|
HC INDIRECT CALORIMETRY
|
Facility
|
IP
|
$1,166.29
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$758.09 |
| Max. Negotiated Rate |
$1,166.29 |
| Rate for Payer: Aetna Commercial |
$1,049.66
|
| Rate for Payer: ASR ASR |
$1,131.30
|
| Rate for Payer: ASR Commercial |
$1,131.30
|
| Rate for Payer: BCBS Trust/PPO |
$950.41
|
| Rate for Payer: BCN Commercial |
$904.22
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cofinity Commercial |
$1,096.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.03
|
| Rate for Payer: Healthscope Commercial |
$1,166.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,131.30
|
| Rate for Payer: Mclaren Commercial |
$1,049.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.35
|
| Rate for Payer: Nomi Health Commercial |
$956.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,026.34
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
OP
|
$1,166.29
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,166.29 |
| Rate for Payer: Aetna Commercial |
$1,049.66
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$1,131.30
|
| Rate for Payer: ASR Commercial |
$1,131.30
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$955.07
|
| Rate for Payer: BCN Commercial |
$904.22
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cofinity Commercial |
$1,096.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$1,166.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,131.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$1,049.66
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.35
|
| Rate for Payer: Nomi Health Commercial |
$956.36
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$817.57
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,026.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
IP
|
$583.28
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$379.13 |
| Max. Negotiated Rate |
$583.28 |
| Rate for Payer: Aetna Commercial |
$524.95
|
| Rate for Payer: ASR ASR |
$565.78
|
| Rate for Payer: ASR Commercial |
$565.78
|
| Rate for Payer: BCBS Trust/PPO |
$475.31
|
| Rate for Payer: BCN Commercial |
$452.22
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$548.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$583.28
|
| Rate for Payer: Healthscope Whirlpool |
$565.78
|
| Rate for Payer: Mclaren Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$478.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.29
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
OP
|
$583.28
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$379.13 |
| Max. Negotiated Rate |
$1,108.70 |
| Rate for Payer: Aetna Commercial |
$524.95
|
| Rate for Payer: Aetna Medicare |
$715.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.11
|
| Rate for Payer: ASR ASR |
$565.78
|
| Rate for Payer: ASR Commercial |
$565.78
|
| Rate for Payer: BCBS Complete |
$402.57
|
| Rate for Payer: BCBS MAPPO |
$715.29
|
| Rate for Payer: BCBS Trust/PPO |
$477.65
|
| Rate for Payer: BCN Commercial |
$452.22
|
| Rate for Payer: BCN Medicare Advantage |
$715.29
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$548.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.29
|
| Rate for Payer: Healthscope Commercial |
$583.28
|
| Rate for Payer: Healthscope Whirlpool |
$565.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$715.29
|
| Rate for Payer: Mclaren Commercial |
$524.95
|
| Rate for Payer: Mclaren Medicaid |
$383.40
|
| Rate for Payer: Mclaren Medicare |
$715.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.05
|
| Rate for Payer: Meridian Medicaid |
$402.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$478.29
|
| Rate for Payer: PACE Medicare |
$679.53
|
| Rate for Payer: PACE SWMI |
$715.29
|
| Rate for Payer: PHP Commercial |
$786.82
|
| Rate for Payer: PHP Medicaid |
$383.40
|
| Rate for Payer: PHP Medicare Advantage |
$715.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$903.21
|
| Rate for Payer: Priority Health Medicare |
$715.29
|
| Rate for Payer: Priority Health Narrow Network |
$722.57
|
| Rate for Payer: Railroad Medicare Medicare |
$715.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.29
|
| Rate for Payer: UHC Exchange |
$1,108.70
|
| Rate for Payer: UHC Medicare Advantage |
$715.29
|
| Rate for Payer: UHCCP DNSP |
$715.29
|
| Rate for Payer: UHCCP Medicaid |
$383.40
|
| Rate for Payer: VA VA |
$715.29
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
IP
|
$2,661.14
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,729.74 |
| Max. Negotiated Rate |
$2,661.14 |
| Rate for Payer: Aetna Commercial |
$2,395.03
|
| Rate for Payer: ASR ASR |
$2,581.31
|
| Rate for Payer: ASR Commercial |
$2,581.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,168.56
|
| Rate for Payer: BCN Commercial |
$2,063.18
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cofinity Commercial |
$2,501.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,128.91
|
| Rate for Payer: Healthscope Commercial |
$2,661.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,581.31
|
| Rate for Payer: Mclaren Commercial |
$2,395.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,261.97
|
| Rate for Payer: Nomi Health Commercial |
$2,182.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,341.80
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
