|
HC HEM/ONC CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR Commercial |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$368.50
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.29
|
| Rate for Payer: Priority Health Narrow Network |
$315.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.12
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.42
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.72
|
| Rate for Payer: Priority Health Narrow Network |
$52.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$1,378.21 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: Aetna Medicare |
$889.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: ASR ASR |
$1,127.61
|
| Rate for Payer: ASR Commercial |
$1,127.61
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCBS Trust/PPO |
$951.95
|
| Rate for Payer: BCN Commercial |
$901.27
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$1,092.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$889.17
|
| Rate for Payer: Mclaren Commercial |
$1,046.23
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: Nomi Health Commercial |
$953.23
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$978.09
|
| Rate for Payer: PHP Medicaid |
$476.60
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.56
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health Narrow Network |
$814.90
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,378.21
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP DNSP |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$1,162.48
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.61 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: ASR ASR |
$1,127.61
|
| Rate for Payer: ASR Commercial |
$1,127.61
|
| Rate for Payer: BCBS Trust/PPO |
$947.30
|
| Rate for Payer: BCN Commercial |
$901.27
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$1,092.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.61
|
| Rate for Payer: Mclaren Commercial |
$1,046.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: Nomi Health Commercial |
$953.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.98
|
|
|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.46
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: ASR ASR |
$22.76
|
| Rate for Payer: ASR Commercial |
$22.76
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.21
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Healthscope Whirlpool |
$22.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$21.11
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$19.24
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.22
|
| Rate for Payer: PHP Medicaid |
$2.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.56
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$16.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHCCP DNSP |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: ASR ASR |
$22.76
|
| Rate for Payer: ASR Commercial |
$22.76
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Healthscope Whirlpool |
$22.76
|
| Rate for Payer: Mclaren Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.64
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$486.27
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$486.27 |
| Rate for Payer: Aetna Commercial |
$437.64
|
| Rate for Payer: Aetna Medicare |
$243.13
|
| Rate for Payer: ASR ASR |
$471.68
|
| Rate for Payer: ASR Commercial |
$471.68
|
| Rate for Payer: BCBS Complete |
$194.51
|
| Rate for Payer: BCBS Trust/PPO |
$398.21
|
| Rate for Payer: BCN Commercial |
$377.01
|
| Rate for Payer: Cash Price |
$389.02
|
| Rate for Payer: Cofinity Commercial |
$457.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$486.27
|
| Rate for Payer: Healthscope Whirlpool |
$471.68
|
| Rate for Payer: Mclaren Commercial |
$437.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.33
|
| Rate for Payer: Nomi Health Commercial |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.07
|
| Rate for Payer: Priority Health Narrow Network |
$340.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.92
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$486.27
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.08 |
| Max. Negotiated Rate |
$486.27 |
| Rate for Payer: Aetna Commercial |
$437.64
|
| Rate for Payer: ASR ASR |
$471.68
|
| Rate for Payer: ASR Commercial |
$471.68
|
| Rate for Payer: BCBS Trust/PPO |
$396.26
|
| Rate for Payer: BCN Commercial |
$377.01
|
| Rate for Payer: Cash Price |
$389.02
|
| Rate for Payer: Cofinity Commercial |
$457.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$486.27
|
| Rate for Payer: Healthscope Whirlpool |
$471.68
|
| Rate for Payer: Mclaren Commercial |
$437.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.33
|
| Rate for Payer: Nomi Health Commercial |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.92
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,482.05 |
| Max. Negotiated Rate |
$5,357.00 |
| Rate for Payer: Aetna Commercial |
$4,821.30
|
| Rate for Payer: ASR ASR |
$5,196.29
|
| Rate for Payer: ASR Commercial |
$5,196.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,365.42
|
| Rate for Payer: BCN Commercial |
$4,153.28
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$5,035.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$5,357.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,196.29
|
| Rate for Payer: Mclaren Commercial |
$4,821.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,553.45
|
| Rate for Payer: Nomi Health Commercial |
$4,392.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,482.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,714.16
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,142.80 |
| Max. Negotiated Rate |
$5,357.00 |
| Rate for Payer: Aetna Commercial |
$4,821.30
|
| Rate for Payer: Aetna Medicare |
$2,678.50
|
| Rate for Payer: ASR ASR |
$5,196.29
|
| Rate for Payer: ASR Commercial |
$5,196.29
|
| Rate for Payer: BCBS Complete |
$2,142.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,386.85
|
| Rate for Payer: BCN Commercial |
$4,153.28
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$5,035.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$5,357.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,196.29
|
| Rate for Payer: Mclaren Commercial |
$4,821.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,553.45
|
| Rate for Payer: Nomi Health Commercial |
$4,392.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,482.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,693.80
|
| Rate for Payer: Priority Health Narrow Network |
$3,755.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,714.16
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$127.80
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$127.17
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$13.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.09
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$7.02
|
| Rate for Payer: Mclaren Medicare |
$13.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$12.44
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Medicaid |
$7.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow Network |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.09
|
| Rate for Payer: UHC Exchange |
$20.29
|
| Rate for Payer: UHC Medicare Advantage |
$13.09
|
| Rate for Payer: UHCCP DNSP |
$13.09
|
| Rate for Payer: UHCCP Medicaid |
$7.02
|
| Rate for Payer: VA VA |
$13.09
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$46.31 |
| Rate for Payer: Aetna Commercial |
$41.68
|
| Rate for Payer: ASR ASR |
$44.92
|
| Rate for Payer: ASR Commercial |
$44.92
|
| Rate for Payer: BCBS Trust/PPO |
$37.74
|
| Rate for Payer: BCN Commercial |
$35.90
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$43.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$46.31
