|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
IP
|
$2,533.58
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,773.51 |
| Max. Negotiated Rate |
$2,533.58 |
| Rate for Payer: Aetna Commercial |
$2,280.22
|
| Rate for Payer: ASR ASR |
$2,457.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,964.28
|
| Rate for Payer: BCN Commercial |
$1,964.28
|
| Rate for Payer: Cash Price |
$2,026.86
|
| Rate for Payer: Cofinity Commercial |
$2,381.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,026.86
|
| Rate for Payer: Healthscope Commercial |
$2,533.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,457.57
|
| Rate for Payer: Mclaren Commercial |
$2,280.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,153.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,773.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,229.55
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
OP
|
$2,533.58
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,533.58 |
| Rate for Payer: Aetna Commercial |
$2,280.22
|
| 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 |
$2,457.57
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,964.28
|
| Rate for Payer: BCN Commercial |
$1,964.28
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,026.86
|
| Rate for Payer: Cash Price |
$2,026.86
|
| Rate for Payer: Cofinity Commercial |
$2,381.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,026.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,533.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,457.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,280.22
|
| 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 |
$2,153.54
|
| 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 |
$1,773.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,229.55
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR UPPER EXTREM NO JOINT W CON
|
Facility
|
OP
|
$2,329.17
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,329.17 |
| Rate for Payer: Aetna Commercial |
$2,096.25
|
| Rate for Payer: Aetna Commercial |
$3,144.38
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,259.29
|
| Rate for Payer: ASR ASR |
$3,388.94
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,708.70
|
| Rate for Payer: BCN Commercial |
$2,708.70
|
| Rate for Payer: BCN Commercial |
$1,805.81
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,795.00
|
| Rate for Payer: Cash Price |
$2,795.00
|
| Rate for Payer: Cash Price |
$1,863.34
|
| Rate for Payer: Cash Price |
$1,863.34
|
| Rate for Payer: Cofinity Commercial |
$3,284.12
|
| Rate for Payer: Cofinity Commercial |
$2,189.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,795.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,863.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,329.17
|
| Rate for Payer: Healthscope Commercial |
$3,493.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,259.29
|
| Rate for Payer: Healthscope Whirlpool |
$3,388.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$3,144.38
|
| Rate for Payer: Mclaren Commercial |
$2,096.25
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,979.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,969.69
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,445.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,049.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,074.50
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR UPPER EXTREM NO JOINT W CON
|
Facility
|
IP
|
$3,493.75
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,445.62 |
| Max. Negotiated Rate |
$3,493.75 |
| Rate for Payer: Aetna Commercial |
$3,144.38
|
| Rate for Payer: Aetna Commercial |
$2,096.25
|
| Rate for Payer: ASR ASR |
$3,388.94
|
| Rate for Payer: ASR ASR |
$2,259.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,708.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.81
|
| Rate for Payer: BCN Commercial |
$1,805.81
|
| Rate for Payer: BCN Commercial |
$2,708.70
|
| Rate for Payer: Cash Price |
$1,863.34
|
| Rate for Payer: Cash Price |
$2,795.00
|
| Rate for Payer: Cofinity Commercial |
$2,189.42
|
| Rate for Payer: Cofinity Commercial |
$3,284.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,795.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,863.34
|
| Rate for Payer: Healthscope Commercial |
$3,493.75
|
| Rate for Payer: Healthscope Commercial |
$2,329.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,259.29
|
| Rate for Payer: Healthscope Whirlpool |
$3,388.94
|
| Rate for Payer: Mclaren Commercial |
$3,144.38
|
| Rate for Payer: Mclaren Commercial |
$2,096.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,969.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,979.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,445.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,049.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,074.50
|
|
|
HC MR UPPER EXTREM NO JOINT WO CON
|
Facility
|
OP
|
$1,995.22
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,995.22 |
| Rate for Payer: Aetna Commercial |
$1,795.70
|
| Rate for Payer: Aetna Commercial |
$2,693.55
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,935.36
|
| Rate for Payer: ASR ASR |
$2,903.05
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.89
|
| Rate for Payer: BCN Commercial |
$2,320.34
|
| Rate for Payer: BCN Commercial |
$1,546.89
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$2,394.26
|
| Rate for Payer: Cash Price |
$2,394.26
|
| Rate for Payer: Cofinity Commercial |
$1,875.51
|
| Rate for Payer: Cofinity Commercial |
$2,813.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,995.22
|
| Rate for Payer: Healthscope Commercial |
