|
HC INDIRECT CALORIMETRY
|
Facility
|
IP
|
$1,189.62
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$892.22 |
| Max. Negotiated Rate |
$1,189.62 |
| Rate for Payer: Aetna Commercial |
$1,070.66
|
| Rate for Payer: ASR ASR |
$1,153.93
|
| Rate for Payer: BCBS Trust/PPO |
$976.92
|
| Rate for Payer: BCN Commercial |
$976.92
|
| Rate for Payer: Cash Price |
$951.70
|
| Rate for Payer: Cofinity Commercial |
$1,118.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.70
|
| Rate for Payer: Healthscope Commercial |
$1,153.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.62
|
| Rate for Payer: Mclaren Commercial |
$1,070.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,011.18
|
| Rate for Payer: Nomi Health Commercial |
$975.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$892.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.87
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
OP
|
$1,189.62
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$1,189.62 |
| Rate for Payer: Aetna Commercial |
$1,070.66
|
| 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 |
$1,153.93
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$980.84
|
| Rate for Payer: BCN Commercial |
$980.84
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$951.70
|
| Rate for Payer: Cash Price |
$951.70
|
| Rate for Payer: Cofinity Commercial |
$1,118.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$1,153.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$1,070.66
|
| 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 |
$1,011.18
|
| Rate for Payer: Nomi Health Commercial |
$975.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$892.22
|
| 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 |
$1,042.35
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$833.92
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.87
|
| 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 INDIUM 111 DTPA PER MCI
|
Facility
|
OP
|
$594.95
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$389.96 |
| Max. Negotiated Rate |
$1,155.71 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: Aetna Medicare |
$745.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$932.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$932.02
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Complete |
$409.49
|
| Rate for Payer: BCBS MAPPO |
$745.62
|
| Rate for Payer: BCBS Trust/PPO |
$490.54
|
| Rate for Payer: BCN Commercial |
$490.54
|
| Rate for Payer: BCN Medicare Advantage |
$745.62
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.62
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$745.62
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Mclaren Medicaid |
$745.62
|
| Rate for Payer: Mclaren Medicare |
$745.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.90
|
| Rate for Payer: Meridian Medicaid |
$409.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$857.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$820.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: PACE Medicare |
$708.34
|
| Rate for Payer: PACE SWMI |
$745.62
|
| Rate for Payer: PHP Commercial |
$820.18
|
| Rate for Payer: PHP Medicaid |
$399.65
|
| Rate for Payer: PHP Medicare Advantage |
$745.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$903.21
|
| Rate for Payer: Priority Health Medicare |
$745.62
|
| Rate for Payer: Priority Health Narrow Network |
$722.57
|
| Rate for Payer: Railroad Medicare Medicare |
$745.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$745.62
|
| Rate for Payer: UHC Exchange |
$1,155.71
|
| Rate for Payer: UHC Medicaid |
$389.96
|
| Rate for Payer: UHCCP DNSP |
$745.62
|
| Rate for Payer: UHCCP Medicaid |
$389.96
|
| Rate for Payer: VA VA |
$745.62
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
IP
|
$594.95
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$446.21 |
| Max. Negotiated Rate |
$594.95 |
| Rate for Payer: Aetna Commercial |
$535.46
|
| Rate for Payer: ASR ASR |
$577.10
|
| Rate for Payer: BCBS Trust/PPO |
$488.57
|
| Rate for Payer: BCN Commercial |
$488.57
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cofinity Commercial |
$559.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.96
|
| Rate for Payer: Healthscope Commercial |
$577.10
|
| Rate for Payer: Healthscope Whirlpool |
$594.95
|
| Rate for Payer: Mclaren Commercial |
$535.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.71
|
| Rate for Payer: Nomi Health Commercial |
$487.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.56
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
IP
|
$2,714.36
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,035.77 |
| Max. Negotiated Rate |
$2,714.36 |
| Rate for Payer: Aetna Commercial |
$2,442.92
|
| Rate for Payer: ASR ASR |
$2,632.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,229.03
|
| Rate for Payer: BCN Commercial |
$2,229.03
|
| Rate for Payer: Cash Price |
$2,171.49
|
| Rate for Payer: Cofinity Commercial |
$2,551.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,171.49
|
| Rate for Payer: Healthscope Commercial |
