|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$95.37 |
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$92.51
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$73.94
|
| Rate for Payer: BCN Commercial |
$73.94
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$89.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$95.37
|
| Rate for Payer: Healthscope Whirlpool |
$92.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$85.83
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.63
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.79
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$67.71
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$95.37 |
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: ASR ASR |
$92.51
|
| Rate for Payer: BCBS Trust/PPO |
$73.94
|
| Rate for Payer: BCN Commercial |
$73.94
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$89.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.30
|
| Rate for Payer: Healthscope Commercial |
$95.37
|
| Rate for Payer: Healthscope Whirlpool |
$92.51
|
| Rate for Payer: Mclaren Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.93
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.63
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.61
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$64.45
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,904.34
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,333.04 |
| Max. Negotiated Rate |
$1,904.34 |
| Rate for Payer: Aetna Commercial |
$1,713.91
|
| Rate for Payer: ASR ASR |
$1,847.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.43
|
| Rate for Payer: BCN Commercial |
$1,476.43
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cofinity Commercial |
$1,790.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.47
|
| Rate for Payer: Healthscope Commercial |
$1,904.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,847.21
|
| Rate for Payer: Mclaren Commercial |
$1,713.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,675.82
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,904.34
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$673.71 |
| Max. Negotiated Rate |
$1,904.34 |
| Rate for Payer: Aetna Commercial |
$1,713.91
|
| Rate for Payer: Aetna Medicare |
$1,231.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,539.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,539.56
|
| Rate for Payer: ASR ASR |
$1,847.21
|
| Rate for Payer: BCBS Complete |
$707.46
|
| Rate for Payer: BCBS MAPPO |
$1,231.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.43
|
| Rate for Payer: BCN Commercial |
$1,476.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,231.65
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cofinity Commercial |
$1,790.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,231.65
|
| Rate for Payer: Healthscope Commercial |
$1,904.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,847.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,231.65
|
| Rate for Payer: Mclaren Commercial |
$1,713.91
|
| Rate for Payer: Mclaren Medicaid |
$673.71
|
| Rate for Payer: Mclaren Medicare |
$1,231.65
|
| Rate for Payer: Meridian Medicaid |
$707.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,293.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,416.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.69
|
| Rate for Payer: PACE Medicare |
$1,170.07
|
| Rate for Payer: PACE SWMI |
$1,231.65
|
| Rate for Payer: PHP Commercial |
$1,354.82
|
| Rate for Payer: PHP Medicaid |
$673.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,231.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,732.95
|
| Rate for Payer: Priority Health Medicare |
$1,231.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,352.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,231.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,675.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,268.60
|
| Rate for Payer: VA VA |
$1,231.65
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,161.08
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$2,161.08 |
| Rate for Payer: Aetna Commercial |
$1,944.97
|
| Rate for Payer: Aetna Medicare |
$440.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$550.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$550.81
|
| Rate for Payer: ASR ASR |
$2,096.25
|
| Rate for Payer: BCBS Complete |
$253.11
|
| Rate for Payer: BCBS MAPPO |
$440.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.49
|
| Rate for Payer: BCN Commercial |
$1,675.49
|
| Rate for Payer: BCN Medicare Advantage |
$440.65
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cofinity Commercial |
$2,031.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,728.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.65
|
| Rate for Payer: Healthscope Commercial |
$2,161.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$440.65
|
| Rate for Payer: Mclaren Commercial |
$1,944.97
|
| Rate for Payer: Mclaren Medicaid |
$241.04
|
| Rate for Payer: Mclaren Medicare |
$440.65
|
| Rate for Payer: Meridian Medicaid |
$253.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$462.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$506.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,836.92
|
| Rate for Payer: PACE Medicare |
$418.62
|
| Rate for Payer: PACE SWMI |
$440.65
|
| Rate for Payer: PHP Commercial |
$484.72
|
| Rate for Payer: PHP Medicaid |
$241.04
|
| Rate for Payer: PHP Medicare Advantage |
$440.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.81
