotiated Rate |
$953.80 |
| Rate for Payer: Aetna Commercial |
$858.42
|
| Rate for Payer: ASR ASR |
$925.19
|
| Rate for Payer: BCBS Trust/PPO |
$783.26
|
| Rate for Payer: BCN Commercial |
$783.26
|
| Rate for Payer: Cash Price |
$763.04
|
| Rate for Payer: Cofinity Commercial |
$896.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.04
|
| Rate for Payer: Healthscope Commercial |
$925.19
|
| Rate for Payer: Healthscope Whirlpool |
$953.80
|
| Rate for Payer: Mclaren Commercial |
$858.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.73
|
| Rate for Payer: Nomi Health Commercial |
$782.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$839.34
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$953.80
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$953.80 |
| Rate for Payer: Aetna Commercial |
$858.42
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$925.19
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$786.41
|
| Rate for Payer: BCN Commercial |
$786.41
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$763.04
|
| Rate for Payer: Cash Price |
$763.04
|
| Rate for Payer: Cofinity Commercial |
$896.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$925.19
|
| Rate for Payer: Healthscope Whirlpool |
$953.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$858.42
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.73
|
| Rate for Payer: Nomi Health Commercial |
$782.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.35
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$835.72
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$668.61
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$839.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,810.03 |
| Max. Negotiated Rate |
$40,368.00 |
| Rate for Payer: Aetna Commercial |
$8,172.04
|
| Rate for Payer: Aetna Medicare |
$26,043.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,554.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,554.84
|
| Rate for Payer: ASR ASR |
$8,807.64
|
| Rate for Payer: BCBS Complete |
$14,303.29
|
| Rate for Payer: BCBS MAPPO |
$26,043.87
|
| Rate for Payer: BCBS Trust/PPO |
$7,486.49
|
| Rate for Payer: BCN Commercial |
$7,486.49
|
| Rate for Payer: BCN Medicare Advantage |
$26,043.87
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Commercial |
$8,535.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,043.87
|
| Rate for Payer: Healthscope Commercial |
$8,807.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,080.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,043.87
|
| Rate for Payer: Mclaren Commercial |
$8,172.04
|
| Rate for Payer: Mclaren Medicaid |
$26,043.87
|
| Rate for Payer: Mclaren Medicare |
$26,043.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,346.06
|
| Rate for Payer: Meridian Medicaid |
$14,303.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,950.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,648.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PACE Medicare |
$24,741.68
|
| Rate for Payer: PACE SWMI |
$26,043.87
|
| Rate for Payer: PHP Commercial |
$28,648.26
|
| Rate for Payer: PHP Medicaid |
$13,959.51
|
| Rate for Payer: PHP Medicare Advantage |
$26,043.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,620.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,068.71
|
| Rate for Payer: Priority Health Medicare |
$26,043.87
|
| Rate for Payer: Priority Health Narrow Network |
$11,254.97
|
| Rate for Payer: Railroad Medicare Medicare |
$26,043.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,990.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,043.87
|
| Rate for Payer: UHC Exchange |
$40,368.00
|
| Rate for Payer: UHC Medicaid |
$13,620.94
|
| Rate for Payer: UHCCP DNSP |
$26,043.87
|
| Rate for Payer: UHCCP Medicaid |
$13,620.94
|
| Rate for Payer: VA VA |
$26,043.87
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,810.03 |
| Max. Negotiated Rate |
$9,080.04 |
| Rate for Payer: Aetna Commercial |
$8,172.04
|
| Rate for Payer: ASR ASR |
$8,807.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,456.53
|
| Rate for Payer: BCN Commercial |
$7,456.53
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Commercial |
$8,535.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,807.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,080.04
|
| Rate for Payer: Mclaren Commercial |
$8,172.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,990.44
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$31.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$18.14
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$9.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.15
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$106.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.14
|
| Rate for Payer: UHC Exchange |
$28.12
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$133.15 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Medicare |
$18.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$31.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$18.14
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$9.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$19.95
|
| Rate for Payer: PHP Medicaid |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.15
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$106.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.14
|
| Rate for Payer: UHC Exchange |
$28.12
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHCCP DNSP |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$41.16 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$31.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.29
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$15.29
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: Meridian Medicaid |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$16.82
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.29
|
| Rate for Payer: UHC Exchange |
$23.70
|
| Rate for Payer: UHC Medicaid |
$8.00
|
| Rate for Payer: UHCCP DNSP |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.00
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: Aetna Medicare |
$13.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.40
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$31.50
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.12
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$13.12
|
| Rate for Payer: Mclaren Medicare |
$13.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.78
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$14.43
|
| Rate for Payer: PHP Medicaid |
$7.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.62
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health Narrow Network |
$39.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.12
|
| Rate for Payer: UHC Exchange |
$20.34
|
| Rate for Payer: UHC Medicaid |
$6.86
|
| Rate for Payer: UHCCP DNSP |
$13.12
|
| Rate for Payer: UHCCP Medicaid |
$6.86
|
| Rate for Payer: VA VA |
$13.12
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$34.38
|
| Rate for Payer: ASR ASR |
$37.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Commercial |
$35.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$37.05
|
| Rate for Payer: Healthscope Whirlpool |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$31.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.62
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$124.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$111.74
|
| 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 |
$120.44
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$102.37
|
| Rate for Payer: BCN Commercial |
$102.37
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$124.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| 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 |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| 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 |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.79
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$87.04
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$111.74
|
| Rate for Payer: ASR ASR |
$120.44
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$101.96
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$124.16
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$124.16
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$111.74
|
| 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 |
$120.44
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$102.37
|
| Rate for Payer: BCN Commercial |
$102.37
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$124.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Mclaren Medicaid |
$42.84
|
| 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 |
$23.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| 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 |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.79
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$87.04
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicaid |
$22.41
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.41
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$111.74
|
| Rate for Payer: ASR ASR |
$120.44
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$101.96
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$116.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$120.44
|
| Rate for Payer: Healthscope Whirlpool |
$124.16
|
| Rate for Payer: Mclaren Commercial |
$111.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.26
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,142.70
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,142.70 |
| Rate for Payer: Aetna Commercial |
$1,028.43
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$1,108.42
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$942.16
|
| Rate for Payer: BCN Commercial |
$942.16
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$914.16
|
| Rate for Payer: Cash Price |
$914.16
|
| Rate for Payer: Cofinity Commercial |
$1,074.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,108.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,142.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,028.43
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.29
|
| Rate for Payer: Nomi Health Commercial |
$937.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.02
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,001.23
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$801.03
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,005.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,142.70
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$857.02 |
| Max. Negotiated Rate |
$1,142.70 |
| Rate for Payer: Aetna Commercial |
$1,028.43
|
| Rate for Payer: ASR ASR |
$1,108.42
|
| Rate for Payer: BCBS Trust/PPO |
$938.39
|
| Rate for Payer: BCN Commercial |
$938.39
|
| Rate for Payer: Cash Price |
$914.16
|
| Rate for Payer: Cofinity Commercial |
$1,074.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.16
|
| Rate for Payer: Healthscope Commercial |
$1,108.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,142.70
|
| Rate for Payer: Mclaren Commercial |
$1,028.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.29
|
| Rate for Payer: Nomi Health Commercial |
$937.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,005.58
|
|
