|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$259.06
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
36100573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$233.15
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$251.29
|
| Rate for Payer: ASR Commercial |
$251.29
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$212.14
|
| Rate for Payer: BCN Commercial |
$200.85
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cofinity Commercial |
$243.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Healthscope Whirlpool |
$251.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$233.15
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.20
|
| Rate for Payer: Nomi Health Commercial |
$212.43
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.06
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$197.65
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC IDENTIFICATION BY AGGLUTINATION
|
Facility
|
IP
|
$29.86
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
30600091
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$29.86 |
| Rate for Payer: Aetna Commercial |
$26.87
|
| Rate for Payer: ASR ASR |
$28.96
|
| Rate for Payer: ASR Commercial |
$28.96
|
| Rate for Payer: BCBS Trust/PPO |
$24.33
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.89
|
| Rate for Payer: Healthscope Commercial |
$29.86
|
| Rate for Payer: Healthscope Whirlpool |
$28.96
|
| Rate for Payer: Mclaren Commercial |
$26.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.38
|
| Rate for Payer: Nomi Health Commercial |
$24.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.28
|
|
|
HC IDENTIFICATION BY AGGLUTINATION
|
Facility
|
OP
|
$29.86
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
30600091
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$29.86 |
| Rate for Payer: Aetna Commercial |
$26.87
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$28.96
|
| Rate for Payer: ASR Commercial |
$28.96
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$24.45
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$23.89
|
| Rate for Payer: Cash Price |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$29.86
|
| Rate for Payer: Healthscope Whirlpool |
$28.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$26.87
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.38
|
| Rate for Payer: Nomi Health Commercial |
$24.49
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.16
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$20.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC I&D (OB SURGERY)
|
Facility
|
OP
|
$535.51
|
|
| Hospital Charge Code |
36000054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$535.51 |
| Rate for Payer: Aetna Commercial |
$481.96
|
| Rate for Payer: Aetna Medicare |
$267.76
|
| Rate for Payer: ASR ASR |
$519.44
|
| Rate for Payer: ASR Commercial |
$519.44
|
| Rate for Payer: BCBS Complete |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$438.53
|
| Rate for Payer: BCN Commercial |
$415.18
|
| Rate for Payer: Cash Price |
$428.41
|
| Rate for Payer: Cofinity Commercial |
$503.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.41
|
| Rate for Payer: Healthscope Commercial |
$535.51
|
| Rate for Payer: Healthscope Whirlpool |
$519.44
|
| Rate for Payer: Mclaren Commercial |
$481.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.21
|
| Rate for Payer: Priority Health Narrow Network |
$375.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.25
|
|
|
HC I&D (OB SURGERY)
|
Facility
|
IP
|
$535.51
|
|
| Hospital Charge Code |
36000054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.08 |
| Max. Negotiated Rate |
$535.51 |
| Rate for Payer: Aetna Commercial |
$481.96
|
| Rate for Payer: ASR ASR |
$519.44
|
| Rate for Payer: ASR Commercial |
$519.44
|
| Rate for Payer: BCBS Trust/PPO |
$436.39
|
| Rate for Payer: BCN Commercial |
$415.18
|
| Rate for Payer: Cash Price |
$428.41
|
| Rate for Payer: Cofinity Commercial |
$503.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.41
|
| Rate for Payer: Healthscope Commercial |
$535.51
|
| Rate for Payer: Healthscope Whirlpool |
$519.44
|
| Rate for Payer: Mclaren Commercial |
$481.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.25
|
|
|
HC I&D PILONIDAL CYST
|
Facility
|
IP
|
$931.90
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$605.74 |
| Max. Negotiated Rate |
$931.90 |
| Rate for Payer: Aetna Commercial |
$838.71
|
| Rate for Payer: ASR ASR |
$903.94
|
| Rate for Payer: ASR Commercial |
$903.94
|
| Rate for Payer: BCBS Trust/PPO |
$759.41
|
| Rate for Payer: BCN Commercial |
$722.50
|
| Rate for Payer: Cash Price |
$745.52
|
| Rate for Payer: Cofinity Commercial |
$875.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.52
|
| Rate for Payer: Healthscope Commercial |
$931.90
|
| Rate for Payer: Healthscope Whirlpool |
$903.94
|
| Rate for Payer: Mclaren Commercial |
$838.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$792.12
|
| Rate for Payer: Nomi Health Commercial |
$764.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.07
|
|
|
HC I&D PILONIDAL CYST
|
Facility
|
OP
|
$931.90
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.49 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$838.71
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$903.94
|
| Rate for Payer: ASR Commercial |
$903.94
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$763.13
|
| Rate for Payer: BCN Commercial |
$722.50
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$745.52
|
| Rate for Payer: Cash Price |
$745.52
|
| Rate for Payer: Cofinity Commercial |
$875.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$931.90
|
| Rate for Payer: Healthscope Whirlpool |
$903.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$838.71
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$792.12
|
| Rate for Payer: Nomi Health Commercial |
$764.16
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.11
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$186.49
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC I&D PROCEDURE
|
Facility
|
IP
|
$490.15
|
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.60 |
| Max. Negotiated Rate |
$490.15 |
| Rate for Payer: Aetna Commercial |
$441.14
|
| Rate for Payer: ASR ASR |
$475.45
|
| Rate for Payer: ASR Commercial |
$475.45
|
| Rate for Payer: BCBS Trust/PPO |
$399.42
|
| Rate for Payer: BCN Commercial |
$380.01
|
| Rate for Payer: Cash Price |
$392.12
|
| Rate for Payer: Cofinity Commercial |
$460.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.12
|
| Rate for Payer: Healthscope Commercial |
$490.15
|
| Rate for Payer: Healthscope Whirlpool |
$475.45
|
| Rate for Payer: Mclaren Commercial |
$441.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.63
|
| Rate for Payer: Nomi Health Commercial |
$401.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.33
|
|
|
HC I&D PROCEDURE
|
Facility
|
OP
|
$490.15
|
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.06 |
| Max. Negotiated Rate |
$490.15 |
| Rate for Payer: Aetna Commercial |
$441.14
|
| Rate for Payer: Aetna Medicare |
$245.08
|
| Rate for Payer: ASR ASR |
$475.45
|
| Rate for Payer: ASR Commercial |
$475.45
|
| Rate for Payer: BCBS Complete |
$196.06
|
| Rate for Payer: BCBS Trust/PPO |
$401.38
|
| Rate for Payer: BCN Commercial |