OP
|
$2,661.14
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.14 |
| Max. Negotiated Rate |
$2,661.14 |
| Rate for Payer: Aetna Commercial |
$2,395.03
|
| Rate for Payer: Aetna Medicare |
$772.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$965.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$965.80
|
| Rate for Payer: ASR ASR |
$2,581.31
|
| Rate for Payer: ASR Commercial |
$2,581.31
|
| Rate for Payer: BCBS Complete |
$434.84
|
| Rate for Payer: BCBS MAPPO |
$772.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,179.21
|
| Rate for Payer: BCN Commercial |
$2,063.18
|
| Rate for Payer: BCN Medicare Advantage |
$772.64
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cofinity Commercial |
$2,501.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,128.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.64
|
| Rate for Payer: Healthscope Commercial |
$2,661.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,581.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$772.64
|
| Rate for Payer: Mclaren Commercial |
$2,395.03
|
| Rate for Payer: Mclaren Medicaid |
$414.14
|
| Rate for Payer: Mclaren Medicare |
$772.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.27
|
| Rate for Payer: Meridian Medicaid |
$434.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$888.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,261.97
|
| Rate for Payer: Nomi Health Commercial |
$2,182.13
|
| Rate for Payer: PACE Medicare |
$734.01
|
| Rate for Payer: PACE SWMI |
$772.64
|
| Rate for Payer: PHP Commercial |
$849.90
|
| Rate for Payer: PHP Medicaid |
$414.14
|
| Rate for Payer: PHP Medicare Advantage |
$772.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,196.03
|
| Rate for Payer: Priority Health Medicare |
$772.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,756.82
|
| Rate for Payer: Railroad Medicare Medicare |
$772.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,341.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.64
|
| Rate for Payer: UHC Exchange |
$1,197.59
|
| Rate for Payer: UHC Medicare Advantage |
$772.64
|
| Rate for Payer: UHCCP DNSP |
$772.64
|
| Rate for Payer: UHCCP Medicaid |
$414.14
|
| Rate for Payer: VA VA |
$772.64
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
IP
|
$164.75
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$107.09 |
| Max. Negotiated Rate |
$164.75 |
| Rate for Payer: Aetna Commercial |
$148.28
|
| Rate for Payer: ASR ASR |
$159.81
|
| Rate for Payer: ASR Commercial |
$159.81
|
| Rate for Payer: BCBS Trust/PPO |
$134.25
|
| Rate for Payer: BCN Commercial |
$127.73
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cofinity Commercial |
$154.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.80
|
| Rate for Payer: Healthscope Commercial |
$164.75
|
| Rate for Payer: Healthscope Whirlpool |
$159.81
|
| Rate for Payer: Mclaren Commercial |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.04
|
| Rate for Payer: Nomi Health Commercial |
$135.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.98
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
OP
|
$164.75
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$65.90 |
| Max. Negotiated Rate |
$164.75 |
| Rate for Payer: Aetna Commercial |
$148.28
|
| Rate for Payer: Aetna Medicare |
$82.38
|
| Rate for Payer: ASR ASR |
$159.81
|
| Rate for Payer: ASR Commercial |
$159.81
|
| Rate for Payer: BCBS Complete |
$65.90
|
| Rate for Payer: BCBS Trust/PPO |
$134.91
|
| Rate for Payer: BCN Commercial |
$127.73
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cofinity Commercial |
$154.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.80
|
| Rate for Payer: Healthscope Commercial |
$164.75
|
| Rate for Payer: Healthscope Whirlpool |
$159.81
|
| Rate for Payer: Mclaren Commercial |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.04
|
| Rate for Payer: Nomi Health Commercial |
$135.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.59
|
| Rate for Payer: Priority Health Narrow Network |
$94.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.98
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
IP
|
$3,753.24
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,439.61 |
| Max. Negotiated Rate |
$3,753.24 |
| Rate for Payer: Aetna Commercial |
$3,377.92
|
| Rate for Payer: ASR ASR |
$3,640.64
|
| Rate for Payer: ASR Commercial |
$3,640.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,058.52
|
| Rate for Payer: BCN Commercial |
$2,909.89
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cofinity Commercial |
$3,528.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.59
|
| Rate for Payer: Healthscope Commercial |
$3,753.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,640.64
|
| Rate for Payer: Mclaren Commercial |
$3,377.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.25
|
| Rate for Payer: Nomi Health Commercial |
$3,077.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,302.85
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
OP
|
$3,753.24
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$637.54 |
| Max. Negotiated Rate |
$3,753.24 |
| Rate for Payer: Aetna Commercial |
$3,377.92
|
| Rate for Payer: Aetna Medicare |
$1,189.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,486.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,486.80
