|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$236.45 |
| Rate for Payer: Aetna Commercial |
$212.81
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$229.36
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$194.95
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$229.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$212.81
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$46.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$236.45 |
| Rate for Payer: Aetna Commercial |
$212.81
|
| Rate for Payer: ASR ASR |
$229.36
|
| Rate for Payer: BCBS Trust/PPO |
$194.17
|
| Rate for Payer: BCN Commercial |
$194.17
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$229.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.45
|
| Rate for Payer: Mclaren Commercial |
$212.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.08
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$236.45 |
| Rate for Payer: Aetna Commercial |
$212.81
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$229.36
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$194.95
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$229.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$212.81
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$46.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$236.45 |
| Rate for Payer: Aetna Commercial |
$212.81
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$229.36
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$194.95
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$229.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$212.81
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$46.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$236.45 |
| Rate for Payer: Aetna Commercial |
$212.81
|
| Rate for Payer: ASR ASR |
$229.36
|
| Rate for Payer: BCBS Trust/PPO |
$194.17
|
| Rate for Payer: BCN Commercial |
$194.17
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$229.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.45
|
| Rate for Payer: Mclaren Commercial |
$212.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.08
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
IP
|
$98.52
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$98.52 |
| Rate for Payer: Aetna Commercial |
$88.67
|
| Rate for Payer: ASR ASR |
$95.56
|
| Rate for Payer: BCBS Trust/PPO |
$80.90
|
| Rate for Payer: BCN Commercial |
$80.90
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Healthscope Commercial |
$95.56
|
| Rate for Payer: Healthscope Whirlpool |
$98.52
|
| Rate for Payer: Mclaren Commercial |
$88.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Nomi Health Commercial |
$80.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.70
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
OP
|
$98.52
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Aetna Commercial |
$88.67
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$95.56
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$81.23
|
| Rate for Payer: BCN Commercial |
$81.23
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$95.56
|
| Rate for Payer: Healthscope Whirlpool |
$98.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$88.67
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$46.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Nomi Health Commercial |
$80.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$129.57
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$129.57 |
| Rate for Payer: Aetna Commercial |
$116.61
|
| Rate for Payer: ASR ASR |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$106.40
|
| Rate for Payer: BCN Commercial |
$106.40
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cofinity Commercial |
$121.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.66
|
| Rate for Payer: Healthscope Commercial |
$125.68
|
| Rate for Payer: Healthscope Whirlpool |
$129.57
|
| Rate for Payer: Mclaren Commercial |
$116.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.13
|
| Rate for Payer: Nomi Health Commercial |
$106.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.02
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$129.57
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$116.61
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$125.68
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$106.83
|
| Rate for Payer: BCCCP Commercial |
$94.70
|
| Rate for Payer: BCN Commercial |
$106.83
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cofinity Commercial |
$121.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$125.68
|
| Rate for Payer: Healthscope Whirlpool |
$129.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$116.61
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.13
|
| Rate for Payer: Nomi Health Commercial |
$106.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.18
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.37
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$70.69
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC FRUCTOSAMINE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC FRUCTOSAMINE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$16.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.95
