|
HC HLA57 GENOTYPE, ABACAVIR
|
Facility
|
IP
|
$283.48
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
31000137
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$212.61 |
| Max. Negotiated Rate |
$283.48 |
| Rate for Payer: Aetna Commercial |
$255.13
|
| Rate for Payer: ASR ASR |
$274.98
|
| Rate for Payer: BCBS Trust/PPO |
$232.79
|
| Rate for Payer: BCN Commercial |
$232.79
|
| Rate for Payer: Cash Price |
$226.78
|
| Rate for Payer: Cofinity Commercial |
$266.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.78
|
| Rate for Payer: Healthscope Commercial |
$274.98
|
| Rate for Payer: Healthscope Whirlpool |
$283.48
|
| Rate for Payer: Mclaren Commercial |
$255.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.96
|
| Rate for Payer: Nomi Health Commercial |
$232.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.46
|
|
|
HC HLA57 GENOTYPE, ABACAVIR
|
Facility
|
OP
|
$283.48
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
31000137
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.86 |
| Max. Negotiated Rate |
$283.48 |
| Rate for Payer: Aetna Commercial |
$255.13
|
| Rate for Payer: Aetna Medicare |
$169.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.38
|
| Rate for Payer: ASR ASR |
$274.98
|
| Rate for Payer: BCBS Complete |
$93.31
|
| Rate for Payer: BCBS MAPPO |
$169.90
|
| Rate for Payer: BCBS Trust/PPO |
$233.73
|
| Rate for Payer: BCN Commercial |
$233.73
|
| Rate for Payer: BCN Medicare Advantage |
$169.90
|
| Rate for Payer: Cash Price |
$226.78
|
| Rate for Payer: Cash Price |
$226.78
|
| Rate for Payer: Cofinity Commercial |
$266.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.90
|
| Rate for Payer: Healthscope Commercial |
$274.98
|
| Rate for Payer: Healthscope Whirlpool |
$283.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.90
|
| Rate for Payer: Mclaren Commercial |
$255.13
|
| Rate for Payer: Mclaren Medicaid |
$169.90
|
| Rate for Payer: Mclaren Medicare |
$169.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.40
|
| Rate for Payer: Meridian Medicaid |
$93.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.96
|
| Rate for Payer: Nomi Health Commercial |
$232.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.61
|
| Rate for Payer: PACE Medicare |
$161.41
|
| Rate for Payer: PACE SWMI |
$169.90
|
| Rate for Payer: PHP Commercial |
$186.89
|
| Rate for Payer: PHP Medicaid |
$91.07
|
| Rate for Payer: PHP Medicare Advantage |
$169.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$188.06
|
| Rate for Payer: Priority Health Medicare |
$169.90
|
| Rate for Payer: Priority Health Narrow Network |
$150.44
|
| Rate for Payer: Railroad Medicare Medicare |
$169.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.90
|
| Rate for Payer: UHC Exchange |
$263.35
|
| Rate for Payer: UHC Medicaid |
$88.86
|
| Rate for Payer: UHCCP DNSP |
$169.90
|
| Rate for Payer: UHCCP Medicaid |
$88.86
|
| Rate for Payer: VA VA |
$169.90
|
|
|
HC HLA B27 TISSUE TYPING
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.83
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
|
|
HC HLA B27 TISSUE TYPING
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$113.79 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: ASR ASR |
$49.41
|
| Rate for Payer: BCBS Complete |
$14.17
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.00
|
| Rate for Payer: BCN Commercial |
$42.00
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$49.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$25.81
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$41.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$28.39
|
| Rate for Payer: PHP Medicaid |
$13.83
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.79
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$91.03
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicaid |
$13.50
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.50
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC HLA MATCH PLATELETS
|
Facility
|
IP
|
$2,811.89
|
|
|
Service Code
|
HCPCS P9052
|
| Hospital Charge Code |
39000062
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,108.92 |
| Max. Negotiated Rate |
$2,811.89 |
| Rate for Payer: Aetna Commercial |
$2,530.70
|
| Rate for Payer: ASR ASR |
$2,727.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.12
|
| Rate for Payer: BCN Commercial |
$2,309.12
|
| Rate for Payer: Cash Price |
$2,249.51
|
| Rate for Payer: Cofinity Commercial |
$2,643.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,249.51
|
| Rate for Payer: Healthscope Commercial |
$2,727.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,811.89
|
| Rate for Payer: Mclaren Commercial |
$2,530.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,390.11
|
| Rate for Payer: Nomi Health Commercial |
$2,305.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,474.46
|
|
|
HC HLA MATCH PLATELETS
|
Facility
|
OP
|
$2,811.89
|
|
|
Service Code
|
HCPCS P9052
|
| Hospital Charge Code |
39000062
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$361.16 |
| Max. Negotiated Rate |
