|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,575.76
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$690.41 |
| Max. Negotiated Rate |
$2,575.76 |
| Rate for Payer: Aetna Commercial |
$2,318.18
|
| Rate for Payer: Aetna Medicare |
$1,262.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,577.72
|
| Rate for Payer: ASR ASR |
$2,498.49
|
| Rate for Payer: BCBS Complete |
$725.00
|
| Rate for Payer: BCBS MAPPO |
$1,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,996.99
|
| Rate for Payer: BCN Commercial |
$1,996.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cofinity Commercial |
$2,421.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$2,575.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,498.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,262.18
|
| Rate for Payer: Mclaren Commercial |
$2,318.18
|
| Rate for Payer: Mclaren Medicaid |
$690.41
|
| Rate for Payer: Mclaren Medicare |
$1,262.18
|
| Rate for Payer: Meridian Medicaid |
$725.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,325.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,451.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,189.40
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,388.40
|
| Rate for Payer: PHP Medicaid |
$690.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,262.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,343.94
|
| Rate for Payer: Priority Health Medicare |
$1,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,828.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,266.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: VA VA |
$1,262.18
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,768.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,337.60 |
| Max. Negotiated Rate |
$4,768.00 |
| Rate for Payer: Aetna Commercial |
$4,291.20
|
| Rate for Payer: ASR ASR |
$4,624.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,696.63
|
| Rate for Payer: BCN Commercial |
$3,696.63
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cofinity Commercial |
$4,481.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,814.40
|
| Rate for Payer: Healthscope Commercial |
$4,768.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,624.96
|
| Rate for Payer: Mclaren Commercial |
$4,291.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,052.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,337.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,195.84
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$760.66 |
| Max. Negotiated Rate |
$4,768.00 |
| Rate for Payer: Aetna Commercial |
$4,291.20
|
| Rate for Payer: Aetna Medicare |
$1,390.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,738.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,738.26
|
| Rate for Payer: ASR ASR |
$4,624.96
|
| Rate for Payer: BCBS Complete |
$798.77
|
| Rate for Payer: BCBS MAPPO |
$1,390.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,696.63
|
| Rate for Payer: BCN Commercial |
$3,696.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.61
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cofinity Commercial |
$4,481.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,814.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.61
|
| Rate for Payer: Healthscope Commercial |
$4,768.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,624.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,390.61
|
| Rate for Payer: Mclaren Commercial |
$4,291.20
|
| Rate for Payer: Mclaren Medicaid |
$760.66
|
| Rate for Payer: Mclaren Medicare |
$1,390.61
|
| Rate for Payer: Meridian Medicaid |
$798.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,460.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,052.80
|
| Rate for Payer: PACE Medicare |
$1,321.08
|
| Rate for Payer: PACE SWMI |
$1,390.61
|
| Rate for Payer: PHP Commercial |
$1,529.67
|
| Rate for Payer: PHP Medicaid |
$760.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,337.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,338.88
|
| Rate for Payer: Priority Health Medicare |
$1,390.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,385.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,390.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,195.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.33
|
| Rate for Payer: VA VA |
$1,390.61
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,243.20
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$760.66 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Aetna Commercial |
$3,818.88
|
| Rate for Payer: Aetna Medicare |
$1,390.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,738.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,738.26
|
| Rate for Payer: ASR ASR |
$4,115.90
|
| Rate for Payer: BCBS Complete |
$798.77
|
| Rate for Payer: BCBS MAPPO |
$1,390.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,289.75
|
| Rate for Payer: BCN Commercial |
$3,289.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.61
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cofinity Commercial |
$3,988.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.61
|
| Rate for Payer: Healthscope Commercial |
$4,243.20
|
| Rate for Payer: Healthscope Whirlpool |
$4,115.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,390.61
|
| Rate for Payer: Mclaren Commercial |
$3,818.88
|
| Rate for Payer: Mclaren Medicaid |
$760.66
|
| Rate for Payer: Mclaren Medicare |
$1,390.61
|
| Rate for Payer: Meridian Medicaid |
$798.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,460.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.72
|
| Rate for Payer: PACE Medicare |
$1,321.08
|
| Rate for Payer: PACE SWMI |
$1,390.61
|
| Rate for Payer: PHP Commercial |
$1,529.67
|
| Rate for Payer: PHP Medicaid |
$760.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,861.31
