|
HC MOUSE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Aetna Commercial |
$150.69
|
| Rate for Payer: ASR ASR |
$162.41
|
| Rate for Payer: BCBS Trust/PPO |
$129.81
|
| Rate for Payer: BCN Commercial |
$129.81
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.94
|
| Rate for Payer: Healthscope Commercial |
$167.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.41
|
| Rate for Payer: Mclaren Commercial |
$150.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.34
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$150.69
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$162.41
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$129.81
|
| Rate for Payer: BCN Commercial |
$129.81
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$167.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$150.69
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.34
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$52.73 |
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: ASR ASR |
$51.15
|
| Rate for Payer: BCBS Trust/PPO |
$40.88
|
| Rate for Payer: BCN Commercial |
$40.88
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$49.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.18
|
| Rate for Payer: Healthscope Commercial |
$52.73
|
| Rate for Payer: Healthscope Whirlpool |
$51.15
|
| Rate for Payer: Mclaren Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.40
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$47.46
|
| Rate for Payer: ASR ASR |
$51.15
|
| Rate for Payer: BCBS Complete |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$40.88
|
| Rate for Payer: BCN Commercial |
$40.88
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$49.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.18
|
| Rate for Payer: Healthscope Commercial |
$52.73
|
| Rate for Payer: Healthscope Whirlpool |
$51.15
|
| Rate for Payer: Mclaren Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.40
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
IP
|
$372.30
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$260.61 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Aetna Commercial |
$335.07
|
| Rate for Payer: ASR ASR |
$361.13
|
| Rate for Payer: BCBS Trust/PPO |
$288.64
|
| Rate for Payer: BCN Commercial |
$288.64
|
| Rate for Payer: Cash Price |
$297.84
|
| Rate for Payer: Cofinity Commercial |
$349.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.84
|
| Rate for Payer: Healthscope Commercial |
$372.30
|
| Rate for Payer: Healthscope Whirlpool |
$361.13
|
| Rate for Payer: Mclaren Commercial |
$335.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.62
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
OP
|
$372.30
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Aetna Commercial |
$335.07
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: ASR ASR |
$361.13
|
| Rate for Payer: BCBS Complete |
$106.38
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$288.64
|
| Rate for Payer: BCN Commercial |
$288.64
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$297.84
|
| Rate for Payer: Cash Price |
$297.84
|
| Rate for Payer: Cofinity Commercial |
$349.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$372.30
|
| Rate for Payer: Healthscope Whirlpool |
$361.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$185.20
|
| Rate for Payer: Mclaren Commercial |
$335.07
|
| Rate for Payer: Mclaren Medicaid |
$101.30
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Medicaid |
$106.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.46
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$203.72
|
| Rate for Payer: PHP Medicaid |
$101.30
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.79
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health Narrow Network |
$264.33
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.62
|
| Rate for Payer: UHC Medicare Advantage |
$190.76
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
OP
|
$588.54
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$588.54 |
| Rate for Payer: Aetna Commercial |
$529.69
|
| Rate for Payer: Aetna Medicare |
$300.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.00
|
| Rate for Payer: ASR ASR |
$570.88
|
| Rate for Payer: BCBS Complete |
$172.32
|
| Rate for Payer: BCBS MAPPO |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$456.30
|
| Rate for Payer: BCN Commercial |
$456.30
|
| Rate for Payer: BCN Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$470.83
|
| Rate for Payer: Cash Price |
$470.83
|
| Rate for Payer: Cofinity Commercial |
$553.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$588.54
|
| Rate for Payer: Healthscope Whirlpool |
$570.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$529.69
|
| Rate for Payer: Mclaren Medicaid |
$164.10
|
| Rate for Payer: Mclaren Medicare |
$300.00
|
| Rate for Payer: Meridian Medicaid |
$172.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$315.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$500.26
|
| Rate for Payer: PACE Medicare |
$285.00
|
| Rate for Payer: PACE SWMI |
$300.00
|
| Rate for Payer: PHP Commercial |
$330.00
|
| Rate for Payer: PHP Medicaid |
$164.10
|
| Rate for Payer: PHP Medicare Advantage |
$300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.57
|
| Rate for Payer: Priority Health Medicare |
$300.00
|
| Rate for Payer: Priority Health Narrow Network |
$417.86
|
| Rate for Payer: Railroad Medicare Medicare |
$300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.92
|
| Rate for Payer: UHC Medicare Advantage |
$309.00
|
| Rate for Payer: VA VA |
$300.00
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
IP
|
$588.54
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$411.98 |
| Max. Negotiated Rate |
$588.54 |
| Rate for Payer: Aetna Commercial |
$529.69
|
| Rate for Payer: ASR ASR |
$570.88
|
| Rate for Payer: BCBS Trust/PPO |
$456.30
|
| Rate for Payer: BCN Commercial |
$456.30
|
| Rate for Payer: Cash Price |
$470.83
|
| Rate for Payer: Cofinity Commercial |
$553.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.83
|
| Rate for Payer: Healthscope Commercial |
$588.54
|
| Rate for Payer: Healthscope Whirlpool |
$570.88
|
| Rate for Payer: Mclaren Commercial |
$529.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$500.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.92
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
IP
|
$635.46
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$444.82 |
| Max. Negotiated Rate |
$635.46 |
| Rate for Payer: Aetna Commercial |
$571.91
|
| Rate for Payer: ASR ASR |
$616.40
|
| Rate for Payer: BCBS Trust/PPO |
$492.67
|
| Rate for Payer: BCN Commercial |
$492.67
|
| Rate for Payer: Cash Price |
$508.37
|
| Rate for Payer: Cofinity Commercial |
$597.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.37
|
| Rate for Payer: Healthscope Commercial |
$635.46
|
| Rate for Payer: Healthscope Whirlpool |
