|
HC HIV TYPE 2 ANTIBODY
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
30200291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.90
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$55.38
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: BCN Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.52
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.20
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PACE Medicare |
$12.84
|
| Rate for Payer: PACE SWMI |
$13.52
|
| Rate for Payer: PHP Commercial |
$14.87
|
| Rate for Payer: PHP Medicaid |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$13.52
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.52
|
| Rate for Payer: UHC Exchange |
$20.96
|
| Rate for Payer: UHC Medicare Advantage |
$13.52
|
| Rate for Payer: UHCCP DNSP |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$13.52
|
|
|
HC HIV TYPE 2 ANTIBODY
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
30200291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.11
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC HIV WESTERN BLOT CONFIRMATION
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC HIV WESTERN BLOT CONFIRMATION
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$62.65
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.03
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$53.63
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.37
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HLA57 GENOTYPE, ABACAVIR
|
Facility
|
IP
|
$277.92
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
31000137
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$180.65 |
| Max. Negotiated Rate |
$277.92 |
| Rate for Payer: Aetna Commercial |
$250.13
|
| Rate for Payer: ASR ASR |
$269.58
|
| Rate for Payer: ASR Commercial |
$269.58
|
| Rate for Payer: BCBS Trust/PPO |
$226.48
|
| Rate for Payer: BCN Commercial |
$215.47
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cofinity Commercial |
$261.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Healthscope Commercial |
$277.92
|
| Rate for Payer: Healthscope Whirlpool |
$269.58
|
| Rate for Payer: Mclaren Commercial |
$250.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.23
|
| Rate for Payer: Nomi Health Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.57
|
|
|
HC HLA57 GENOTYPE, ABACAVIR
|
Facility
|
OP
|
$277.92
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
31000137
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$277.92 |
| Rate for Payer: Aetna Commercial |
$250.13
|
| Rate for Payer: Aetna Medicare |
$169.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.38
|
| Rate for Payer: ASR ASR |
$269.58
|
| Rate for Payer: ASR Commercial |
$269.58
|
| Rate for Payer: BCBS Complete |
$95.62
|
| Rate for Payer: BCBS MAPPO |
$169.90
|
| Rate for Payer: BCBS Trust/PPO |
$227.59
|
| Rate for Payer: BCN Commercial |
$215.47
|
| Rate for Payer: BCN Medicare Advantage |
$169.90
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cofinity Commercial |
$261.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.90
|
| Rate for Payer: Healthscope Commercial |
$277.92
|
| Rate for Payer: Healthscope Whirlpool |
$269.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.90
|
| Rate for Payer: Mclaren Commercial |
$250.13
|
| Rate for Payer: Mclaren Medicaid |
$91.07
|
| Rate for Payer: Mclaren Medicare |
$169.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.40
|
| Rate for Payer: Meridian Medicaid |
$95.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.23
|
| Rate for Payer: Nomi Health Commercial |
$227.89
|
| Rate for Payer: PACE Medicare |
$161.41
|
| Rate for Payer: PACE SWMI |
$169.90
|
| Rate for Payer: PHP Commercial |
$186.89
|
| Rate for Payer: PHP Medicaid |
$91.07
|
| Rate for Payer: PHP Medicare Advantage |
$169.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.51
|
| Rate for Payer: Priority Health Medicare |
$169.90
|
| Rate for Payer: Priority Health Narrow Network |
$194.82
|
| Rate for Payer: Railroad Medicare Medicare |
$169.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.90
|
| Rate for Payer: UHC Exchange |
$263.35
|
| Rate for Payer: UHC Medicare Advantage |
$169.90
|
| Rate for Payer: UHCCP DNSP |
$169.90
|
| Rate for Payer: UHCCP Medicaid |
$91.07
|
| Rate for Payer: VA VA |
$169.90
|
|
|
HC HLA B27 TISSUE TYPING
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$28.39
|
| Rate for Payer: PHP Medicaid |
$13.83
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.76
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$35.01
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC HLA B27 TISSUE TYPING
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
|
|
HC HLA MATCH PLATELETS
|
Facility
|
IP
|
$2,756.75
|
|
|
Service Code
|
HCPCS P9052
|
| Hospital Charge Code |
39000062
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,791.89 |
| Max. Negotiated Rate |
$2,756.75 |
| Rate for Payer: Aetna Commercial |
$2,481.07
|
| Rate for Payer: ASR ASR |
$2,674.05
|
| Rate for Payer: ASR Commercial |
$2,674.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.48
|
| Rate for Payer: BCN Commercial |
$2,137.31
|
| Rate for Payer: Cash Price |
$2,205.40
|
| Rate for Payer: Cofinity Commercial |
$2,591.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,205.40
|
| Rate for Payer: Healthscope Commercial |
$2,756.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,674.05
|
| Rate for Payer: Mclaren Commercial |
$2,481.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,343.24
|
| Rate for Payer: Nomi Health Commercial |