|
| Rate for Payer: Priority Health Medicare |
$1,390.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,012.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,390.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,734.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.33
|
| Rate for Payer: VA VA |
$1,390.61
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,243.20
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,970.24 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Aetna Commercial |
$3,818.88
|
| Rate for Payer: ASR ASR |
$4,115.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,289.75
|
| Rate for Payer: BCN Commercial |
$3,289.75
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cofinity Commercial |
$3,988.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.56
|
| Rate for Payer: Healthscope Commercial |
$4,243.20
|
| Rate for Payer: Healthscope Whirlpool |
$4,115.90
|
| Rate for Payer: Mclaren Commercial |
$3,818.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,734.02
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,590.62
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,913.43 |
| Max. Negotiated Rate |
$5,590.62 |
| Rate for Payer: Aetna Commercial |
$5,031.56
|
| Rate for Payer: ASR ASR |
$5,422.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,334.41
|
| Rate for Payer: BCN Commercial |
$4,334.41
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cofinity Commercial |
$5,255.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,472.50
|
| Rate for Payer: Healthscope Commercial |
$5,590.62
|
| Rate for Payer: Healthscope Whirlpool |
$5,422.90
|
| Rate for Payer: Mclaren Commercial |
$5,031.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,752.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,913.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,919.75
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,590.62
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$760.66 |
| Max. Negotiated Rate |
$5,590.62 |
| Rate for Payer: Aetna Commercial |
$5,031.56
|
| Rate for Payer: Aetna Medicare |
$1,390.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,738.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,738.26
|
| Rate for Payer: ASR ASR |
$5,422.90
|
| Rate for Payer: BCBS Complete |
$798.77
|
| Rate for Payer: BCBS MAPPO |
$1,390.61
|
| Rate for Payer: BCBS Trust/PPO |
$4,334.41
|
| Rate for Payer: BCN Commercial |
$4,334.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.61
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cofinity Commercial |
$5,255.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,472.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.61
|
| Rate for Payer: Healthscope Commercial |
$5,590.62
|
| Rate for Payer: Healthscope Whirlpool |
$5,422.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,390.61
|
| Rate for Payer: Mclaren Commercial |
$5,031.56
|
| Rate for Payer: Mclaren Medicaid |
$760.66
|
| Rate for Payer: Mclaren Medicare |
$1,390.61
|
| Rate for Payer: Meridian Medicaid |
$798.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,460.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,752.03
|
| Rate for Payer: PACE Medicare |
$1,321.08
|
| Rate for Payer: PACE SWMI |
$1,390.61
|
| Rate for Payer: PHP Commercial |
$1,529.67
|
| Rate for Payer: PHP Medicaid |
$760.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,913.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,087.46
|
| Rate for Payer: Priority Health Medicare |
$1,390.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,969.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,390.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,919.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.33
|
| Rate for Payer: VA VA |
$1,390.61
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,065.83 |
| Max. Negotiated Rate |
$7,236.90 |
| Rate for Payer: Aetna Commercial |
$6,513.21
|
| Rate for Payer: Aetna Commercial |
$7,530.30
|
| Rate for Payer: ASR ASR |
$7,019.79
|
| Rate for Payer: ASR ASR |
$8,115.99
|
| Rate for Payer: BCBS Trust/PPO |
$6,486.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,610.77
|
| Rate for Payer: BCN Commercial |
$6,486.94
|
| Rate for Payer: BCN Commercial |
$5,610.77
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$7,864.98
|
| Rate for Payer: Cofinity Commercial |
$6,802.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,693.60
|
| Rate for Payer: Healthscope Commercial |
$7,236.90
|
| Rate for Payer: Healthscope Commercial |
$8,367.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,019.79
|
| Rate for Payer: Healthscope Whirlpool |
$8,115.99
|
| Rate for Payer: Mclaren Commercial |
$6,513.21
|
| Rate for Payer: Mclaren Commercial |
$7,530.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,151.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,111.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,856.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,065.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,368.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,362.96
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$8,367.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$760.66 |
| Max. Negotiated Rate |
$8,367.00 |
| Rate for Payer: Aetna Commercial |
$7,530.30
|
| Rate for Payer: Aetna Commercial |
$6,513.21
|
| Rate for Payer: Aetna Medicare |
$1,390.61
|
| Rate for Payer: Aetna Medicare |
$1,390.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,738.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,738.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,738.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,738.26
|
| Rate for Payer: ASR ASR |
$8,115.99
|
| Rate for Payer: ASR ASR |
$7,019.79
|