$2,632.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,714.36
|
| Rate for Payer: Mclaren Commercial |
$2,442.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.21
|
| Rate for Payer: Nomi Health Commercial |
$2,225.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,035.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,388.64
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
OP
|
$2,714.36
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$434.85 |
| Max. Negotiated Rate |
$2,714.36 |
| Rate for Payer: Aetna Commercial |
$2,442.92
|
| Rate for Payer: Aetna Medicare |
$831.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,039.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,039.33
|
| Rate for Payer: ASR ASR |
$2,632.93
|
| Rate for Payer: BCBS Complete |
$456.64
|
| Rate for Payer: BCBS MAPPO |
$831.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,237.99
|
| Rate for Payer: BCN Commercial |
$2,237.99
|
| Rate for Payer: BCN Medicare Advantage |
$831.46
|
| Rate for Payer: Cash Price |
$2,171.49
|
| Rate for Payer: Cash Price |
$2,171.49
|
| Rate for Payer: Cofinity Commercial |
$2,551.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,171.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$831.46
|
| Rate for Payer: Healthscope Commercial |
$2,632.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,714.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$831.46
|
| Rate for Payer: Mclaren Commercial |
$2,442.92
|
| Rate for Payer: Mclaren Medicaid |
$831.46
|
| Rate for Payer: Mclaren Medicare |
$831.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$873.03
|
| Rate for Payer: Meridian Medicaid |
$456.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$956.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$914.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.21
|
| Rate for Payer: Nomi Health Commercial |
$2,225.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,035.77
|
| Rate for Payer: PACE Medicare |
$789.89
|
| Rate for Payer: PACE SWMI |
$831.46
|
| Rate for Payer: PHP Commercial |
$914.61
|
| Rate for Payer: PHP Medicaid |
$445.66
|
| Rate for Payer: PHP Medicare Advantage |
$831.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,421.12
|
| Rate for Payer: Priority Health Medicare |
$831.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,936.90
|
| Rate for Payer: Railroad Medicare Medicare |
$831.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,388.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$831.46
|
| Rate for Payer: UHC Exchange |
$1,288.76
|
| Rate for Payer: UHC Medicaid |
$434.85
|
| Rate for Payer: UHCCP DNSP |
$831.46
|
| Rate for Payer: UHCCP Medicaid |
$434.85
|
| Rate for Payer: VA VA |
$831.46
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
IP
|
$168.05
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$126.04 |
| Max. Negotiated Rate |
$168.05 |
| Rate for Payer: Aetna Commercial |
$151.25
|
| Rate for Payer: ASR ASR |
$163.01
|
| Rate for Payer: BCBS Trust/PPO |
$138.00
|
| Rate for Payer: BCN Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$157.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.44
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Healthscope Whirlpool |
$168.05
|
| Rate for Payer: Mclaren Commercial |
$151.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.84
|
| Rate for Payer: Nomi Health Commercial |
$137.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.88
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
OP
|
$168.05
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$168.05 |
| Rate for Payer: Aetna Commercial |
$151.25
|
| Rate for Payer: Aetna Medicare |
$62.18
|
| Rate for Payer: ASR ASR |
$163.01
|
| Rate for Payer: BCBS Complete |
$67.22
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$138.56
|
| Rate for Payer: Cash Price |
$134.44
|
| Rate for Payer: Cash Price |
$134.44
|
| Rate for Payer: Cofinity Commercial |
$157.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.44
|
| Rate for Payer: Healthscope Commercial |
$163.01
|
| Rate for Payer: Healthscope Whirlpool |
$168.05
|
| Rate for Payer: Mclaren Commercial |
$151.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.84
|
| Rate for Payer: Nomi Health Commercial |
$137.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.88
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
IP
|
$3,828.30
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,871.22 |
| Max. Negotiated Rate |
$3,828.30 |
| Rate for Payer: Aetna Commercial |
$3,445.47
|
| Rate for Payer: ASR ASR |
$3,713.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,143.80
|
| Rate for Payer: BCN Commercial |
$3,143.80
|
| Rate for Payer: Cash Price |
$3,062.64
|
| Rate for Payer: Cofinity Commercial |
$3,598.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,062.64
|
| Rate for Payer: Healthscope Commercial |
$3,713.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,828.30
|
| Rate for Payer: Mclaren Commercial |
$3,445.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,254.05
|
