|
HC FUNGAL SEROLOGY SURVEY
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
30600137
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$72.63 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.77
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$13.42
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.42
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.42
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$13.42
|
| Rate for Payer: Mclaren Medicare |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.09
|
| Rate for Payer: Meridian Medicaid |
$7.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$12.75
|
| Rate for Payer: PACE SWMI |
$13.42
|
| Rate for Payer: PHP Commercial |
$14.76
|
| Rate for Payer: PHP Medicaid |
$7.19
|
| Rate for Payer: PHP Medicare Advantage |
$13.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.63
|
| Rate for Payer: Priority Health Medicare |
$13.42
|
| Rate for Payer: Priority Health Narrow Network |
$58.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.42
|
| Rate for Payer: UHC Exchange |
$20.80
|
| Rate for Payer: UHC Medicaid |
$7.02
|
| Rate for Payer: UHCCP DNSP |
$13.42
|
| Rate for Payer: UHCCP Medicaid |
$7.02
|
| Rate for Payer: VA VA |
$13.42
|
|
|
HC FUNGAL SEROLOGY SURVEY
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
30600137
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT1
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT1
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$34.32
|
| Rate for Payer: BCN Commercial |
$34.32
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$12.90
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: PHP Medicaid |
$6.91
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.90
|
| Rate for Payer: UHC Exchange |
$20.00
|
| Rate for Payer: UHC Medicaid |
$6.75
|
| Rate for Payer: UHCCP DNSP |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 2
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200245
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 2
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200245
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$34.32
|
| Rate for Payer: BCN Commercial |
$34.32
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.47
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$11.47
|
| Rate for Payer: Mclaren Medicare |
$11.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.04
|
| Rate for Payer: Meridian Medicaid |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PACE Medicare |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: PHP Medicaid |
$6.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.47
|
| Rate for Payer: UHC Exchange |
$17.78
|
| Rate for Payer: UHC Medicaid |
$6.00
|
| Rate for Payer: UHCCP DNSP |
$11.47
|
| Rate for Payer: UHCCP Medicaid |
$6.00
|
| Rate for Payer: VA VA |
$11.47
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 3
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
30200287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.24
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS MAPPO |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$13.79
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.79
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$13.79
|
| Rate for Payer: Mclaren Medicare |
$13.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.48
|
| Rate for Payer: Meridian Medicaid |
$7.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.79
|
| Rate for Payer: PHP Commercial |
$15.17
|
| Rate for Payer: PHP Medicaid |
$7.39
|
| Rate for Payer: PHP Medicare Advantage |
$13.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Medicare |
$13.79
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: Railroad Medicare Medicare |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.79
|
| Rate for Payer: UHC Exchange |
$21.37
|
| Rate for Payer: UHC Medicaid |
$7.21
|
| Rate for Payer: UHCCP DNSP |
$13.79
|
| Rate for Payer: UHCCP Medicaid |
$7.21
|
| Rate for Payer: VA VA |
$13.79
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 3
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
30200287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC FUNGITELL ASSAY
|
Facility
|
OP
|
$161.26
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$161.26 |
| Rate for Payer: Aetna Commercial |
$145.13
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: ASR ASR |
$156.42
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$132.96
|
| Rate for Payer: BCN Commercial |
$132.96
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$156.42
|
| Rate for Payer: Healthscope Whirlpool |
$161.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$145.13
|
| Rate for Payer: Mclaren Medicaid |
$11.98
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Nomi Health Commercial |
$132.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141.30
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$113.04
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC FUNGITELL ASSAY
|
Facility
|
IP
|
$161.26
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$161.26 |
| Rate for Payer: Aetna Commercial |
$145.13
|
| Rate for Payer: ASR ASR |
$156.42
|
| Rate for Payer: BCBS Trust/PPO |
$132.43
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Commercial |
$151.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Healthscope Commercial |
$156.42
|
| Rate for Payer: Healthscope Whirlpool |
$161.26
|
| Rate for Payer: Mclaren Commercial |
$145.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Nomi Health Commercial |
$132.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.91
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$390.15 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: BCBS Trust/PPO |
$427.19
|
| Rate for Payer: BCN Commercial |
$427.19
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$504.59
|
| Rate for Payer: Healthscope Whirlpool |
$520.20
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$428.90
|
| Rate for Payer: BCN Commercial |
$428.90
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$504.59
|
| Rate for Payer: Healthscope Whirlpool |
$520.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.06
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$170.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$44.89
|
| Rate for Payer: Aetna Medicare |
$21.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: ASR ASR |
$48.38
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$41.13
|
| Rate for Payer: BCN Commercial |
$41.13
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Whirlpool |
$49.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.67
|
| Rate for Payer: Mclaren Commercial |
$44.89
|
| Rate for Payer: Mclaren Medicaid |
$21.67
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$11.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Medicaid |
$11.62
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.85
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow Network |
$18.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.67
|
| Rate for Payer: UHC Exchange |
$33.59
|
| Rate for Payer: UHC Medicaid |
$11.33
|
| Rate for Payer: UHCCP DNSP |
$21.67
|
| Rate for Payer: UHCCP Medicaid |
$11.33
|
| Rate for Payer: VA VA |
$21.67
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$44.89
|
| Rate for Payer: ASR ASR |
$48.38
|
| Rate for Payer: BCBS Trust/PPO |
$40.96
|
| Rate for Payer: BCN Commercial |
$40.96
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Whirlpool |
$49.88
|
| Rate for Payer: Mclaren Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.89
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: ASR ASR |
$2.13
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$2.13
|
| Rate for Payer: Healthscope Whirlpool |
$2.20
|
| Rate for Payer: Mclaren Commercial |
$1.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.29
|
| Rate for Payer: Priority Health Narrow Network |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.94
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: ASR ASR |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$2.13
|
| Rate for Payer: Healthscope Whirlpool |
$2.20
|
| Rate for Payer: Mclaren Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.94
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: BCBS Trust/PPO |
$54.68
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$64.59
|
| Rate for Payer: Healthscope Whirlpool |
$66.59
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS Trust/PPO |
$54.90
|
| Rate for Payer: BCN Commercial |
$54.90
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$64.59
|
| Rate for Payer: Healthscope Whirlpool |
$66.59
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.07
|
| Rate for Payer: Priority Health Narrow Network |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Medicare |
$35.34
|
| Rate for Payer: ASR ASR |
$92.64
|
| Rate for Payer: BCBS Complete |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$78.75
|
| Rate for Payer: BCN Commercial |
$78.75
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Healthscope Whirlpool |
$95.51
|
| Rate for Payer: Mclaren Commercial |
$85.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.73
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.05
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: ASR ASR |
$92.64
|
| Rate for Payer: BCBS Trust/PPO |
$78.43
|
| Rate for Payer: BCN Commercial |
$78.43
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Healthscope Whirlpool |
$95.51
|
| Rate for Payer: Mclaren Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.05
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$144.76 |
| Rate for Payer: Aetna Commercial |
$130.28
|
| Rate for Payer: ASR ASR |
$140.42
|
| Rate for Payer: BCBS Trust/PPO |
$118.88
|
| Rate for Payer: BCN Commercial |
$118.88
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Commercial |
$136.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Healthscope Commercial |
$140.42
|
| Rate for Payer: Healthscope Whirlpool |
$144.76
|
| Rate for Payer: Mclaren Commercial |
$130.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Nomi Health Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.39
|
|