| Rate for Payer: BCBS Complete |
$798.77
|
| Rate for Payer: BCBS Complete |
$798.77
|
| Rate for Payer: BCBS MAPPO |
$1,390.61
|
| Rate for Payer: BCBS MAPPO |
$1,390.61
|
| Rate for Payer: BCBS Trust/PPO |
$6,486.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,610.77
|
| Rate for Payer: BCN Commercial |
$5,610.77
|
| Rate for Payer: BCN Commercial |
$6,486.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.61
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,802.69
|
| Rate for Payer: Cofinity Commercial |
$7,864.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,693.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.61
|
| Rate for Payer: Healthscope Commercial |
$8,367.00
|
| Rate for Payer: Healthscope Commercial |
$7,236.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,019.79
|
| Rate for Payer: Healthscope Whirlpool |
$8,115.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,390.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,390.61
|
| Rate for Payer: Mclaren Commercial |
$7,530.30
|
| Rate for Payer: Mclaren Commercial |
$6,513.21
|
| Rate for Payer: Mclaren Medicaid |
$760.66
|
| Rate for Payer: Mclaren Medicaid |
$760.66
|
| Rate for Payer: Mclaren Medicare |
$1,390.61
|
| Rate for Payer: Mclaren Medicare |
$1,390.61
|
| Rate for Payer: Meridian Medicaid |
$798.77
|
| Rate for Payer: Meridian Medicaid |
$798.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,460.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,460.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,151.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,111.95
|
| Rate for Payer: PACE Medicare |
$1,321.08
|
| Rate for Payer: PACE Medicare |
$1,321.08
|
| Rate for Payer: PACE SWMI |
$1,390.61
|
| Rate for Payer: PACE SWMI |
$1,390.61
|
| Rate for Payer: PHP Commercial |
$1,529.67
|
| Rate for Payer: PHP Commercial |
$1,529.67
|
| Rate for Payer: PHP Medicaid |
$760.66
|
| Rate for Payer: PHP Medicaid |
$760.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,856.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,065.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,613.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,585.58
|
| Rate for Payer: Priority Health Medicare |
$1,390.61
|
| Rate for Payer: Priority Health Medicare |
$1,390.61
|
| Rate for Payer: Priority Health Narrow Network |
$5,940.57
|
| Rate for Payer: Priority Health Narrow Network |
$5,138.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,390.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,390.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,362.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,368.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.33
|
| Rate for Payer: VA VA |
$1,390.61
|
| Rate for Payer: VA VA |
$1,390.61
|
|
|
HC PFO
|
Facility
|
IP
|
$25,737.20
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,016.04 |
| Max. Negotiated Rate |
$25,737.20 |
| Rate for Payer: Aetna Commercial |
$23,163.48
|
| Rate for Payer: ASR ASR |
$24,965.08
|
| Rate for Payer: BCBS Trust/PPO |
$19,954.05
|
| Rate for Payer: BCN Commercial |
$19,954.05
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cofinity Commercial |
$24,192.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,589.76
|
| Rate for Payer: Healthscope Commercial |
$25,737.20
|
| Rate for Payer: Healthscope Whirlpool |
$24,965.08
|
| Rate for Payer: Mclaren Commercial |
$23,163.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,876.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,016.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,648.74
|
|
|
HC PFO
|
Facility
|
OP
|
$25,737.20
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,525.86 |
| Max. Negotiated Rate |
$25,737.20 |
| Rate for Payer: Aetna Commercial |
$23,163.48
|
| Rate for Payer: Aetna Medicare |
$15,586.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: ASR ASR |
$24,965.08
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$19,954.05
|
| Rate for Payer: BCN Commercial |
$19,954.05
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cofinity Commercial |
$24,192.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,589.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Healthscope Commercial |
$25,737.20
|
| Rate for Payer: Healthscope Whirlpool |
$24,965.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,586.58
|
| Rate for Payer: Mclaren Commercial |
$23,163.48
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,876.62
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Commercial |
$17,145.24
|
| Rate for Payer: PHP Medicaid |
$8,525.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,016.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,420.85
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$18,273.41
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22,648.74
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,498.20 |
| Max. Negotiated Rate |
$11,245.50 |
| Rate for Payer: Aetna Commercial |
$10,120.95
|
| Rate for Payer: ASR ASR |
$10,908.14
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: BCBS Trust/PPO |
$8,718.64
|
| Rate for Payer: BCN Commercial |
$8,718.64
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$10,570.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$11,245.50
|
| Rate for Payer: Healthscope Whirlpool |
$10,908.14
|
| Rate for Payer: Mclaren Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,233.40
|
| Rate for Payer: Priority Health Narrow Network |
$7,984.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,896.04
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,871.85 |
| Max. Negotiated Rate |
$11,245.50 |
| Rate for Payer: Aetna Commercial |
$10,120.95
|
| Rate for Payer: ASR ASR |
$10,908.14
|
| Rate for Payer: BCBS Trust/PPO |
$8,718.64
|
| Rate for Payer: BCN Commercial |