|
| Rate for Payer: Healthscope Whirlpool |
$44.92
|
| Rate for Payer: Mclaren Commercial |
$41.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.75
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$46.31 |
| Rate for Payer: Aetna Commercial |
$41.68
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.80
|
| Rate for Payer: ASR ASR |
$44.92
|
| Rate for Payer: ASR Commercial |
$44.92
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS MAPPO |
$11.84
|
| Rate for Payer: BCBS Trust/PPO |
$37.92
|
| Rate for Payer: BCN Commercial |
$35.90
|
| Rate for Payer: BCN Medicare Advantage |
$11.84
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$43.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$46.31
|
| Rate for Payer: Healthscope Whirlpool |
$44.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$41.68
|
| Rate for Payer: Mclaren Medicaid |
$6.35
|
| Rate for Payer: Mclaren Medicare |
$11.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.43
|
| Rate for Payer: Meridian Medicaid |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: PACE Medicare |
$11.25
|
| Rate for Payer: PACE SWMI |
$11.84
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Medicaid |
$6.35
|
| Rate for Payer: PHP Medicare Advantage |
$11.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.58
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health Narrow Network |
$32.46
|
| Rate for Payer: Railroad Medicare Medicare |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.84
|
| Rate for Payer: UHC Exchange |
$18.35
|
| Rate for Payer: UHC Medicare Advantage |
$11.84
|
| Rate for Payer: UHCCP DNSP |
$11.84
|
| Rate for Payer: UHCCP Medicaid |
$6.35
|
| Rate for Payer: VA VA |
$11.84
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$244.49
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$244.49 |
| Rate for Payer: Aetna Commercial |
$220.04
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$237.16
|
| Rate for Payer: ASR Commercial |
$237.16
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$200.21
|
| Rate for Payer: BCN Commercial |
$189.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cofinity Commercial |
$229.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$244.49
|
| Rate for Payer: Healthscope Whirlpool |
$237.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$220.04
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.82
|
| Rate for Payer: Nomi Health Commercial |
$200.48
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$9.85
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.22
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$171.39
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$28.47
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP DNSP |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$9.85
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$244.49
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$244.49 |
| Rate for Payer: Aetna Commercial |
$220.04
|
| Rate for Payer: ASR ASR |
$237.16
|
| Rate for Payer: ASR Commercial |
$237.16
|
| Rate for Payer: BCBS Trust/PPO |
$199.23
|
| Rate for Payer: BCN Commercial |
$189.55
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cofinity Commercial |
$229.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.59
|
| Rate for Payer: Healthscope Commercial |
$244.49
|
| Rate for Payer: Healthscope Whirlpool |
$237.16
|
| Rate for Payer: Mclaren Commercial |
$220.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.82
|
| Rate for Payer: Nomi Health Commercial |
$200.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.15
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$8.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.17
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$8.99
|
| Rate for Payer: PHP Medicaid |
$4.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.17
|
| Rate for Payer: UHC Exchange |
$12.66
|
| Rate for Payer: UHC Medicare Advantage |
$8.17
|
| Rate for Payer: UHCCP DNSP |
$8.17
|
| Rate for Payer: UHCCP Medicaid |
$4.38
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,551.24
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,196.12
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$3,444.70
|
| Rate for Payer: ASR Commercial |
$3,444.70
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,908.11
|
| Rate for Payer: BCN Commercial |
$2,753.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cofinity Commercial |
$3,338.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,840.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,551.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,444.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,196.12
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.55
|
| Rate for Payer: Nomi Health Commercial |
$2,912.02
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,308.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,111.60
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,489.42
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,125.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,551.24
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,308.31 |
| Max. Negotiated Rate |
$3,551.24 |
| Rate for Payer: Aetna Commercial |
$3,196.12
|
| Rate for Payer: ASR ASR |
$3,444.70
|
| Rate for Payer: ASR Commercial |
$3,444.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,893.91
|
| Rate for Payer: BCN Commercial |
$2,753.28
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cofinity Commercial |
$3,338.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,840.99
|
| Rate for Payer: Healthscope Commercial |
$3,551.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,444.70
|
| Rate for Payer: Mclaren Commercial |
$3,196.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.55
|
| Rate for Payer: Nomi Health Commercial |
$2,912.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,308.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,125.09
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$130.76
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$130.76 |
| Rate for Payer: Aetna Commercial |
$117.68
|
| Rate for Payer: ASR ASR |
$126.84
|
| Rate for Payer: ASR Commercial |
$126.84
|
| Rate for Payer: BCBS Trust/PPO |
$106.56
|
| Rate for Payer: BCN Commercial |
$101.38
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$122.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Healthscope Commercial |
$130.76
|
| Rate for Payer: Healthscope Whirlpool |
$126.84
|
| Rate for Payer: Mclaren Commercial |
$117.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$107.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.07
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$130.76
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$130.76 |
| Rate for Payer: Aetna Commercial |
$117.68
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.07
|
| Rate for Payer: ASR ASR |
$126.84
|
| Rate for Payer: ASR Commercial |
$126.84
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$107.08
|
| Rate for Payer: BCN Commercial |
$101.38
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$122.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$130.76
|
| Rate for Payer: Healthscope Whirlpool |
$126.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$117.68
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$107.22
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$12.39
|
| Rate for Payer: PHP Medicaid |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.57
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$91.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Exchange |
$17.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.26
|
| Rate for Payer: UHCCP DNSP |
$11.26
|
| Rate for Payer: UHCCP Medicaid |
$6.04
|
| Rate for Payer: VA VA |
$11.26
|
|