|
| Rate for Payer: Priority Health Medicare |
$440.65
|
| Rate for Payer: Priority Health Narrow Network |
$652.65
|
| Rate for Payer: Railroad Medicare Medicare |
$440.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.75
|
| Rate for Payer: UHC Medicare Advantage |
$453.87
|
| Rate for Payer: VA VA |
$440.65
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,161.08
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,512.76 |
| Max. Negotiated Rate |
$2,161.08 |
| Rate for Payer: Aetna Commercial |
$1,944.97
|
| Rate for Payer: ASR ASR |
$2,096.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.49
|
| Rate for Payer: BCN Commercial |
$1,675.49
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cofinity Commercial |
$2,031.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,728.86
|
| Rate for Payer: Healthscope Commercial |
$2,161.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.25
|
| Rate for Payer: Mclaren Commercial |
$1,944.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,836.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.75
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,830.07
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.17 |
| Max. Negotiated Rate |
$2,830.07 |
| Rate for Payer: Aetna Commercial |
$2,547.06
|
| Rate for Payer: Aetna Medicare |
$627.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$784.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$784.21
|
| Rate for Payer: ASR ASR |
$2,745.17
|
| Rate for Payer: BCBS Complete |
$360.36
|
| Rate for Payer: BCBS MAPPO |
$627.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,194.15
|
| Rate for Payer: BCN Commercial |
$2,194.15
|
| Rate for Payer: BCN Medicare Advantage |
$627.37
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cofinity Commercial |
$2,660.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,264.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.37
|
| Rate for Payer: Healthscope Commercial |
$2,830.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,745.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$627.37
|
| Rate for Payer: Mclaren Commercial |
$2,547.06
|
| Rate for Payer: Mclaren Medicaid |
$343.17
|
| Rate for Payer: Mclaren Medicare |
$627.37
|
| Rate for Payer: Meridian Medicaid |
$360.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$658.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,405.56
|
| Rate for Payer: PACE Medicare |
$596.00
|
| Rate for Payer: PACE SWMI |
$627.37
|
| Rate for Payer: PHP Commercial |
$690.11
|
| Rate for Payer: PHP Medicaid |
$343.17
|
| Rate for Payer: PHP Medicare Advantage |
$627.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,345.32
|
| Rate for Payer: Priority Health Medicare |
$627.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,076.26
|
| Rate for Payer: Railroad Medicare Medicare |
$627.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,490.46
|
| Rate for Payer: UHC Medicare Advantage |
$646.19
|
| Rate for Payer: VA VA |
$627.37
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,830.07
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,981.05 |
| Max. Negotiated Rate |
$2,830.07 |
| Rate for Payer: Aetna Commercial |
$2,547.06
|
| Rate for Payer: ASR ASR |
$2,745.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,194.15
|
| Rate for Payer: BCN Commercial |
$2,194.15
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cofinity Commercial |
$2,660.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,264.06
|
| Rate for Payer: Healthscope Commercial |
$2,830.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,745.17
|
| Rate for Payer: Mclaren Commercial |
$2,547.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,405.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,490.46
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,318.86
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.17 |
| Max. Negotiated Rate |
$1,345.32 |
| Rate for Payer: Aetna Commercial |
$1,186.97
|
| Rate for Payer: Aetna Medicare |
$627.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$784.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$784.21
|
| Rate for Payer: ASR ASR |
$1,279.29
|
| Rate for Payer: BCBS Complete |
$360.36
|
| Rate for Payer: BCBS MAPPO |
$627.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.51
|
| Rate for Payer: BCN Commercial |
$1,022.51
|
| Rate for Payer: BCN Medicare Advantage |
$627.37
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cofinity Commercial |
$1,239.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.37
|
| Rate for Payer: Healthscope Commercial |
$1,318.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$627.37
|
| Rate for Payer: Mclaren Commercial |
$1,186.97
|
| Rate for Payer: Mclaren Medicaid |
$343.17
|
| Rate for Payer: Mclaren Medicare |
$627.37
|
| Rate for Payer: Meridian Medicaid |
$360.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$658.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.03
|
| Rate for Payer: PACE Medicare |
$596.00
|
| Rate for Payer: PACE SWMI |
$627.37
|
| Rate for Payer: PHP Commercial |
$690.11
|
| Rate for Payer: PHP Medicaid |
$343.17
|
| Rate for Payer: PHP Medicare Advantage |
$627.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,345.32
|
| Rate for Payer: Priority Health Medicare |
$627.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,076.26
|
| Rate for Payer: Railroad Medicare Medicare |
$627.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,160.60
|
| Rate for Payer: UHC Medicare Advantage |