| Rate for Payer: Nomi Health Commercial |
$3,139.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,871.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,368.90
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
OP
|
$3,828.30
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.48 |
| Max. Negotiated Rate |
$3,828.30 |
| Rate for Payer: Aetna Commercial |
$3,445.47
|
| Rate for Payer: Aetna Medicare |
$1,213.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,516.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,516.45
|
| Rate for Payer: ASR ASR |
$3,713.45
|
| Rate for Payer: BCBS Complete |
$666.27
|
| Rate for Payer: BCBS MAPPO |
$1,213.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,156.43
|
| Rate for Payer: BCN Commercial |
$3,156.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,213.16
|
| Rate for Payer: Cash Price |
$3,062.64
|
| Rate for Payer: Cash Price |
$3,062.64
|
| Rate for Payer: Cofinity Commercial |
$3,598.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,062.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,213.16
|
| Rate for Payer: Healthscope Commercial |
$3,713.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,828.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,213.16
|
| Rate for Payer: Mclaren Commercial |
$3,445.47
|
| Rate for Payer: Mclaren Medicaid |
$1,213.16
|
| Rate for Payer: Mclaren Medicare |
$1,213.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.82
|
| Rate for Payer: Meridian Medicaid |
$666.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,395.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,254.05
|
| Rate for Payer: Nomi Health Commercial |
$3,139.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,871.22
|
| Rate for Payer: PACE Medicare |
$1,152.50
|
| Rate for Payer: PACE SWMI |
$1,213.16
|
| Rate for Payer: PHP Commercial |
$1,334.48
|
| Rate for Payer: PHP Medicaid |
$650.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,213.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,354.36
|
| Rate for Payer: Priority Health Medicare |
$1,213.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,683.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,213.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,368.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,213.16
|
| Rate for Payer: UHC Exchange |
$1,880.40
|
| Rate for Payer: UHC Medicaid |
$634.48
|
| Rate for Payer: UHCCP DNSP |
$1,213.16
|
| Rate for Payer: UHCCP Medicaid |
$634.48
|
| Rate for Payer: VA VA |
$1,213.16
|
|
|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,388.73
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.55 |
| Max. Negotiated Rate |
$1,388.73 |
| Rate for Payer: Aetna Commercial |
$1,249.86
|
| Rate for Payer: ASR ASR |
$1,347.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.43
|
| Rate for Payer: BCN Commercial |
$1,140.43
|
| Rate for Payer: Cash Price |
$1,110.98
|
| Rate for Payer: Cofinity Commercial |
$1,305.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.98
|
| Rate for Payer: Healthscope Commercial |
$1,347.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,388.73
|
| Rate for Payer: Mclaren Commercial |
$1,249.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,180.42
|
| Rate for Payer: Nomi Health Commercial |
$1,138.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,222.08
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,388.73
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.83 |
| Max. Negotiated Rate |
$1,388.73 |
| Rate for Payer: Aetna Commercial |
$1,249.86
|
| Rate for Payer: Aetna Medicare |
$513.83
|
| Rate for Payer: ASR ASR |
$1,347.07
|
| Rate for Payer: BCBS Complete |
$555.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.01
|
| Rate for Payer: BCN Commercial |
$1,145.01
|
| Rate for Payer: Cash Price |
$1,110.98
|
| Rate for Payer: Cofinity Commercial |
$1,305.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.98
|
| Rate for Payer: Healthscope Commercial |
$1,347.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,388.73
|
| Rate for Payer: Mclaren Commercial |
$1,249.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,110.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,180.42
|
| Rate for Payer: Nomi Health Commercial |
$1,138.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,216.81
|
| Rate for Payer: Priority Health Narrow Network |
$973.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,222.08
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$684.33
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$684.33 |
| Rate for Payer: Aetna Commercial |
$615.90
|
| Rate for Payer: Aetna Medicare |
$253.20
|
| Rate for Payer: ASR ASR |
$663.80
|
| Rate for Payer: BCBS Complete |
$273.73
|
| Rate for Payer: BCBS Trust/PPO |
$564.23
|
| Rate for Payer: BCN Commercial |
$564.23
|
| Rate for Payer: Cash Price |
$547.46
|
| Rate for Payer: Cofinity Commercial |
$643.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.46
|
| Rate for Payer: Healthscope Commercial |
$663.80
|
| Rate for Payer: Healthscope Whirlpool |
$684.33
|