$616.40
|
| Rate for Payer: Mclaren Commercial |
$571.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$559.20
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
OP
|
$635.46
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$635.46 |
| Rate for Payer: Aetna Commercial |
$571.91
|
| Rate for Payer: Aetna Medicare |
$121.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.04
|
| Rate for Payer: ASR ASR |
$616.40
|
| Rate for Payer: BCBS Complete |
$69.86
|
| Rate for Payer: BCBS MAPPO |
$121.63
|
| Rate for Payer: BCBS Trust/PPO |
$492.67
|
| Rate for Payer: BCN Commercial |
$492.67
|
| Rate for Payer: BCN Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$508.37
|
| Rate for Payer: Cash Price |
$508.37
|
| Rate for Payer: Cofinity Commercial |
$597.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.63
|
| Rate for Payer: Healthscope Commercial |
$635.46
|
| Rate for Payer: Healthscope Whirlpool |
$616.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$121.63
|
| Rate for Payer: Mclaren Commercial |
$571.91
|
| Rate for Payer: Mclaren Medicaid |
$66.53
|
| Rate for Payer: Mclaren Medicare |
$121.63
|
| Rate for Payer: Meridian Medicaid |
$69.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.14
|
| Rate for Payer: PACE Medicare |
$115.55
|
| Rate for Payer: PACE SWMI |
$121.63
|
| Rate for Payer: PHP Commercial |
$133.79
|
| Rate for Payer: PHP Medicaid |
$66.53
|
| Rate for Payer: PHP Medicare Advantage |
$121.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.27
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health Narrow Network |
$451.18
|
| Rate for Payer: Railroad Medicare Medicare |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$559.20
|
| Rate for Payer: UHC Medicare Advantage |
$125.28
|
| Rate for Payer: VA VA |
$121.63
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
IP
|
$403.92
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$282.74 |
| Max. Negotiated Rate |
$403.92 |
| Rate for Payer: Aetna Commercial |
$363.53
|
| Rate for Payer: ASR ASR |
$391.80
|
| Rate for Payer: BCBS Trust/PPO |
$313.16
|
| Rate for Payer: BCN Commercial |
$313.16
|
| Rate for Payer: Cash Price |
$323.14
|
| Rate for Payer: Cofinity Commercial |
$379.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.14
|
| Rate for Payer: Healthscope Commercial |
$403.92
|
| Rate for Payer: Healthscope Whirlpool |
$391.80
|
| Rate for Payer: Mclaren Commercial |
$363.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.45
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
OP
|
$403.92
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$403.92 |
| Rate for Payer: Aetna Commercial |
$363.53
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$391.80
|
| Rate for Payer: BCBS Complete |
$52.65
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$313.16
|
| Rate for Payer: BCN Commercial |
$313.16
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$323.14
|
| Rate for Payer: Cash Price |
$323.14
|
| Rate for Payer: Cofinity Commercial |
$379.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$403.92
|
| Rate for Payer: Healthscope Whirlpool |
$391.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$363.53
|
| Rate for Payer: Mclaren Medicaid |
$50.14
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Medicaid |
$52.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.33
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$50.14
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.88
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$44.70
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.45
|
| Rate for Payer: UHC Medicare Advantage |
$94.41
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
OP
|
$2,318.35
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,318.35 |
| Rate for Payer: Aetna Commercial |
$2,086.52
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,248.80
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.42
|
| Rate for Payer: BCN Commercial |
$1,797.42
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,854.68
|
| Rate for Payer: Cash Price |
$1,854.68
|
| Rate for Payer: Cofinity Commercial |
$2,179.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,854.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,318.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,086.52
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,970.60
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,582.37
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,265.90
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,040.15
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
IP
|
$2,318.35
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,622.84 |
| Max. Negotiated Rate |
$2,318.35 |
| Rate for Payer: Aetna Commercial |
$2,086.52
|
| Rate for Payer: ASR ASR |
$2,248.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.42
|
| Rate for Payer: BCN Commercial |
$1,797.42
|
| Rate for Payer: Cash Price |
$1,854.68
|
| Rate for Payer: Cofinity Commercial |
$2,179.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,854.68
|
| Rate for Payer: Healthscope Commercial |
$2,318.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.80
|
| Rate for Payer: Mclaren Commercial |
$2,086.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,970.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,040.15
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
IP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,448.35 |
| Max. Negotiated Rate |
$2,069.07 |
| Rate for Payer: Aetna Commercial |
$1,862.16
|
| Rate for Payer: ASR ASR |
$2,007.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.15
|
| Rate for Payer: BCN Commercial |
$1,604.15
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,944.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,655.26
|
| Rate for Payer: Healthscope Commercial |
$2,069.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,007.00
|
| Rate for Payer: Mclaren Commercial |
$1,862.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,820.78
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
OP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$2,069.07 |
| Rate for Payer: Aetna Commercial |
$1,862.16
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$2,007.00
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.15
|
| Rate for Payer: BCN Commercial |
$1,604.15
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,944.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,655.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$2,069.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,007.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,862.16
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,425.87
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.70
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,820.78
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
OP
|
$3,029.71