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.76
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$16.76
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.76
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$16.76
|
| Rate for Payer: Mclaren Medicare |
$16.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.60
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$15.92
|
| Rate for Payer: PACE SWMI |
$16.76
|
| Rate for Payer: PHP Commercial |
$18.44
|
| Rate for Payer: PHP Medicaid |
$8.98
|
| Rate for Payer: PHP Medicare Advantage |
$16.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$16.76
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.76
|
| Rate for Payer: UHC Exchange |
$25.98
|
| Rate for Payer: UHC Medicaid |
$8.77
|
| Rate for Payer: UHCCP DNSP |
$16.76
|
| Rate for Payer: UHCCP Medicaid |
$8.77
|
| Rate for Payer: VA VA |
$16.76
|
|
|
HC FRUCTOSE SEMEN
|
Facility
|
IP
|
$98.74
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
30100206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.06 |
| Max. Negotiated Rate |
$98.74 |
| Rate for Payer: Aetna Commercial |
$88.87
|
| Rate for Payer: ASR ASR |
$95.78
|
| Rate for Payer: BCBS Trust/PPO |
$81.09
|
| Rate for Payer: BCN Commercial |
$81.09
|
| Rate for Payer: Cash Price |
$78.99
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.99
|
| Rate for Payer: Healthscope Commercial |
$95.78
|
| Rate for Payer: Healthscope Whirlpool |
$98.74
|
| Rate for Payer: Mclaren Commercial |
$88.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.93
|
| Rate for Payer: Nomi Health Commercial |
$80.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.89
|
|
|
HC FRUCTOSE SEMEN
|
Facility
|
OP
|
$98.74
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
30100206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$98.74 |
| Rate for Payer: Aetna Commercial |
$88.87
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.68
|
| Rate for Payer: ASR ASR |
$95.78
|
| Rate for Payer: BCBS Complete |
$9.52
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$81.41
|
| Rate for Payer: BCN Commercial |
$81.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$78.99
|
| Rate for Payer: Cash Price |
$78.99
|
| Rate for Payer: Cofinity Commercial |
$92.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$95.78
|
| Rate for Payer: Healthscope Whirlpool |
$98.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.34
|
| Rate for Payer: Mclaren Commercial |
$88.87
|
| Rate for Payer: Mclaren Medicaid |
$17.34
|
| Rate for Payer: Mclaren Medicare |
$17.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Medicaid |
$9.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.93
|
| Rate for Payer: Nomi Health Commercial |
$80.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.06
|
| Rate for Payer: PACE Medicare |
$16.47
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: PHP Medicaid |
$9.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.52
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow Network |
$69.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.34
|
| Rate for Payer: UHC Exchange |
$26.88
|
| Rate for Payer: UHC Medicaid |
$9.07
|
| Rate for Payer: UHCCP DNSP |
$17.34
|
| Rate for Payer: UHCCP Medicaid |
$9.07
|
| Rate for Payer: VA VA |
$17.34
|
|
|
HC FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Facility
|
OP
|
$2,439.15
|
|
|
Service Code
|
CPT 15261
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$902.49 |
| Max. Negotiated Rate |
$2,439.15 |
| Rate for Payer: Aetna Commercial |
$2,195.24
|
| Rate for Payer: Aetna Medicare |
$902.49
|
| Rate for Payer: ASR ASR |
$2,365.98
|
| Rate for Payer: BCBS Complete |
$975.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,011.08
|
| Rate for Payer: BCN Commercial |
$2,011.08
|
| Rate for Payer: Cash Price |
$1,951.32
|
| Rate for Payer: Cofinity Commercial |
$2,292.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.32
|
| Rate for Payer: Healthscope Commercial |
$2,365.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,439.15
|
| Rate for Payer: Mclaren Commercial |
$2,195.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,951.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.28
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,829.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,137.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,709.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,146.45
|
|
|
HC FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Facility
|
IP
|
$2,439.15
|
|
|
Service Code
|
CPT 15261
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,829.36 |
| Max. Negotiated Rate |
$2,439.15 |
| Rate for Payer: Aetna Commercial |
$2,195.24
|
| Rate for Payer: ASR ASR |
$2,365.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,003.03
|
| Rate for Payer: BCN Commercial |
$2,003.03
|
| Rate for Payer: Cash Price |
$1,951.32
|
| Rate for Payer: Cofinity Commercial |
$2,292.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.32
|
| Rate for Payer: Healthscope Commercial |
$2,365.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,439.15
|
| Rate for Payer: Mclaren Commercial |
$2,195.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.28