| Rate for Payer: Mclaren Commercial |
$615.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.68
|
| Rate for Payer: Nomi Health Commercial |
$561.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$599.61
|
| Rate for Payer: Priority Health Narrow Network |
$479.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.21
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$684.33
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$513.25 |
| Max. Negotiated Rate |
$684.33 |
| Rate for Payer: Aetna Commercial |
$615.90
|
| Rate for Payer: ASR ASR |
$663.80
|
| Rate for Payer: BCBS Trust/PPO |
$561.97
|
| Rate for Payer: BCN Commercial |
$561.97
|
| Rate for Payer: Cash Price |
$547.46
|
| Rate for Payer: Cofinity Commercial |
$643.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.46
|
| Rate for Payer: Healthscope Commercial |
$663.80
|
| Rate for Payer: Healthscope Whirlpool |
$684.33
|
| Rate for Payer: Mclaren Commercial |
$615.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.68
|
| Rate for Payer: Nomi Health Commercial |
$561.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.21
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$159.18
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: ASR ASR |
$154.40
|
| Rate for Payer: BCBS Trust/PPO |
$130.72
|
| Rate for Payer: BCN Commercial |
$130.72
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$149.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Healthscope Whirlpool |
$159.18
|
| Rate for Payer: Mclaren Commercial |
$143.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.08
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$159.18
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$154.40
|
| Rate for Payer: BCBS Complete |
$52.61
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$131.24
|
| Rate for Payer: BCN Commercial |
$131.24
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$149.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Healthscope Whirlpool |
$159.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$143.26
|
| Rate for Payer: Mclaren Medicaid |
$95.80
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$52.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$51.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$139.47
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$111.59
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.80
|
| Rate for Payer: UHC Exchange |
$148.49
|
| Rate for Payer: UHC Medicaid |
$50.10
|
| Rate for Payer: UHCCP DNSP |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$50.10
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$192.47
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna Commercial |
$173.22
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: ASR ASR |
$186.70
|
| Rate for Payer: BCBS Complete |
$7.75
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$158.69
|
| Rate for Payer: BCN Commercial |
$158.69
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cofinity Commercial |
$180.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$186.70
|
| Rate for Payer: Healthscope Whirlpool |
$192.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.12
|
| Rate for Payer: Mclaren Commercial |
$173.22
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.60
|
| Rate for Payer: Nomi Health Commercial |
$157.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.35
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicaid |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.64
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$134.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.12
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicaid |
$7.38
|
| Rate for Payer: UHCCP DNSP |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.38
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$192.47
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.35 |
| Max. Negotiated Rate |
$192.47 |
| Rate for Payer: Aetna Commercial |
$173.22
|
| Rate for Payer: ASR ASR |
$186.70
|
| Rate for Payer: BCBS Trust/PPO |
$158.06
|
| Rate for Payer: BCN Commercial |
$158.06
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cofinity Commercial |
$180.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.98
|
| Rate for Payer: Healthscope Commercial |
$186.70
|
| Rate for Payer: Healthscope Whirlpool |
$192.47
|
| Rate for Payer: Mclaren Commercial |
$173.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.60
|
| Rate for Payer: Nomi Health Commercial |
$157.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.37
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$247.25
|
| Rate for Payer: BCBS Complete |
$21.18
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$210.17
|
| Rate for Payer: BCN Commercial |
$210.17
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$239.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$247.25
|
| Rate for Payer: Healthscope Whirlpool |
$254.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$229.41
|
| Rate for Payer: Mclaren Medicaid |
$38.57
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.69