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$3,029.71 |
| Rate for Payer: Aetna Commercial |
$2,726.74
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,938.82
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,348.93
|
| Rate for Payer: BCN Commercial |
$2,348.93
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,423.77
|
| Rate for Payer: Cash Price |
$2,423.77
|
| Rate for Payer: Cofinity Commercial |
$2,847.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,423.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$3,029.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,938.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,726.74
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,575.25
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,120.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,929.22
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,543.38
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,666.14
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
IP
|
$3,029.71
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,120.80 |
| Max. Negotiated Rate |
$3,029.71 |
| Rate for Payer: Aetna Commercial |
$2,726.74
|
| Rate for Payer: ASR ASR |
$2,938.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,348.93
|
| Rate for Payer: BCN Commercial |
$2,348.93
|
| Rate for Payer: Cash Price |
$2,423.77
|
| Rate for Payer: Cofinity Commercial |
$2,847.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,423.77
|
| Rate for Payer: Healthscope Commercial |
$3,029.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,938.82
|
| Rate for Payer: Mclaren Commercial |
$2,726.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,575.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,120.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,666.14
|
|
|
HC MRA HEAD WO CON
|
Facility
|
OP
|
$1,773.73
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,773.73 |
| Rate for Payer: Aetna Commercial |
$1,596.36
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,720.52
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,375.17
|
| Rate for Payer: BCN Commercial |
$1,375.17
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,418.98
|
| Rate for Payer: Cash Price |
$1,418.98
|
| Rate for Payer: Cofinity Commercial |
$1,667.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,773.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,720.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,596.36
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,507.67
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,241.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,226.28
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$981.02
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,560.88
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MRA HEAD WO CON
|
Facility
|
IP
|
$1,773.73
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,241.61 |
| Max. Negotiated Rate |
$1,773.73 |
| Rate for Payer: Aetna Commercial |
$1,596.36
|
| Rate for Payer: ASR ASR |
$1,720.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,375.17
|
| Rate for Payer: BCN Commercial |
$1,375.17
|
| Rate for Payer: Cash Price |
$1,418.98
|
| Rate for Payer: Cofinity Commercial |
$1,667.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.98
|
| Rate for Payer: Healthscope Commercial |
$1,773.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,720.52
|
| Rate for Payer: Mclaren Commercial |
$1,596.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,507.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,241.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,560.88
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
OP
|
$2,992.94
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,992.94 |
| Rate for Payer: Aetna Commercial |
$2,693.65
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,903.15
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.43
|
| Rate for Payer: BCN Commercial |
$2,320.43
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cofinity Commercial |
$2,813.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,992.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,903.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,693.65
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.00
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,019.00
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,615.20
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,633.79
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
IP
|
$2,992.94
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,095.06 |
| Max. Negotiated Rate |
$2,992.94 |
| Rate for Payer: Aetna Commercial |
$2,693.65
|
| Rate for Payer: ASR ASR |
$2,903.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.43
|
| Rate for Payer: BCN Commercial |
$2,320.43
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cofinity Commercial |
$2,813.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.35
|
| Rate for Payer: Healthscope Commercial |
$2,992.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,903.15
|
| Rate for Payer: Mclaren Commercial |
$2,693.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,633.79
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
IP
|
$1,384.85
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$969.40 |
| Max. Negotiated Rate |
$1,384.85 |
| Rate for Payer: Aetna Commercial |
$1,246.36
|
| Rate for Payer: ASR ASR |
$1,343.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.67
|
| Rate for Payer: BCN Commercial |
$1,073.67
|
| Rate for Payer: Cash Price |
$1,107.88
|
| Rate for Payer: Cofinity Commercial |
$1,301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.88
|
| Rate for Payer: Healthscope Commercial |
$1,384.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.30
|
| Rate for Payer: Mclaren Commercial |
$1,246.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,218.67
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
OP
|
$1,384.85
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,384.85 |
| Rate for Payer: Aetna Commercial |
$1,246.36
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,343.30
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.67
|
| Rate for Payer: BCN Commercial |
$1,073.67
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,107.88
|
| Rate for Payer: Cash Price |
$1,107.88
|
| Rate for Payer: Cofinity Commercial |
$1,301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,107.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,384.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,246.36
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.12
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,260.21
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$983.24
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,218.67
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