$2,992.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,903.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,935.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$2,693.55
|
| Rate for Payer: Mclaren Commercial |
$1,795.70
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,543.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.94
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,094.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.74
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,246.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,246.19
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,633.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.79
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR UPPER EXTREM NO JOINT WO CON
|
Facility
|
IP
|
$1,995.22
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,396.65 |
| Max. Negotiated Rate |
$1,995.22 |
| Rate for Payer: Aetna Commercial |
$1,795.70
|
| Rate for Payer: Aetna Commercial |
$2,693.55
|
| Rate for Payer: ASR ASR |
$1,935.36
|
| Rate for Payer: ASR ASR |
$2,903.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.89
|
| Rate for Payer: BCN Commercial |
$2,320.34
|
| Rate for Payer: BCN Commercial |
$1,546.89
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$2,394.26
|
| Rate for Payer: Cofinity Commercial |
$1,875.51
|
| Rate for Payer: Cofinity Commercial |
$2,813.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Healthscope Commercial |
$1,995.22
|
| Rate for Payer: Healthscope Commercial |
$2,992.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,903.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,935.36
|
| Rate for Payer: Mclaren Commercial |
$2,693.55
|
| Rate for Payer: Mclaren Commercial |
$1,795.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,543.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,094.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,633.69
|
|
|
HC MR UPPER EXTREM NO JOINT WO W CON
|
Facility
|
OP
|
$3,436.30
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$3,436.30 |
| Rate for Payer: Aetna Commercial |
$3,092.67
|
| Rate for Payer: Aetna Commercial |
$2,061.77
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,222.13
|
| Rate for Payer: ASR ASR |
$3,333.21
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,664.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,776.10
|
| Rate for Payer: BCN Commercial |
$1,776.10
|
| Rate for Payer: BCN Commercial |
$2,664.16
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,749.04
|
| Rate for Payer: Cash Price |
$2,749.04
|
| Rate for Payer: Cash Price |
$1,832.69
|
| Rate for Payer: Cash Price |
$1,832.69
|
| Rate for Payer: Cofinity Commercial |
$3,230.12
|
| Rate for Payer: Cofinity Commercial |
$2,153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,832.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,749.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$3,436.30
|
| Rate for Payer: Healthscope Commercial |
$2,290.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,222.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,333.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$3,092.67
|
| Rate for Payer: Mclaren Commercial |
$2,061.77
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,920.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,947.23
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,405.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,603.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,015.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,023.94
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR UPPER EXTREM NO JOINT WO W CON
|
Facility
|
IP
|
$3,436.30
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,405.41 |
| Max. Negotiated Rate |
$3,436.30 |
| Rate for Payer: Aetna Commercial |
$3,092.67
|
| Rate for Payer: Aetna Commercial |
$2,061.77
|
| Rate for Payer: ASR ASR |
$3,333.21
|
| Rate for Payer: ASR ASR |
$2,222.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,776.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,664.16
|
| Rate for Payer: BCN Commercial |
$2,664.16
|
| Rate for Payer: BCN Commercial |
$1,776.10
|
| Rate for Payer: Cash Price |
$1,832.69
|
| Rate for Payer: Cash Price |
$2,749.04
|
| Rate for Payer: Cofinity Commercial |
$3,230.12
|
| Rate for Payer: Cofinity Commercial |
$2,153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,832.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,749.04
|
| Rate for Payer: Healthscope Commercial |
$2,290.86
|
| Rate for Payer: Healthscope Commercial |
$3,436.30
|
| Rate for Payer: Healthscope Whirlpool |
$3,333.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,222.13
|
| Rate for Payer: Mclaren Commercial |
$2,061.77
|
| Rate for Payer: Mclaren Commercial |
$3,092.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,947.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,920.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,405.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,603.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,015.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,023.94
|
|
|
HC MSMART BM CMPT1
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100045
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: ASR ASR |
$232.80
|
| Rate for Payer: BCBS Trust/PPO |
$186.07
|
| Rate for Payer: BCN Commercial |
$186.07
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$225.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.00
|
| Rate for Payer: Healthscope Commercial |
$240.00
|
| Rate for Payer: Healthscope Whirlpool |
$232.80
|
| Rate for Payer: Mclaren Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.20
|
|
|
HC MSMART BM CMPT1