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,829.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,146.45
|
|
|
HC FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Facility
|
OP
|
$3,515.06
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,515.06 |
| Rate for Payer: Aetna Commercial |
$3,163.55
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$3,409.61
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,898.17
|
| Rate for Payer: BCN Commercial |
$2,898.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Commercial |
$3,304.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$3,409.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,515.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$3,163.55
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$2,882.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,079.90
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,464.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,093.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Facility
|
IP
|
$3,515.06
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,636.30 |
| Max. Negotiated Rate |
$3,515.06 |
| Rate for Payer: Aetna Commercial |
$3,163.55
|
| Rate for Payer: ASR ASR |
$3,409.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,886.57
|
| Rate for Payer: BCN Commercial |
$2,886.57
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Commercial |
$3,304.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Healthscope Commercial |
$3,409.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,515.06
|
| Rate for Payer: Mclaren Commercial |
$3,163.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$2,882.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,093.25
|
|
|
HC F/U EP STUDY
|
Facility
|
OP
|
$5,725.83
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,013.81 |
| Max. Negotiated Rate |
$12,046.01 |
| Rate for Payer: Aetna Commercial |
$5,153.25
|
| Rate for Payer: Aetna Medicare |
$7,771.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,714.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,714.52
|
| Rate for Payer: ASR ASR |
$5,554.06
|
| Rate for Payer: BCBS Complete |
$4,268.17
|
| Rate for Payer: BCBS MAPPO |
$7,771.62
|
| Rate for Payer: BCBS Trust/PPO |
$4,720.95
|
| Rate for Payer: BCN Commercial |
$4,720.95
|
| Rate for Payer: BCN Medicare Advantage |
$7,771.62
|
| Rate for Payer: Cash Price |
$4,580.66
|
| Rate for Payer: Cash Price |
$4,580.66
|
| Rate for Payer: Cofinity Commercial |
$5,382.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,580.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,771.62
|
| Rate for Payer: Healthscope Commercial |
$5,554.06
|
| Rate for Payer: Healthscope Whirlpool |
$5,725.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,771.62
|
| Rate for Payer: Mclaren Commercial |
$5,153.25
|
| Rate for Payer: Mclaren Medicaid |
$7,771.62
|
| Rate for Payer: Mclaren Medicare |
$7,771.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,160.20
|
| Rate for Payer: Meridian Medicaid |
$4,268.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,937.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,548.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,866.96
|
| Rate for Payer: Nomi Health Commercial |
$4,695.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,294.37
|
| Rate for Payer: PACE Medicare |
$7,383.04
|
| Rate for Payer: PACE SWMI |
$7,771.62
|
| Rate for Payer: PHP Commercial |
$8,548.78
|
| Rate for Payer: PHP Medicaid |
$4,165.59
|
| Rate for Payer: PHP Medicare Advantage |
$7,771.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,064.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,016.97
|
| Rate for Payer: Priority Health Medicare |
$7,771.62
|
| Rate for Payer: Priority Health Narrow Network |
$4,013.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7,771.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,038.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,771.62
|
| Rate for Payer: UHC Exchange |
$12,046.01
|
| Rate for Payer: UHC Medicaid |
$4,064.56
|
| Rate for Payer: UHCCP DNSP |
$7,771.62
|
| Rate for Payer: UHCCP Medicaid |
$4,064.56
|
| Rate for Payer: VA VA |
$7,771.62
|
|
|
HC F/U EP STUDY
|
Facility
|
IP
|
$5,725.83
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,294.37 |
| Max. Negotiated Rate |
$5,725.83 |
| Rate for Payer: Aetna Commercial |
$5,153.25
|
| Rate for Payer: ASR ASR |
$5,554.06
|
| Rate for Payer: BCBS Trust/PPO |
$4,702.05
|
| Rate for Payer: BCN Commercial |
$4,702.05
|
| Rate for Payer: Cash Price |
$4,580.66
|
| Rate for Payer: Cofinity Commercial |
$5,382.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,580.66
|
| Rate for Payer: Healthscope Commercial |
$5,554.06
|
| Rate for Payer: Healthscope Whirlpool |
$5,725.83
|
| Rate for Payer: Mclaren Commercial |
$5,153.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,866.96
|
| Rate for Payer: Nomi Health Commercial |
$4,695.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,294.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,038.73
|
|
|
HC FUNC BACK EVAL
|
Facility
|
OP
|
$128.16
|
|
| Hospital Charge Code |
42400003
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: Aetna Medicare |