$8,718.64
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$10,570.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$11,245.50
|
| Rate for Payer: Healthscope Whirlpool |
$10,908.14
|
| Rate for Payer: Mclaren Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,896.04
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,802.52
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,521.01 |
| Max. Negotiated Rate |
$3,802.52 |
| Rate for Payer: Aetna Commercial |
$3,422.27
|
| Rate for Payer: ASR ASR |
$3,688.44
|
| Rate for Payer: BCBS Complete |
$1,521.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.09
|
| Rate for Payer: BCN Commercial |
$2,948.09
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,574.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,042.02
|
| Rate for Payer: Healthscope Commercial |
$3,802.52
|
| Rate for Payer: Healthscope Whirlpool |
$3,688.44
|
| Rate for Payer: Mclaren Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,460.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,699.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,346.22
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
IP
|
$3,802.52
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,661.76 |
| Max. Negotiated Rate |
$3,802.52 |
| Rate for Payer: Aetna Commercial |
$3,422.27
|
| Rate for Payer: ASR ASR |
$3,688.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.09
|
| Rate for Payer: BCN Commercial |
$2,948.09
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,574.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,042.02
|
| Rate for Payer: Healthscope Commercial |
$3,802.52
|
| Rate for Payer: Healthscope Whirlpool |
$3,688.44
|
| Rate for Payer: Mclaren Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,346.22
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
OP
|
$271.39
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$271.39 |
| Rate for Payer: Aetna Commercial |
$244.25
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$263.25
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$210.41
|
| Rate for Payer: BCN Commercial |
$210.41
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cofinity Commercial |
$255.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$271.39
|
| Rate for Payer: Healthscope Whirlpool |
$263.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$244.25
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.68
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.96
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$192.69
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.82
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
IP
|
$271.39
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.97 |
| Max. Negotiated Rate |
$271.39 |
| Rate for Payer: Aetna Commercial |
$244.25
|
| Rate for Payer: ASR ASR |
$263.25
|
| Rate for Payer: BCBS Trust/PPO |
$210.41
|
| Rate for Payer: BCN Commercial |
$210.41
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cofinity Commercial |
$255.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.11
|
| Rate for Payer: Healthscope Commercial |
$271.39
|
| Rate for Payer: Healthscope Whirlpool |
$263.25
|
| Rate for Payer: Mclaren Commercial |
$244.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.82
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.50
|
| Rate for Payer: Priority Health Narrow Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: ASR ASR |
$24.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$25.00
|
| Rate for Payer: Healthscope Whirlpool |
$24.25
|
| Rate for Payer: Mclaren Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.75
|
| Rate for Payer: Priority Health Narrow Network |
$17.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.00
|
|
|
HC PH BLOOD
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$86.71 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.75
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: BCBS MAPPO |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: BCN Medicare Advantage |
$11.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.00
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$6.02
|
| Rate for Payer: Mclaren Medicare |
$11.00
|
| Rate for Payer: Meridian Medicaid |
$6.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$10.45
|
| Rate for Payer: PACE SWMI |
$11.00
|
| Rate for Payer: PHP Commercial |
$12.10
|
| Rate for Payer: PHP Medicaid |
$6.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.71
|
| Rate for Payer: Priority Health Medicare |
$11.00
|
| Rate for Payer: Priority Health Narrow Network |
$69.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
| Rate for Payer: UHC Medicare Advantage |
$11.33
|
| Rate for Payer: VA VA |
$11.00
|
|
|
HC PH BLOOD
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$24.68
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: ASR ASR |
$23.94
|
| Rate for Payer: BCBS Complete |
$2.06
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Whirlpool |
$23.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.58
|
| Rate for Payer: Mclaren Commercial |
$22.21
|
| Rate for Payer: Mclaren Medicaid |
$1.96
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Medicaid |
$2.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.98
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: PHP Medicaid |
$1.96
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$10.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.72
|
| Rate for Payer: UHC Medicare Advantage |
$3.69
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$24.68
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: ASR ASR |
$23.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Whirlpool |
$23.94
|
| Rate for Payer: Mclaren Commercial |
$22.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.72
|
|