$380.01
|
| Rate for Payer: Cash Price |
$392.12
|
| Rate for Payer: Cofinity Commercial |
$460.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.12
|
| Rate for Payer: Healthscope Commercial |
$490.15
|
| Rate for Payer: Healthscope Whirlpool |
$475.45
|
| Rate for Payer: Mclaren Commercial |
$441.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.63
|
| Rate for Payer: Nomi Health Commercial |
$401.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.47
|
| Rate for Payer: Priority Health Narrow Network |
$343.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.33
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
OP
|
$849.27
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
76100319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$849.27 |
| Rate for Payer: Aetna Commercial |
$764.34
|
| Rate for Payer: Aetna Medicare |
$298.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: ASR ASR |
$823.79
|
| Rate for Payer: ASR Commercial |
$823.79
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$695.47
|
| Rate for Payer: BCN Commercial |
$658.44
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cofinity Commercial |
$798.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$849.27
|
| Rate for Payer: Healthscope Whirlpool |
$823.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$298.04
|
| Rate for Payer: Mclaren Commercial |
$764.34
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$721.88
|
| Rate for Payer: Nomi Health Commercial |
$696.40
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: PHP Medicaid |
$159.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.21
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$375.37
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$461.96
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP DNSP |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: VA VA |
$298.04
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$849.27
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
76100319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.03 |
| Max. Negotiated Rate |
$849.27 |
| Rate for Payer: Aetna Commercial |
$764.34
|
| Rate for Payer: ASR ASR |
$823.79
|
| Rate for Payer: ASR Commercial |
$823.79
|
| Rate for Payer: BCBS Trust/PPO |
$692.07
|
| Rate for Payer: BCN Commercial |
$658.44
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cofinity Commercial |
$798.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.42
|
| Rate for Payer: Healthscope Commercial |
$849.27
|
| Rate for Payer: Healthscope Whirlpool |
$823.79
|
| Rate for Payer: Mclaren Commercial |
$764.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$721.88
|
| Rate for Payer: Nomi Health Commercial |
$696.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.36
|
|
|
HC IFR MEASUREMENT
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100132
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,521.07 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,160.65
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC IFR MEASUREMENT
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100132
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.16
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.99
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$134.39
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
IP
|
$13.46
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: ASR ASR |
$13.06
|
| Rate for Payer: ASR Commercial |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.97
|
| Rate for Payer: BCN Commercial |
$10.44
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.77
|
| Rate for Payer: Healthscope Commercial |
$13.46
|
| Rate for Payer: Healthscope Whirlpool |
$13.06
|
| Rate for Payer: Mclaren Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.84
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
OP
|
$13.46
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.02
|
| Rate for Payer: ASR ASR |
$13.06
|
| Rate for Payer: ASR Commercial |
$13.06
|
| Rate for Payer: BCBS Complete |
$4.51
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$11.02
|
| Rate for Payer: BCN Commercial |
$10.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$13.46
|
| Rate for Payer: Healthscope Whirlpool |
$13.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.02
|
| Rate for Payer: Mclaren Commercial |
$12.11
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: Meridian Medicaid |
$4.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.04
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: PHP Medicaid |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.79
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow Network |
$9.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$12.43
|
| Rate for Payer: UHC Medicare Advantage |
$8.02
|
| Rate for Payer: UHCCP DNSP |
$8.02
|
| Rate for Payer: UHCCP Medicaid |
$4.30
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.70
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.42
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.59
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$11.67
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$12.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.78
|
| Rate for Payer: UHCCP DNSP |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.70
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.42
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$17.02 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: PHP Medicaid |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.02
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$13.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP DNSP |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$157.86 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: Aetna Medicare |
$294.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.15
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Complete |
$165.76
|
| Rate for Payer: BCBS MAPPO |
$294.52
|
| Rate for Payer: BCBS Trust/PPO |
$394.51
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: BCN Medicare Advantage |
$294.52
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$294.52
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Mclaren Medicaid |
$157.86
|
| Rate for Payer: Mclaren Medicare |
$294.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.25
|
| Rate for Payer: Meridian Medicaid |
$165.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Medicare |
$279.79
|
| Rate for Payer: PACE SWMI |
$294.52
|
| Rate for Payer: PHP Commercial |
$323.97
|
| Rate for Payer: PHP Medicaid |
$157.86
|
| Rate for Payer: PHP Medicare Advantage |
$294.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.84
|
| Rate for Payer: Priority Health Medicare |
$294.52
|
| Rate for Payer: Priority Health Narrow Network |
$214.27
|
| Rate for Payer: Railroad Medicare Medicare |
$294.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.52
|
| Rate for Payer: UHC Exchange |
$456.51
|
| Rate for Payer: UHC Medicare Advantage |
$294.52
|
| Rate for Payer: UHCCP DNSP |
$294.52
|
| Rate for Payer: UHCCP Medicaid |
$157.86
|
| Rate for Payer: VA VA |
$294.52
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Trust/PPO |
$392.59
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
|