|
| Rate for Payer: ASR ASR |
$3,640.64
|
| Rate for Payer: ASR Commercial |
$3,640.64
|
| Rate for Payer: BCBS Complete |
$669.42
|
| Rate for Payer: BCBS MAPPO |
$1,189.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,073.53
|
| Rate for Payer: BCN Commercial |
$2,909.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,189.44
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cofinity Commercial |
$3,528.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,189.44
|
| Rate for Payer: Healthscope Commercial |
$3,753.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,640.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,189.44
|
| Rate for Payer: Mclaren Commercial |
$3,377.92
|
| Rate for Payer: Mclaren Medicaid |
$637.54
|
| Rate for Payer: Mclaren Medicare |
$1,189.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,248.91
|
| Rate for Payer: Meridian Medicaid |
$669.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,367.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.25
|
| Rate for Payer: Nomi Health Commercial |
$3,077.66
|
| Rate for Payer: PACE Medicare |
$1,129.97
|
| Rate for Payer: PACE SWMI |
$1,189.44
|
| Rate for Payer: PHP Commercial |
$1,308.38
|
| Rate for Payer: PHP Medicaid |
$637.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,189.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,288.59
|
| Rate for Payer: Priority Health Medicare |
$1,189.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,631.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,302.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,189.44
|
| Rate for Payer: UHC Exchange |
$1,843.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,189.44
|
| Rate for Payer: UHCCP DNSP |
$1,189.44
|
| Rate for Payer: UHCCP Medicaid |
$637.54
|
| Rate for Payer: VA VA |
$1,189.44
|
|
|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.98 |
| Max. Negotiated Rate |
$1,361.50 |
| Rate for Payer: Aetna Commercial |
$1,225.35
|
| Rate for Payer: ASR ASR |
$1,320.66
|
| Rate for Payer: ASR Commercial |
$1,320.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.49
|
| Rate for Payer: BCN Commercial |
$1,055.57
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,361.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.66
|
| Rate for Payer: Mclaren Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: Nomi Health Commercial |
$1,116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,198.12
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$1,361.50 |
| Rate for Payer: Aetna Commercial |
$1,225.35
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: ASR ASR |
$1,320.66
|
| Rate for Payer: ASR Commercial |
$1,320.66
|
| Rate for Payer: BCBS Complete |
$544.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.93
|
| Rate for Payer: BCN Commercial |
$1,055.57
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,361.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.66
|
| Rate for Payer: Mclaren Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: Nomi Health Commercial |
$1,116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.95
|
| Rate for Payer: Priority Health Narrow Network |
$954.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,198.12
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$436.09 |
| Max. Negotiated Rate |
$670.91 |
| Rate for Payer: Aetna Commercial |
$603.82
|
| Rate for Payer: ASR ASR |
$650.78
|
| Rate for Payer: ASR Commercial |
$650.78
|
| Rate for Payer: BCBS Trust/PPO |
$546.72
|
| Rate for Payer: BCN Commercial |
$520.16
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$630.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$670.91
|
| Rate for Payer: Healthscope Whirlpool |
$650.78
|
| Rate for Payer: Mclaren Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: Nomi Health Commercial |
$550.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.40
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$670.91 |
| Rate for Payer: Aetna Commercial |
$603.82
|
| Rate for Payer: Aetna Medicare |
$335.46
|
| Rate for Payer: ASR ASR |
$650.78
|
| Rate for Payer: ASR Commercial |
$650.78
|
| Rate for Payer: BCBS Complete |
$268.36
|
| Rate for Payer: BCBS Trust/PPO |
$549.41
|
| Rate for Payer: BCN Commercial |
$520.16
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$630.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$670.91
|
| Rate for Payer: Healthscope Whirlpool |
$650.78
|
| Rate for Payer: Mclaren Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: Nomi Health Commercial |
$550.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.85
|
| Rate for Payer: Priority Health Narrow Network |
$470.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.40
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| 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 INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$127.80
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$124.85
|
| 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: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$51.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| 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 Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Exchange |