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$38.95
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicaid |
$20.17
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$191.18 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: ASR ASR |
$247.25
|
| Rate for Payer: BCBS Trust/PPO |
$209.32
|
| Rate for Payer: BCN Commercial |
$209.32
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$239.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$247.25
|
| Rate for Payer: Healthscope Whirlpool |
$254.90
|
| Rate for Payer: Mclaren Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.31
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$221.29
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$165.97 |
| Max. Negotiated Rate |
$221.29 |
| Rate for Payer: Aetna Commercial |
$199.16
|
| Rate for Payer: ASR ASR |
$214.65
|
| Rate for Payer: BCBS Trust/PPO |
$181.72
|
| Rate for Payer: BCN Commercial |
$181.72
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Commercial |
$208.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Healthscope Commercial |
$214.65
|
| Rate for Payer: Healthscope Whirlpool |
$221.29
|
| Rate for Payer: Mclaren Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$181.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.74
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$221.29
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: Aetna Commercial |
$199.16
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$214.65
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$182.45
|
| Rate for Payer: BCN Commercial |
$182.45
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Commercial |
$208.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$214.65
|
| Rate for Payer: Healthscope Whirlpool |
$221.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$199.16
|
| Rate for Payer: Mclaren Medicaid |
$142.63
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$181.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.97
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$244.84
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$195.87
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$148.64
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$133.78
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$144.18
|
| Rate for Payer: BCBS Complete |
$52.61
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$122.55
|
| Rate for Payer: BCN Commercial |
$122.55
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cofinity Commercial |
$139.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$144.18
|
| Rate for Payer: Healthscope Whirlpool |
$148.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$133.78
|
| Rate for Payer: Mclaren Medicaid |
$95.80
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$52.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.34
|
| Rate for Payer: Nomi Health Commercial |
$121.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.48
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$51.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.24
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$104.20
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.80
|
| Rate for Payer: UHC Exchange |
$148.49
|
| Rate for Payer: UHC Medicaid |
$50.10
|
| Rate for Payer: UHCCP DNSP |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$50.10
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$148.64
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$111.48 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$133.78
|
| Rate for Payer: ASR ASR |
$144.18
|
| Rate for Payer: BCBS Trust/PPO |
$122.06
|
| Rate for Payer: BCN Commercial |
$122.06
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cofinity Commercial |
$139.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.91
|
| Rate for Payer: Healthscope Commercial |
$144.18
|
| Rate for Payer: Healthscope Whirlpool |
$148.64
|
| Rate for Payer: Mclaren Commercial |
$133.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.34
|
| Rate for Payer: Nomi Health Commercial |
$121.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.80
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$227.81
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: Aetna Commercial |
$205.03
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$220.98
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$187.83
|
| Rate for Payer: BCN Commercial |
$187.83
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$214.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$220.98
|
| Rate for Payer: Healthscope Whirlpool |
$227.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$205.03
|
| Rate for Payer: Mclaren Medicaid |
$142.63
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.64
|
| Rate for Payer: Nomi Health Commercial |
$186.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.86
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$244.84
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$195.87
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
