|
HC IFR MEASUREMENT
|
Facility
|
IP
|
$3,956.14
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100132
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,967.11 |
| Max. Negotiated Rate |
$3,956.14 |
| Rate for Payer: Aetna Commercial |
$3,560.53
|
| Rate for Payer: ASR ASR |
$3,837.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,248.78
|
| Rate for Payer: BCN Commercial |
$3,248.78
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Commercial |
$3,718.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,837.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,956.14
|
| Rate for Payer: Mclaren Commercial |
$3,560.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Nomi Health Commercial |
$3,244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,481.40
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
OP
|
$14.37
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$14.37 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.03
|
| Rate for Payer: ASR ASR |
$13.94
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$11.85
|
| Rate for Payer: BCN Commercial |
$11.85
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: Healthscope Whirlpool |
$14.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.02
|
| Rate for Payer: Mclaren Commercial |
$12.93
|
| Rate for Payer: Mclaren Medicaid |
$8.02
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: Meridian Medicaid |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Nomi Health Commercial |
$11.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.78
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: PHP Medicaid |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.59
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow Network |
$10.07
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.02
|
| Rate for Payer: UHC Exchange |
$12.43
|
| Rate for Payer: UHC Medicaid |
$4.19
|
| Rate for Payer: UHCCP DNSP |
$8.02
|
| Rate for Payer: UHCCP Medicaid |
$4.19
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
IP
|
$14.37
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$14.37 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: ASR ASR |
$13.94
|
| Rate for Payer: BCBS Trust/PPO |
$11.80
|
| Rate for Payer: BCN Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: Healthscope Whirlpool |
$14.37
|
| Rate for Payer: Mclaren Commercial |
$12.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Nomi Health Commercial |
$11.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.65
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$9.30
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
OP
|
$16.98
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$16.47
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$14.00
|
| Rate for Payer: BCN Commercial |
$14.00
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Whirlpool |
$16.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$15.28
|
| Rate for Payer: Mclaren Medicaid |
$7.78
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.43
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.88
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$11.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.78
|
| Rate for Payer: UHC Exchange |
$12.06
|
| Rate for Payer: UHC Medicaid |
$4.07
|
| Rate for Payer: UHCCP DNSP |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.07
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
IP
|
$16.98
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: ASR ASR |
$16.47
|
| Rate for Payer: BCBS Trust/PPO |
$13.94
|
| Rate for Payer: BCN Commercial |
$13.94
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Whirlpool |
$16.98
|
| Rate for Payer: Mclaren Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.43
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.94
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$9.30
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.75
|
| Rate for Payer: BCN Commercial |
$8.75
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: Mclaren Medicaid |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Medicaid |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$15.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UHC Medicaid |
$2.59
|
| Rate for Payer: UHCCP DNSP |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.59
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$8.71
|
| Rate for Payer: BCN Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$527.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$395.42 |
| Max. Negotiated Rate |
$527.22 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: ASR ASR |
$511.40
|
| Rate for Payer: BCBS Trust/PPO |
$432.95
|
| Rate for Payer: BCN Commercial |
$432.95
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cofinity Commercial |
$495.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.78
|
| Rate for Payer: Healthscope Commercial |
$511.40
|
| Rate for Payer: Healthscope Whirlpool |
$527.22
|
| Rate for Payer: Mclaren Commercial |
$474.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.14
|
| Rate for Payer: Nomi Health Commercial |
$432.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.95
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$527.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$527.22 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna Medicare |
$294.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.15
|
| Rate for Payer: ASR ASR |
$511.40
|
| Rate for Payer: BCBS Complete |
$161.75
|
| Rate for Payer: BCBS MAPPO |
$294.52
|
| Rate for Payer: BCBS Trust/PPO |
$434.69
|
| Rate for Payer: BCN Commercial |
$434.69
|
| Rate for Payer: BCN Medicare Advantage |
$294.52
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cofinity Commercial |
$495.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$511.40
|
| Rate for Payer: Healthscope Whirlpool |
$527.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$294.52
|
| Rate for Payer: Mclaren Commercial |