$2,811.89 |
| Rate for Payer: Aetna Commercial |
$2,530.70
|
| Rate for Payer: Aetna Medicare |
$690.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$863.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$863.20
|
| Rate for Payer: ASR ASR |
$2,727.53
|
| Rate for Payer: BCBS Complete |
$379.26
|
| Rate for Payer: BCBS MAPPO |
$690.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,318.40
|
| Rate for Payer: BCN Commercial |
$2,318.40
|
| Rate for Payer: BCN Medicare Advantage |
$690.56
|
| Rate for Payer: Cash Price |
$2,249.51
|
| Rate for Payer: Cash Price |
$2,249.51
|
| Rate for Payer: Cofinity Commercial |
$2,643.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,249.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.56
|
| Rate for Payer: Healthscope Commercial |
$2,727.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,811.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$690.56
|
| Rate for Payer: Mclaren Commercial |
$2,530.70
|
| Rate for Payer: Mclaren Medicaid |
$690.56
|
| Rate for Payer: Mclaren Medicare |
$690.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.09
|
| Rate for Payer: Meridian Medicaid |
$379.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$794.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$759.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,390.11
|
| Rate for Payer: Nomi Health Commercial |
$2,305.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.92
|
| Rate for Payer: PACE Medicare |
$656.03
|
| Rate for Payer: PACE SWMI |
$690.56
|
| Rate for Payer: PHP Commercial |
$759.62
|
| Rate for Payer: PHP Medicaid |
$370.14
|
| Rate for Payer: PHP Medicare Advantage |
$690.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,463.78
|
| Rate for Payer: Priority Health Medicare |
$690.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,971.13
|
| Rate for Payer: Railroad Medicare Medicare |
$690.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,474.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$690.56
|
| Rate for Payer: UHC Exchange |
$1,070.37
|
| Rate for Payer: UHC Medicaid |
$361.16
|
| Rate for Payer: UHCCP DNSP |
$690.56
|
| Rate for Payer: UHCCP Medicaid |
$361.16
|
| Rate for Payer: VA VA |
$690.56
|
|
|
HC HOLTER MONITOR
|
Facility
|
OP
|
$679.03
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
73100001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$679.03 |
| Rate for Payer: Aetna Commercial |
$611.13
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$658.66
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$559.86
|
| Rate for Payer: BCN Commercial |
$559.86
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$543.22
|
| Rate for Payer: Cash Price |
$543.22
|
| Rate for Payer: Cofinity Commercial |
$638.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$658.66
|
| Rate for Payer: Healthscope Whirlpool |
$679.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$611.13
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.18
|
| Rate for Payer: Nomi Health Commercial |
$556.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.27
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.21
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$148.17
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC HOLTER MONITOR
|
Facility
|
IP
|
$679.03
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
73100001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$509.27 |
| Max. Negotiated Rate |
$679.03 |
| Rate for Payer: Aetna Commercial |
$611.13
|
| Rate for Payer: ASR ASR |
$658.66
|
| Rate for Payer: BCBS Trust/PPO |
$557.62
|
| Rate for Payer: BCN Commercial |
$557.62
|
| Rate for Payer: Cash Price |
$543.22
|
| Rate for Payer: Cofinity Commercial |
$638.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.22
|
| Rate for Payer: Healthscope Commercial |
$658.66
|
| Rate for Payer: Healthscope Whirlpool |
$679.03
|
| Rate for Payer: Mclaren Commercial |
$611.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.18
|
| Rate for Payer: Nomi Health Commercial |
$556.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.55
|
|
|
HC HOLTER SCAN
|
Facility
|
IP
|
$1,074.74
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
73100003
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$806.05 |
| Max. Negotiated Rate |
$1,074.74 |
| Rate for Payer: Aetna Commercial |
$967.27
|
| Rate for Payer: ASR ASR |
$1,042.50
|
| Rate for Payer: BCBS Trust/PPO |
$882.58
|
| Rate for Payer: BCN Commercial |
$882.58
|
| Rate for Payer: Cash Price |
$859.79
|
| Rate for Payer: Cofinity Commercial |
$1,010.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.79
|
| Rate for Payer: Healthscope Commercial |
$1,042.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,074.74
|
| Rate for Payer: Mclaren Commercial |
$967.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.53
|
| Rate for Payer: Nomi Health Commercial |
$881.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$945.77
|
|
|
HC HOLTER SCAN
|
Facility
|
OP
|
$1,074.74
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