$646.19
|
| Rate for Payer: VA VA |
$627.37
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,318.86
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$923.20 |
| Max. Negotiated Rate |
$1,318.86 |
| Rate for Payer: Aetna Commercial |
$1,186.97
|
| Rate for Payer: ASR ASR |
$1,279.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.51
|
| Rate for Payer: BCN Commercial |
$1,022.51
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cofinity Commercial |
$1,239.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.09
|
| Rate for Payer: Healthscope Commercial |
$1,318.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,279.29
|
| Rate for Payer: Mclaren Commercial |
$1,186.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,160.60
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$289.68
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$289.68 |
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: ASR ASR |
$280.99
|
| Rate for Payer: BCBS Trust/PPO |
$224.59
|
| Rate for Payer: BCN Commercial |
$224.59
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cofinity Commercial |
$272.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.74
|
| Rate for Payer: Healthscope Commercial |
$289.68
|
| Rate for Payer: Healthscope Whirlpool |
$280.99
|
| Rate for Payer: Mclaren Commercial |
$260.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.92
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$289.68
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.87 |
| Max. Negotiated Rate |
$289.68 |
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: ASR ASR |
$280.99
|
| Rate for Payer: BCBS Complete |
$115.87
|
| Rate for Payer: BCBS Trust/PPO |
$224.59
|
| Rate for Payer: BCN Commercial |
$224.59
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cofinity Commercial |
$272.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.74
|
| Rate for Payer: Healthscope Commercial |
$289.68
|
| Rate for Payer: Healthscope Whirlpool |
$280.99
|
| Rate for Payer: Mclaren Commercial |
$260.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.61
|
| Rate for Payer: Priority Health Narrow Network |
$205.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.92
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$23.67 |
| Rate for Payer: Aetna Commercial |
$21.30
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$22.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$21.30
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.54
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$16.81
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
| Rate for Payer: UHC Medicare Advantage |
$15.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$23.67 |
| Rate for Payer: Aetna Commercial |
$21.30
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$22.96
|
| Rate for Payer: Mclaren Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$23.67 |
| Rate for Payer: Aetna Commercial |
$21.30
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$22.96
|
| Rate for Payer: Mclaren Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$23.67 |
| Rate for Payer: Aetna Commercial |
$21.30
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$22.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$21.30
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.54
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$16.81
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
| Rate for Payer: UHC Medicare Advantage |
$15.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$7.92
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$8.16
|
| Rate for Payer: Healthscope Whirlpool |
$7.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$7.34
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.94
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$7.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.43
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$5.79
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.18
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: ASR ASR |
$7.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$8.16
|
| Rate for Payer: Healthscope Whirlpool |
$7.92
|
| Rate for Payer: Mclaren Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.18
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.18
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$13.74
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$145.86
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: ASR ASR |
$141.48
|
| Rate for Payer: BCBS Complete |
$58.34
|
| Rate for Payer: BCBS Trust/PPO |
$113.09
|
| Rate for Payer: BCN Commercial |
$113.09
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$137.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$145.86
|
| Rate for Payer: Healthscope Whirlpool |
$141.48
|
| Rate for Payer: Mclaren Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.73
|
| Rate for Payer: Priority Health Narrow Network |
$103.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.36
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$145.86
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: ASR ASR |
$141.48
|
| Rate for Payer: BCBS Trust/PPO |
$113.09
|
| Rate for Payer: BCN Commercial |
$113.09
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$137.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$145.86
|
| Rate for Payer: Healthscope Whirlpool |
$141.48
|
| Rate for Payer: Mclaren Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.36
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