$474.50
|
| Rate for Payer: Mclaren Medicaid |
$294.52
|
| Rate for Payer: Mclaren Medicare |
$294.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.25
|
| Rate for Payer: Meridian Medicaid |
$161.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$323.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.14
|
| Rate for Payer: Nomi Health Commercial |
$432.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.42
|
| Rate for Payer: PACE Medicare |
$279.79
|
| Rate for Payer: PACE SWMI |
$294.52
|
| Rate for Payer: PHP Commercial |
$323.97
|
| Rate for Payer: PHP Medicaid |
$157.86
|
| Rate for Payer: PHP Medicare Advantage |
$294.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.29
|
| Rate for Payer: Priority Health Medicare |
$294.52
|
| Rate for Payer: Priority Health Narrow Network |
$236.23
|
| Rate for Payer: Railroad Medicare Medicare |
$294.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$294.52
|
| Rate for Payer: UHC Exchange |
$456.51
|
| Rate for Payer: UHC Medicaid |
$154.03
|
| Rate for Payer: UHCCP DNSP |
$294.52
|
| Rate for Payer: UHCCP Medicaid |
$154.03
|
| Rate for Payer: VA VA |
$294.52
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,354.99
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$871.35 |
| Max. Negotiated Rate |
$2,354.99 |
| Rate for Payer: Aetna Commercial |
$2,119.49
|
| Rate for Payer: Aetna Medicare |
$871.35
|
| Rate for Payer: ASR ASR |
$2,284.34
|
| Rate for Payer: BCBS Complete |
$942.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,941.69
|
| Rate for Payer: BCN Commercial |
$1,941.69
|
| Rate for Payer: Cash Price |
$1,883.99
|
| Rate for Payer: Cofinity Commercial |
$2,213.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.99
|
| Rate for Payer: Healthscope Commercial |
$2,284.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,354.99
|
| Rate for Payer: Mclaren Commercial |
$2,119.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,883.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.74
|
| Rate for Payer: Nomi Health Commercial |
$1,931.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,766.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,063.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,650.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,072.39
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,354.99
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,766.24 |
| Max. Negotiated Rate |
$2,354.99 |
| Rate for Payer: Aetna Commercial |
$2,119.49
|
| Rate for Payer: ASR ASR |
$2,284.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,933.92
|
| Rate for Payer: BCN Commercial |
$1,933.92
|
| Rate for Payer: Cash Price |
$1,883.99
|
| Rate for Payer: Cofinity Commercial |
$2,213.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.99
|
| Rate for Payer: Healthscope Commercial |
$2,284.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,354.99
|
| Rate for Payer: Mclaren Commercial |
$2,119.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.74
|
| Rate for Payer: Nomi Health Commercial |
$1,931.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,766.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,072.39
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,810.84
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,040.01 |
| Max. Negotiated Rate |
$2,810.84 |
| Rate for Payer: Aetna Commercial |
$2,529.76
|
| Rate for Payer: Aetna Medicare |
$1,040.01
|
| Rate for Payer: ASR ASR |
$2,726.51
|
| Rate for Payer: BCBS Complete |
$1,124.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.54
|
| Rate for Payer: BCN Commercial |
$2,317.54
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cofinity Commercial |
$2,642.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,248.67
|
| Rate for Payer: Healthscope Commercial |
$2,726.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,810.84
|
| Rate for Payer: Mclaren Commercial |
$2,529.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,248.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,389.21
|
| Rate for Payer: Nomi Health Commercial |
$2,304.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,462.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,970.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,473.54
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,810.84
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,108.13 |
| Max. Negotiated Rate |
$2,810.84 |
| Rate for Payer: Aetna Commercial |
$2,529.76
|
| Rate for Payer: ASR ASR |
$2,726.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.26
|
| Rate for Payer: BCN Commercial |
$2,308.26
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cofinity Commercial |
$2,642.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,248.67
|
| Rate for Payer: Healthscope Commercial |
$2,726.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,810.84
|
| Rate for Payer: Mclaren Commercial |
$2,529.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,389.21
|
| Rate for Payer: Nomi Health Commercial |
$2,304.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,473.54
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$142.17
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$142.17 |
| Rate for Payer: Aetna Commercial |
$127.95
|
| Rate for Payer: ASR ASR |
$137.90
|
| Rate for Payer: BCBS Trust/PPO |
$116.75
|
| Rate for Payer: BCN Commercial |
$116.75
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cofinity Commercial |
$133.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.74
|
| Rate for Payer: Healthscope Commercial |
$137.90
|
| Rate for Payer: Healthscope Whirlpool |
$142.17
|
| Rate for Payer: Mclaren Commercial |
$127.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.84
|
| Rate for Payer: Nomi Health Commercial |
$116.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.11
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$142.17
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$127.95