$47.42
|
| Rate for Payer: ASR ASR |
$124.32
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS Trust/PPO |
$105.67
|
| Rate for Payer: BCN Commercial |
$105.67
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$120.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$124.32
|
| Rate for Payer: Healthscope Whirlpool |
$128.16
|
| Rate for Payer: Mclaren Commercial |
$115.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$112.29
|
| Rate for Payer: Priority Health Narrow Network |
$89.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.78
|
|
|
HC FUNC BACK EVAL
|
Facility
|
IP
|
$128.16
|
|
| Hospital Charge Code |
42400003
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$96.12 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: ASR ASR |
$124.32
|
| Rate for Payer: BCBS Trust/PPO |
$105.24
|
| Rate for Payer: BCN Commercial |
$105.24
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$120.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$124.32
|
| Rate for Payer: Healthscope Whirlpool |
$128.16
|
| Rate for Payer: Mclaren Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.78
|
|
|
HC FUNGAL ID MOLD
|
Facility
|
OP
|
$68.77
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
30600085
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$68.77 |
| Rate for Payer: Aetna Commercial |
$61.89
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: ASR ASR |
$66.71
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$56.70
|
| Rate for Payer: BCN Commercial |
$56.70
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Commercial |
$64.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Healthscope Whirlpool |
$68.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.32
|
| Rate for Payer: Mclaren Commercial |
$61.89
|
| Rate for Payer: Mclaren Medicaid |
$10.32
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$5.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.45
|
| Rate for Payer: Nomi Health Commercial |
$56.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.58
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: PHP Medicaid |
$5.53
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.26
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health Narrow Network |
$48.21
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.32
|
| Rate for Payer: UHC Exchange |
$16.00
|
| Rate for Payer: UHC Medicaid |
$5.40
|
| Rate for Payer: UHCCP DNSP |
$10.32
|
| Rate for Payer: UHCCP Medicaid |
$5.40
|
| Rate for Payer: VA VA |
$10.32
|
|
|
HC FUNGAL ID MOLD
|
Facility
|
IP
|
$68.77
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
30600085
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$68.77 |
| Rate for Payer: Aetna Commercial |
$61.89
|
| Rate for Payer: ASR ASR |
$66.71
|
| Rate for Payer: BCBS Trust/PPO |
$56.47
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Commercial |
$64.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Healthscope Whirlpool |
$68.77
|
| Rate for Payer: Mclaren Commercial |
$61.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.45
|
| Rate for Payer: Nomi Health Commercial |
$56.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.52
|
|
|
HC FUNGAL ID YEAST
|
Facility
|
IP
|
$68.77
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
30600084
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$68.77 |
| Rate for Payer: Aetna Commercial |
$61.89
|
| Rate for Payer: ASR ASR |
$66.71
|
| Rate for Payer: BCBS Trust/PPO |
$56.47
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Commercial |
$64.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Healthscope Whirlpool |
$68.77
|
| Rate for Payer: Mclaren Commercial |
$61.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.45
|
| Rate for Payer: Nomi Health Commercial |
$56.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.52
|
|
|
HC FUNGAL ID YEAST
|
Facility
|
OP
|
$68.77
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
30600084
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$68.77 |
| Rate for Payer: Aetna Commercial |
$61.89
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: ASR ASR |
$66.71
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$56.70
|
| Rate for Payer: BCN Commercial |
$56.70
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cofinity Commercial |
$64.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Healthscope Whirlpool |
$68.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.32
|
| Rate for Payer: Mclaren Commercial |
$61.89
|
| Rate for Payer: Mclaren Medicaid |
$10.32
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$5.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.45
|
| Rate for Payer: Nomi Health Commercial |
$56.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.58
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: PHP Medicaid |
$5.53
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.26
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health Narrow Network |
$48.21
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.32
|
| Rate for Payer: UHC Exchange |
$16.00
|
| Rate for Payer: UHC Medicaid |
$5.40
|
| Rate for Payer: UHCCP DNSP |
$10.32
|
| Rate for Payer: UHCCP Medicaid |
$5.40
|
| Rate for Payer: VA VA |
$10.32
|
|