73100003
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$1,074.74 |
| Rate for Payer: Aetna Commercial |
$967.27
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$1,042.50
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$886.12
|
| Rate for Payer: BCN Commercial |
$886.12
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$859.79
|
| Rate for Payer: Cash Price |
$859.79
|
| Rate for Payer: Cofinity Commercial |
$1,010.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$1,042.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,074.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$967.27
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.53
|
| Rate for Payer: Nomi Health Commercial |
$881.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.05
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.21
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$148.17
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$945.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC HOME SLEEP TEST TYPE 3 PORTA
|
Facility
|
OP
|
$216.41
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000027
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$333.48 |
| Rate for Payer: Aetna Commercial |
$194.77
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$209.92
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$178.43
|
| Rate for Payer: BCN Commercial |
$178.43
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$209.92
|
| Rate for Payer: Healthscope Whirlpool |
$216.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$194.77
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.62
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$151.70
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC HOME SLEEP TEST TYPE 3 PORTA
|
Facility
|
IP
|
$216.41
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000027
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$216.41 |
| Rate for Payer: Aetna Commercial |
$194.77
|
| Rate for Payer: ASR ASR |
$209.92
|
| Rate for Payer: BCBS Trust/PPO |
$177.72
|
| Rate for Payer: BCN Commercial |
$177.72
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Healthscope Commercial |
$209.92
|
| Rate for Payer: Healthscope Whirlpool |
$216.41
|
| Rate for Payer: Mclaren Commercial |
$194.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.44
|
|
|
HC HOME SLEEP TEST/TYPE 4 PORTA
|
Facility
|
IP
|
$216.41
|
|
|
Service Code
|
HCPCS G0400
|
| Hospital Charge Code |
92000028
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$216.41 |
| Rate for Payer: Aetna Commercial |
$194.77
|
| Rate for Payer: ASR ASR |
$209.92
|
| Rate for Payer: BCBS Trust/PPO |
$177.72
|
| Rate for Payer: BCN Commercial |
$177.72
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Healthscope Commercial |
$209.92
|
| Rate for Payer: Healthscope Whirlpool |
$216.41
|
| Rate for Payer: Mclaren Commercial |
$194.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.44
|
|
|
HC HOME SLEEP TEST/TYPE 4 PORTA
|
Facility
|
OP
|
$216.41
|
|
|
Service Code
|
HCPCS G0400
|
| Hospital Charge Code |
92000028
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$333.48 |
| Rate for Payer: Aetna Commercial |
$194.77
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$209.92
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$178.43
|
| Rate for Payer: BCN Commercial |
$178.43
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$209.92
|
| Rate for Payer: Healthscope Whirlpool |
$216.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$194.77
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.62
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$151.70
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC HOMOCYSTEINE SERUM
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
30100243
|
|
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 HOMOCYSTEINE SERUM
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
30100243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$163.42 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$17.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$17.92
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$17.92
|
| 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 |
$17.92
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.92
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$17.92
|
| Rate for Payer: Mclaren Medicare |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.82
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.71
|
| 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 |
$17.02
|
| Rate for Payer: PACE SWMI |
$17.92
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$163.42
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: Priority Health Narrow Network |
$130.74
|
| Rate for Payer: Railroad Medicare Medicare |
$17.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.92
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.37
|
| Rate for Payer: UHCCP DNSP |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
| Rate for Payer: VA VA |