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$137.90
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$117.22
|
| Rate for Payer: BCN Commercial |
$117.22
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cofinity Commercial |
$133.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$137.90
|
| Rate for Payer: Healthscope Whirlpool |
$142.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$127.95
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.84
|
| Rate for Payer: Nomi Health Commercial |
$116.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.63
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$124.57
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$99.66
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$108.11
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$108.11 |
| Rate for Payer: Aetna Commercial |
$97.30
|
| Rate for Payer: ASR ASR |
$104.87
|
| Rate for Payer: BCBS Trust/PPO |
$88.78
|
| Rate for Payer: BCN Commercial |
$88.78
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cofinity Commercial |
$101.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.49
|
| Rate for Payer: Healthscope Commercial |
$104.87
|
| Rate for Payer: Healthscope Whirlpool |
$108.11
|
| Rate for Payer: Mclaren Commercial |
$97.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.14
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$108.11
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$108.11 |
| Rate for Payer: Aetna Commercial |
$97.30
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: ASR ASR |
$104.87
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: BCBS Trust/PPO |
$89.14
|
| Rate for Payer: BCN Commercial |
$89.14
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cofinity Commercial |
$101.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.49
|
| Rate for Payer: Healthscope Commercial |
$104.87
|
| Rate for Payer: Healthscope Whirlpool |
$108.11
|
| Rate for Payer: Mclaren Commercial |
$97.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.73
|
| Rate for Payer: Priority Health Narrow Network |
$75.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.14
|
|
|
HC IMG RETINA DETCN/MNTR DS POC AUTON A/R UNI/BI
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 92229
|
| Hospital Charge Code |
92000034
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| 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 |
$201.76
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$171.50
|
| Rate for Payer: BCN Commercial |
$171.50
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$201.76
|
| Rate for Payer: Healthscope Whirlpool |
$208.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$187.20
|
| 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 |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$170.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| 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 |
$182.25
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$145.81
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.04
|
| 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 IMG RETINA DETCN/MNTR DS POC AUTON A/R UNI/BI
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 92229
|
| Hospital Charge Code |
92000034
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: ASR ASR |
$201.76
|
| Rate for Payer: BCBS Trust/PPO |
$170.81
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$201.76
|
| Rate for Payer: Healthscope Whirlpool |
$208.00
|
| Rate for Payer: Mclaren Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$170.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.04
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$63.99
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$57.59
|
| Rate for Payer: Aetna Medicare |
$35.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.67
|
| Rate for Payer: ASR ASR |
$62.07
|
| Rate for Payer: BCBS Complete |
$19.63
|
| Rate for Payer: BCBS MAPPO |
$35.74
|
| Rate for Payer: BCBS Trust/PPO |
$52.76
|
| Rate for Payer: BCN Commercial |
$52.76
|
| Rate for Payer: BCN Medicare Advantage |
$35.74
|
| 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 |
$35.74
|
| Rate for Payer: Healthscope Commercial |
$62.07
|
| Rate for Payer: Healthscope Whirlpool |
$63.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.74
|
| Rate for Payer: Mclaren Commercial |
$57.59
|
| Rate for Payer: Mclaren Medicaid |
$35.74
|
| Rate for Payer: Mclaren Medicare |
$35.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.53
|
| Rate for Payer: Meridian Medicaid |
$19.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.39
|
| Rate for Payer: Nomi Health Commercial |
$52.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.99
|
| Rate for Payer: PACE Medicare |
$33.95
|
| Rate for Payer: PACE SWMI |
$35.74
|
| Rate for Payer: PHP Commercial |
$39.31
|
| Rate for Payer: PHP Medicaid |
$19.16
|
| Rate for Payer: PHP Medicare Advantage |
$35.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.07
|
| Rate for Payer: Priority Health Medicare |
$35.74
|
| Rate for Payer: Priority Health Narrow Network |
$44.86
|
| Rate for Payer: Railroad Medicare Medicare |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.74
|
| Rate for Payer: UHC Exchange |
$55.40
|
| Rate for Payer: UHC Medicaid |
$18.69
|
| Rate for Payer: UHCCP DNSP |
$35.74
|
| Rate for Payer: UHCCP Medicaid |
$18.69
|
| Rate for Payer: VA VA |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$63.99
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.99 |
| 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 |
$52.55
|
| Rate for Payer: BCN Commercial |
$52.55
|
| 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 |
$62.07
|
| Rate for Payer: Healthscope Whirlpool |
$63.99
|
| Rate for Payer: Mclaren Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.39
|
| Rate for Payer: Nomi Health Commercial |
$52.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.31
|
|