$2,260.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,425.94
|
|
|
HC HLA MATCH PLATELETS
|
Facility
|
OP
|
$2,756.75
|
|
|
Service Code
|
HCPCS P9052
|
| Hospital Charge Code |
39000062
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$406.43 |
| Max. Negotiated Rate |
$2,756.75 |
| Rate for Payer: Aetna Commercial |
$2,481.07
|
| Rate for Payer: Aetna Medicare |
$758.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$947.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$947.84
|
| Rate for Payer: ASR ASR |
$2,674.05
|
| Rate for Payer: ASR Commercial |
$2,674.05
|
| Rate for Payer: BCBS Complete |
$426.75
|
| Rate for Payer: BCBS MAPPO |
$758.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,257.50
|
| Rate for Payer: BCN Commercial |
$2,137.31
|
| Rate for Payer: BCN Medicare Advantage |
$758.27
|
| Rate for Payer: Cash Price |
$2,205.40
|
| Rate for Payer: Cash Price |
$2,205.40
|
| Rate for Payer: Cofinity Commercial |
$2,591.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,205.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.27
|
| Rate for Payer: Healthscope Commercial |
$2,756.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,674.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$758.27
|
| Rate for Payer: Mclaren Commercial |
$2,481.07
|
| Rate for Payer: Mclaren Medicaid |
$406.43
|
| Rate for Payer: Mclaren Medicare |
$758.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$796.18
|
| Rate for Payer: Meridian Medicaid |
$426.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$872.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,343.24
|
| Rate for Payer: Nomi Health Commercial |
$2,260.53
|
| Rate for Payer: PACE Medicare |
$720.36
|
| Rate for Payer: PACE SWMI |
$758.27
|
| Rate for Payer: PHP Commercial |
$834.10
|
| Rate for Payer: PHP Medicaid |
$406.43
|
| Rate for Payer: PHP Medicare Advantage |
$758.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,415.46
|
| Rate for Payer: Priority Health Medicare |
$758.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,932.48
|
| Rate for Payer: Railroad Medicare Medicare |
$758.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,425.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.27
|
| Rate for Payer: UHC Exchange |
$1,175.32
|
| Rate for Payer: UHC Medicare Advantage |
$758.27
|
| Rate for Payer: UHCCP DNSP |
$758.27
|
| Rate for Payer: UHCCP Medicaid |
$406.43
|
| Rate for Payer: VA VA |
$758.27
|
|
|
HC HOLTER MONITOR
|
Facility
|
IP
|
$665.72
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
73100001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$432.72 |
| Max. Negotiated Rate |
$665.72 |
| Rate for Payer: Aetna Commercial |
$599.15
|
| Rate for Payer: ASR ASR |
$645.75
|
| Rate for Payer: ASR Commercial |
$645.75
|
| Rate for Payer: BCBS Trust/PPO |
$542.50
|
| Rate for Payer: BCN Commercial |
$516.13
|
| Rate for Payer: Cash Price |
$532.58
|
| Rate for Payer: Cofinity Commercial |
$625.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.58
|
| Rate for Payer: Healthscope Commercial |
$665.72
|
| Rate for Payer: Healthscope Whirlpool |
$645.75
|
| Rate for Payer: Mclaren Commercial |
$599.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.86
|
| Rate for Payer: Nomi Health Commercial |
$545.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$585.83
|
|
|
HC HOLTER MONITOR
|
Facility
|
OP
|
$665.72
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
73100001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$665.72 |
| Rate for Payer: Aetna Commercial |
$599.15
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$645.75
|
| Rate for Payer: ASR Commercial |
$645.75
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$545.16
|
| Rate for Payer: BCN Commercial |
$516.13
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$532.58
|
| Rate for Payer: Cash Price |
$532.58
|
| Rate for Payer: Cofinity Commercial |
$625.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$665.72
|
| Rate for Payer: Healthscope Whirlpool |
$645.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$599.15
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.86
|
| Rate for Payer: Nomi Health Commercial |
$545.89
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$583.30
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$466.67
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$585.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC HOLTER SCAN
|
Facility
|
IP
|
$1,053.67
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
73100003
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$684.89 |
| Max. Negotiated Rate |
$1,053.67 |
| Rate for Payer: Aetna Commercial |
$948.30
|
| Rate for Payer: ASR ASR |
$1,022.06
|
| Rate for Payer: ASR Commercial |
$1,022.06
|
| Rate for Payer: BCBS Trust/PPO |
$858.64
|
| Rate for Payer: BCN Commercial |
$816.91
|
| Rate for Payer: Cash Price |
$842.94
|
| Rate for Payer: Cofinity Commercial |
$990.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.94
|
| Rate for Payer: Healthscope Commercial |
$1,053.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.06
|
| Rate for Payer: Mclaren Commercial |
$948.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.62
|
| Rate for Payer: Nomi Health Commercial |
$864.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$927.23
|
|
|
HC HOLTER SCAN
|
Facility
|
OP
|
$1,053.67
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
73100003
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$1,053.67 |
| Rate for Payer: Aetna Commercial |
$948.30