$17.92
|
|
|
HC HOMOVANILLIC ACID RANDOM URINE
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$64.73 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: Aetna Medicare |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.01
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$53.37
|
| Rate for Payer: BCN Commercial |
$53.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.41
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.41
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.41
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Mclaren Medicaid |
$22.41
|
| Rate for Payer: Mclaren Medicare |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.53
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Medicare |
$21.29
|
| Rate for Payer: PACE SWMI |
$22.41
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicaid |
$12.01
|
| Rate for Payer: PHP Medicare Advantage |
$22.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.72
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow Network |
$45.38
|
| Rate for Payer: Railroad Medicare Medicare |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.41
|
| Rate for Payer: UHC Exchange |
$34.74
|
| Rate for Payer: UHC Medicaid |
$11.72
|
| Rate for Payer: UHCCP DNSP |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: VA VA |
$22.41
|
|
|
HC HOMOVANILLIC ACID RANDOM URINE
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$64.73 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Trust/PPO |
$53.16
|
| Rate for Payer: BCN Commercial |
$53.16
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
|
|
HC HOMOVANILLIC ACID URINE
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$64.73 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Trust/PPO |
$53.16
|
| Rate for Payer: BCN Commercial |
$53.16
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
|
|
HC HOMOVANILLIC ACID URINE
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$64.73 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: Aetna Medicare |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.01
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$53.37
|
| Rate for Payer: BCN Commercial |
$53.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.41
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.41
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.41
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Mclaren Medicaid |
$22.41
|
| Rate for Payer: Mclaren Medicare |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.53
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Medicare |
$21.29
|
| Rate for Payer: PACE SWMI |
$22.41
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicaid |
$12.01
|
| Rate for Payer: PHP Medicare Advantage |
$22.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.72
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow Network |
$45.38
|
| Rate for Payer: Railroad Medicare Medicare |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.41
|
| Rate for Payer: UHC Exchange |
$34.74
|
| Rate for Payer: UHC Medicaid |
$11.72
|
| Rate for Payer: UHCCP DNSP |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: VA VA |
$22.41
|
|
|
HC HONEY BEE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200089
|
|
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 HONEY BEE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200089
|
|
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 HOSP OUTPT CONSULT LVL 2
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000125
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$132.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$227.56
|
| Rate for Payer: BCN Commercial |
$227.56
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$267.72
|
| Rate for Payer: Healthscope Whirlpool |
$276.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.66
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$132.66
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$72.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$145.93
|
| Rate for Payer: PHP Medicaid |
$71.11
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$116.80
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health Narrow Network |
$93.44
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$205.62
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP DNSP |
$132.66
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC HOSP OUTPT CONSULT LVL 2
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000125
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$226.65
|
| Rate for Payer: BCN Commercial |
$226.65
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$267.72
|
| Rate for Payer: Healthscope Whirlpool |
$276.00
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOSP OUTPT CONSULT LVL 3
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$226.65
|
| Rate for Payer: BCN Commercial |
$226.65
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$267.72
|
| Rate for Payer: Healthscope Whirlpool |
$276.00
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
