|
HC PHENOBARB LVL
|
Facility
|
OP
|
$98.60
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$95.64
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$76.44
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cofinity Commercial |
$92.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$98.60
|
| Rate for Payer: Healthscope Whirlpool |
$95.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$88.74
|
| Rate for Payer: Mclaren Medicaid |
$8.37
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.81
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicaid |
$8.37
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.53
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$63.62
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.77
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC PHENOBARB LVL
|
Facility
|
IP
|
$98.60
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.02 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: ASR ASR |
$95.64
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$76.44
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cofinity Commercial |
$92.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.88
|
| Rate for Payer: Healthscope Commercial |
$98.60
|
| Rate for Payer: Healthscope Whirlpool |
$95.64
|
| Rate for Payer: Mclaren Commercial |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.77
|
|
|
HC PH GASTRIC
|
Facility
|
OP
|
$24.20
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Aetna Commercial |
$21.78
|
| Rate for Payer: Aetna Medicare |
$6.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: ASR ASR |
$23.47
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCN Commercial |
$18.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Healthscope Commercial |
$24.20
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.71
|
| Rate for Payer: Mclaren Commercial |
$21.78
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicare |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: PACE Medicare |
$6.37
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$7.38
|
| Rate for Payer: PHP Medicaid |
$3.67
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.02
|
| Rate for Payer: Priority Health Medicare |
$6.71
|
| Rate for Payer: Priority Health Narrow Network |
$17.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.30
|
| Rate for Payer: UHC Medicare Advantage |
$6.91
|
| Rate for Payer: VA VA |
$6.71
|
|
|
HC PH GASTRIC
|
Facility
|
IP
|
$24.20
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Aetna Commercial |
$21.78
|
| Rate for Payer: ASR ASR |
$23.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCN Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$24.20
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Mclaren Commercial |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.30
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: ASR ASR |
$92.15
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Trust/PPO |
$73.65
|
| Rate for Payer: BCN Commercial |
$73.65
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$89.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$95.00
|
| Rate for Payer: Healthscope Whirlpool |
$92.15
|
| Rate for Payer: Mclaren Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.45
|
| Rate for Payer: Priority Health Narrow Network |
$67.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.60
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: ASR ASR |
$92.15
|
| Rate for Payer: BCBS Trust/PPO |
$73.65
|
| Rate for Payer: BCN Commercial |
$73.65
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$89.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$95.00
|
| Rate for Payer: Healthscope Whirlpool |
$92.15
|
| Rate for Payer: Mclaren Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.60
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: ASR ASR |
$71.78
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$57.37
|
| Rate for Payer: BCN Commercial |
$57.37
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$69.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$74.00
|
| Rate for Payer: Healthscope Whirlpool |
$71.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.52
|
| Rate for Payer: Mclaren Commercial |
$66.60
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$18.17
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.34
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health Narrow Network |
$52.54
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.12
|
| Rate for Payer: UHC Medicare Advantage |
$17.02
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: ASR ASR |
$71.78
|
| Rate for Payer: BCBS Trust/PPO |
$57.37
|
| Rate for Payer: BCN Commercial |
$57.37
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$69.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Healthscope Commercial |
$74.00
|
| Rate for Payer: Healthscope Whirlpool |
$71.78
|
| Rate for Payer: Mclaren Commercial |
$66.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.12
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$64.35
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.52
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$18.17
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.53
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health Narrow Network |
$58.93
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
| Rate for Payer: UHC Medicare Advantage |
$17.02
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.35
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.84 |
| Max. Negotiated Rate |
$54.06 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: ASR ASR |
$52.44
|
| Rate for Payer: BCBS Trust/PPO |
$41.91
|
| Rate for Payer: BCN Commercial |
$41.91
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$54.06
|
| Rate for Payer: Healthscope Whirlpool |
$52.44
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.57
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$54.06 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$52.44
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$41.91
|
| Rate for Payer: BCN Commercial |
$41.91
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$54.06
|
| Rate for Payer: Healthscope Whirlpool |
$52.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.07
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicaid |
$8.79
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.19
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$38.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.57
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
OP
|
$53.04