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100045
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.21
|
| Rate for Payer: ASR ASR |
$232.80
|
| Rate for Payer: BCBS Complete |
$27.67
|
| Rate for Payer: BCBS MAPPO |
$48.17
|
| Rate for Payer: BCBS Trust/PPO |
$186.07
|
| Rate for Payer: BCN Commercial |
$186.07
|
| Rate for Payer: BCN Medicare Advantage |
$48.17
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$225.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.17
|
| Rate for Payer: Healthscope Commercial |
$240.00
|
| Rate for Payer: Healthscope Whirlpool |
$232.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$48.17
|
| Rate for Payer: Mclaren Commercial |
$216.00
|
| Rate for Payer: Mclaren Medicaid |
$26.35
|
| Rate for Payer: Mclaren Medicare |
$48.17
|
| Rate for Payer: Meridian Medicaid |
$27.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: PACE Medicare |
$45.76
|
| Rate for Payer: PACE SWMI |
$48.17
|
| Rate for Payer: PHP Commercial |
$52.99
|
| Rate for Payer: PHP Medicaid |
$26.35
|
| Rate for Payer: PHP Medicare Advantage |
$48.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.40
|
| Rate for Payer: Priority Health Medicare |
$48.17
|
| Rate for Payer: Priority Health Narrow Network |
$170.40
|
| Rate for Payer: Railroad Medicare Medicare |
$48.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.20
|
| Rate for Payer: UHC Medicare Advantage |
$49.62
|
| Rate for Payer: VA VA |
$48.17
|
|
|
HC MSMART BM CMPT2
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100046
|
|
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 MSMART BM CMPT2
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100046
|
|
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 MSMART BM CMPT3
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: ASR ASR |
$167.81
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$134.13
|
| Rate for Payer: BCN Commercial |
$134.13
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$162.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.40
|
| Rate for Payer: Healthscope Commercial |
$173.00
|
| Rate for Payer: Healthscope Whirlpool |
$167.81
|
| Rate for Payer: Mclaren Commercial |
$155.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| 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 |
$152.24
|
|
|
HC MSMART BM CMPT3
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: ASR ASR |
$167.81
|
| Rate for Payer: BCBS Trust/PPO |
$134.13
|
| Rate for Payer: BCN Commercial |
$134.13
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$162.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.40
|
| Rate for Payer: Healthscope Commercial |
$173.00
|
| Rate for Payer: Healthscope Whirlpool |
$167.81
|
| Rate for Payer: Mclaren Commercial |
$155.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.24
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
IP
|
$63.99
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: ASR ASR |
$62.07
|
| Rate for Payer: BCBS Trust/PPO |
$49.61
|
| Rate for Payer: BCN Commercial |
$49.61
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$60.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$63.99
|
| Rate for Payer: Healthscope Whirlpool |
$62.07
|
| Rate for Payer: Mclaren Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.31
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
OP
|
$63.99
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Aetna Medicare |
$41.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: ASR ASR |
$62.07
|
| Rate for Payer: BCBS Complete |
$23.94
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$49.61
|
| Rate for Payer: BCN Commercial |
$49.61
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$60.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$63.99
|
| Rate for Payer: Healthscope Whirlpool |
$62.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.68
|
| Rate for Payer: Mclaren Commercial |
$57.59
|
| Rate for Payer: Mclaren Medicaid |
$22.80
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Medicaid |
$23.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.39
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: PHP Medicaid |
$22.80
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.23
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health Narrow Network |
$45.43
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.31
|
| Rate for Payer: UHC Medicare Advantage |
$42.93
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR CMPT
|
Facility
|
IP
|
$53.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$48.15
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Trust/PPO |
$41.48
|
| Rate for Payer: BCN Commercial |
$41.48
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$50.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.80
|
| Rate for Payer: Healthscope Commercial |
$53.50
|
| Rate for Payer: Healthscope Whirlpool |
$51.90
|
| Rate for Payer: Mclaren Commercial |
$48.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.08
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR CMPT
|
Facility
|
OP
|
$53.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$48.15
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$41.48
|
| Rate for Payer: BCN Commercial |
$41.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$50.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$53.50
|
| Rate for Payer: Healthscope Whirlpool |
$51.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$48.15
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.68
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$37.98
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.08
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MTHFR 2 MUTATIONS