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$1,022.06
|
| Rate for Payer: ASR Commercial |
$1,022.06
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$862.85
|
| Rate for Payer: BCN Commercial |
$816.91
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$842.94
|
| Rate for Payer: Cash Price |
$842.94
|
| Rate for Payer: Cofinity Commercial |
$990.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$1,053.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$948.30
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.62
|
| Rate for Payer: Nomi Health Commercial |
$864.01
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$923.23
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$738.62
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$927.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC HOME SLEEP TEST TYPE 3 PORTA
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000027
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$212.17 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Trust/PPO |
$172.90
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
|
|
HC HOME SLEEP TEST TYPE 3 PORTA
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000027
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$173.75
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$148.73
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC HOME SLEEP TEST/TYPE 4 PORTA
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
HCPCS G0400
|
| Hospital Charge Code |
92000028
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$212.17 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Trust/PPO |
$172.90
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
|
|
HC HOME SLEEP TEST/TYPE 4 PORTA
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
HCPCS G0400
|
| Hospital Charge Code |
92000028
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$470.74 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$173.75
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$148.73
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC HOMOCYSTEINE SERUM
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
30100243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$17.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.92
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.92
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.92
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.82
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$17.02
|
| Rate for Payer: PACE SWMI |
$17.92
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.92
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicare Advantage |
$17.92
|
| Rate for Payer: UHCCP DNSP |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.92
|
|
|
HC HOMOCYSTEINE SERUM
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
30100243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HOMOVANILLIC ACID RANDOM URINE
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.01
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Complete |
$12.61
|
| Rate for Payer: BCBS MAPPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: BCN Medicare Advantage |
$22.41
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.41
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.41
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Mclaren Medicare |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.53
|
| Rate for Payer: Meridian Medicaid |
$12.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE Medicare |
$21.29
|
| Rate for Payer: PACE SWMI |
$22.41
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicaid |
$12.01
|
| Rate for Payer: PHP Medicare Advantage |
$22.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.60
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| Rate for Payer: Railroad Medicare Medicare |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.41
|
| Rate for Payer: UHC Exchange |
$34.74
|
| Rate for Payer: UHC Medicare Advantage |
$22.41
|
| Rate for Payer: UHCCP DNSP |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$12.01
|
| Rate for Payer: VA VA |
$22.41
|
|
|
HC HOMOVANILLIC ACID RANDOM URINE
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC HOMOVANILLIC ACID URINE
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC HOMOVANILLIC ACID URINE
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.01
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Complete |
$12.61
|
| Rate for Payer: BCBS MAPPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: BCN Medicare Advantage |
$22.41
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.41
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.41
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Mclaren Medicare |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.53
|
| Rate for Payer: Meridian Medicaid |
$12.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE Medicare |
$21.29
|
| Rate for Payer: PACE SWMI |
$22.41
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicaid |
$12.01
|
| Rate for Payer: PHP Medicare Advantage |
$22.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.60
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| Rate for Payer: Railroad Medicare Medicare |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.41
|
| Rate for Payer: UHC Exchange |
$34.74
|
| Rate for Payer: UHC Medicare Advantage |
$22.41
|
| Rate for Payer: UHCCP DNSP |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$12.01
|
| Rate for Payer: VA VA |
$22.41
|
|
|
HC HONEY BEE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