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$53.04 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$51.45
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$41.12
|
| Rate for Payer: BCN Commercial |
$41.12
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$49.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$53.04
|
| Rate for Payer: Healthscope Whirlpool |
$51.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.07
|
| Rate for Payer: Mclaren Commercial |
$47.74
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.08
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicaid |
$8.79
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.27
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$37.66
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.68
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
IP
|
$53.04
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$53.04 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: ASR ASR |
$51.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.12
|
| Rate for Payer: BCN Commercial |
$41.12
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$49.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$53.04
|
| Rate for Payer: Healthscope Whirlpool |
$51.45
|
| Rate for Payer: Mclaren Commercial |
$47.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.68
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
OP
|
$276.60
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$276.60 |
| Rate for Payer: Aetna Commercial |
$248.94
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$268.30
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$214.45
|
| Rate for Payer: BCN Commercial |
$214.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cofinity Commercial |
$260.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$276.60
|
| Rate for Payer: Healthscope Whirlpool |
$268.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$248.94
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.11
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.41
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
IP
|
$276.60
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$276.60 |
| Rate for Payer: Aetna Commercial |
$248.94
|
| Rate for Payer: ASR ASR |
$268.30
|
| Rate for Payer: BCBS Trust/PPO |
$214.45
|
| Rate for Payer: BCN Commercial |
$214.45
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cofinity Commercial |
$260.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.28
|
| Rate for Payer: Healthscope Commercial |
$276.60
|
| Rate for Payer: Healthscope Whirlpool |
$268.30
|
| Rate for Payer: Mclaren Commercial |
$248.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.41
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$212.42 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$199.82
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$159.71
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Healthscope Whirlpool |
$199.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$185.40
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.10
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.28
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: ASR ASR |
$199.82
|
| Rate for Payer: BCBS Trust/PPO |
$159.71
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Healthscope Whirlpool |
$199.82
|
| Rate for Payer: Mclaren Commercial |
$185.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.28
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: ASR ASR |
$199.82
|
| Rate for Payer: BCBS Trust/PPO |
$159.71
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Healthscope Whirlpool |
$199.82
|
| Rate for Payer: Mclaren Commercial |
$185.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.28
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$199.82
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$159.71
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Healthscope Whirlpool |
$199.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$185.40
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.10
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.61
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.28
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.92
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.74
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.59
|
| Rate for Payer: Mclaren Medicare |
$4.74
|
| Rate for Payer: Meridian Medicaid |
$2.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.50
|
| Rate for Payer: PACE SWMI |
$4.74
|
| Rate for Payer: PHP Commercial |
$5.21
|
| Rate for Payer: PHP Medicaid |
$2.59
|
| Rate for Payer: PHP Medicare Advantage |
$4.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.95
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health Narrow Network |
$14.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: VA VA |
$4.74
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$51.90
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.33 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Aetna Commercial |
$46.71
|
| Rate for Payer: ASR ASR |
$50.34
|
| Rate for Payer: BCBS Trust/PPO |
$40.24
|
| Rate for Payer: BCN Commercial |
$40.24
|
| Rate for Payer: Cash Price |
$41.52
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.52
|
| Rate for Payer: Healthscope Commercial |
$51.90
|
| Rate for Payer: Healthscope Whirlpool |
$50.34
|
| Rate for Payer: Mclaren Commercial |
$46.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.67
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$51.90
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Aetna Commercial |
$46.71
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.22
|
| Rate for Payer: ASR ASR |
$50.34
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$40.24
|
| Rate for Payer: BCN Commercial |
$40.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$41.52
|
| Rate for Payer: Cash Price |
$41.52
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$51.90
|
| Rate for Payer: Healthscope Whirlpool |
$50.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.78
|
| Rate for Payer: Mclaren Commercial |
$46.71
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Mclaren Medicare |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$3.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.12
|
| Rate for Payer: PACE Medicare |
$5.49
|
| Rate for Payer: PACE SWMI |
$5.78
|
| Rate for Payer: PHP Commercial |
$6.36
|
| Rate for Payer: PHP Medicaid |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.95
|
| Rate for Payer: VA VA |
$5.78
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