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Medicare |
$65.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.68
|
| Rate for Payer: ASR ASR |
$482.09
|
| Rate for Payer: BCBS Complete |
$37.53
|
| Rate for Payer: BCBS MAPPO |
$65.34
|
| Rate for Payer: BCBS Trust/PPO |
$385.32
|
| Rate for Payer: BCN Commercial |
$385.32
|
| Rate for Payer: BCN Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$467.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$497.00
|
| Rate for Payer: Healthscope Whirlpool |
$482.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$65.34
|
| Rate for Payer: Mclaren Commercial |
$447.30
|
| Rate for Payer: Mclaren Medicaid |
$35.74
|
| Rate for Payer: Mclaren Medicare |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$37.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.45
|
| Rate for Payer: PACE Medicare |
$62.07
|
| Rate for Payer: PACE SWMI |
$65.34
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: PHP Medicaid |
$35.74
|
| Rate for Payer: PHP Medicare Advantage |
$65.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.99
|
| Rate for Payer: Priority Health Medicare |
$65.34
|
| Rate for Payer: Priority Health Narrow Network |
$59.99
|
| Rate for Payer: Railroad Medicare Medicare |
$65.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.36
|
| Rate for Payer: UHC Medicare Advantage |
$67.30
|
| Rate for Payer: VA VA |
$65.34
|
|
|
HC MTHFR 2 MUTATIONS
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: ASR ASR |
$482.09
|
| Rate for Payer: BCBS Trust/PPO |
$385.32
|
| Rate for Payer: BCN Commercial |
$385.32
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$467.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.60
|
| Rate for Payer: Healthscope Commercial |
$497.00
|
| Rate for Payer: Healthscope Whirlpool |
$482.09
|
| Rate for Payer: Mclaren Commercial |
$447.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.36
|
|
|
HC MTHFR MUTATION
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000102
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Medicare |
$65.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.68
|
| Rate for Payer: ASR ASR |
$363.75
|
| Rate for Payer: BCBS Complete |
$37.53
|
| Rate for Payer: BCBS MAPPO |
$65.34
|
| Rate for Payer: BCBS Trust/PPO |
$290.74
|
| Rate for Payer: BCN Commercial |
$290.74
|
| Rate for Payer: BCN Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$352.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$375.00
|
| Rate for Payer: Healthscope Whirlpool |
$363.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$65.34
|
| Rate for Payer: Mclaren Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$35.74
|
| Rate for Payer: Mclaren Medicare |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$37.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PACE Medicare |
$62.07
|
| Rate for Payer: PACE SWMI |
$65.34
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: PHP Medicaid |
$35.74
|
| Rate for Payer: PHP Medicare Advantage |
$65.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.99
|
| Rate for Payer: Priority Health Medicare |
$65.34
|
| Rate for Payer: Priority Health Narrow Network |
$59.99
|
| Rate for Payer: Railroad Medicare Medicare |
$65.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
| Rate for Payer: UHC Medicare Advantage |
$67.30
|
| Rate for Payer: VA VA |
$65.34
|
|
|
HC MTHFR MUTATION
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000102
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: ASR ASR |
$363.75
|
| Rate for Payer: BCBS Trust/PPO |
$290.74
|
| Rate for Payer: BCN Commercial |
$290.74
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$352.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$375.00
|
| Rate for Payer: Healthscope Whirlpool |
$363.75
|
| Rate for Payer: Mclaren Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
|
|
HC M TUBERCULOSIS COMPLEX, PCR
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Medicare |
$41.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: ASR ASR |
$188.18
|
| Rate for Payer: BCBS Complete |
$23.94
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$150.41
|
| Rate for Payer: BCN Commercial |
$150.41
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$182.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$194.00
|
| Rate for Payer: Healthscope Whirlpool |
$188.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.68
|
| Rate for Payer: Mclaren Commercial |
$174.60
|
| Rate for Payer: Mclaren Medicaid |
$22.80
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Medicaid |
$23.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.90
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: PHP Medicaid |
$22.80
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.54
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health Narrow Network |
$137.74
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.72
|
| Rate for Payer: UHC Medicare Advantage |
$42.93
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC M TUBERCULOSIS COMPLEX, PCR
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: ASR ASR |
$188.18
|
| Rate for Payer: BCBS Trust/PPO |
$150.41
|
| Rate for Payer: BCN Commercial |
$150.41
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$182.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.20
|
| Rate for Payer: Healthscope Commercial |
$194.00
|
| Rate for Payer: Healthscope Whirlpool |
$188.18
|
| Rate for Payer: Mclaren Commercial |
$174.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.72
|
|
|
HC MUCORE RACEMOSUS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200093
|
|
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
|
|