$148.49
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP DNSP |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$51.35
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Aetna Commercial |
$169.83
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: ASR ASR |
$183.04
|
| Rate for Payer: ASR Commercial |
$183.04
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$154.53
|
| Rate for Payer: BCN Commercial |
$146.30
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$188.70
|
| Rate for Payer: Healthscope Whirlpool |
$183.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.12
|
| Rate for Payer: Mclaren Commercial |
$169.83
|
| Rate for Payer: Mclaren Medicaid |
$7.57
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$154.73
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicaid |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.34
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$132.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicare Advantage |
$14.12
|
| Rate for Payer: UHCCP DNSP |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.57
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.66 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Aetna Commercial |
$169.83
|
| Rate for Payer: ASR ASR |
$183.04
|
| Rate for Payer: ASR Commercial |
$183.04
|
| Rate for Payer: BCBS Trust/PPO |
$153.77
|
| Rate for Payer: BCN Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$188.70
|
| Rate for Payer: Healthscope Whirlpool |
$183.04
|
| Rate for Payer: Mclaren Commercial |
$169.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$154.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.06
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$204.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.16
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$35.33
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Trust/PPO |
$203.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna Commercial |
$195.26
|
| Rate for Payer: ASR ASR |
$210.44
|
| Rate for Payer: ASR Commercial |
$210.44
|
| Rate for Payer: BCBS Trust/PPO |
$176.79
|
| Rate for Payer: BCN Commercial |
$168.20
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Healthscope Whirlpool |
$210.44
|
| Rate for Payer: Mclaren Commercial |
$195.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$177.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.92
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna Commercial |
$195.26
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$210.44
|
| Rate for Payer: ASR Commercial |
$210.44
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$177.66
|
| Rate for Payer: BCN Commercial |
$168.20
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Healthscope Whirlpool |
$210.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$195.26
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$177.90
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.08
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$177.66
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$76.45
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$148.49 |
| Rate for Payer: Aetna Commercial |
$131.16
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$141.36
|
| Rate for Payer: ASR Commercial |
$141.36
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$119.34
|
| Rate for Payer: BCN Commercial |
$112.98
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$145.73
|
| Rate for Payer: Healthscope Whirlpool |
$141.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$131.16
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$119.50
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$51.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.69
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$102.16
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Exchange |
$148.49
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP DNSP |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$51.35
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$145.73 |
| Rate for Payer: Aetna Commercial |
$131.16
|
| Rate for Payer: ASR ASR |
$141.36
|
| Rate for Payer: ASR Commercial |
$141.36
|
| Rate for Payer: BCBS Trust/PPO |
$118.76
|
| Rate for Payer: BCN Commercial |
$112.98
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Healthscope Commercial |
$145.73
|
| Rate for Payer: Healthscope Whirlpool |
$141.36
|
| Rate for Payer: Mclaren Commercial |
$131.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$119.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.24
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$201.01
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$216.64
|
| Rate for Payer: ASR Commercial |
$216.64
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$182.89
|
| Rate for Payer: BCN Commercial |
$173.16
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cofinity Commercial |
$209.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Healthscope Whirlpool |
$216.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$201.01
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.08
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$177.66
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$76.45
|
| Rate for Payer: VA VA |
$142.63
|
|
