|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
OP
|
$247.20
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$247.20 |
| Rate for Payer: Aetna Commercial |
$222.48
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$239.78
|
| Rate for Payer: BCBS Complete |
$84.30
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$203.82
|
| Rate for Payer: BCN Commercial |
$203.82
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$197.76
|
| Rate for Payer: Cash Price |
$197.76
|
| Rate for Payer: Cofinity Commercial |
$232.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$239.78
|
| Rate for Payer: Healthscope Whirlpool |
$247.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$222.48
|
| Rate for Payer: Mclaren Medicaid |
$153.50
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$84.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.12
|
| Rate for Payer: Nomi Health Commercial |
$202.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.40
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$153.50
|
| Rate for Payer: UHC Exchange |
$237.93
|
| Rate for Payer: UHC Medicaid |
$80.28
|
| Rate for Payer: UHCCP DNSP |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$80.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
IP
|
$247.20
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$247.20 |
| Rate for Payer: Aetna Commercial |
$222.48
|
| Rate for Payer: ASR ASR |
$239.78
|
| Rate for Payer: BCBS Trust/PPO |
$203.00
|
| Rate for Payer: BCN Commercial |
$203.00
|
| Rate for Payer: Cash Price |
$197.76
|
| Rate for Payer: Cofinity Commercial |
$232.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.76
|
| Rate for Payer: Healthscope Commercial |
$239.78
|
| Rate for Payer: Healthscope Whirlpool |
$247.20
|
| Rate for Payer: Mclaren Commercial |
$222.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.12
|
| Rate for Payer: Nomi Health Commercial |
$202.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.54
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
OP
|
$125.08
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$125.08 |
| Rate for Payer: Aetna Commercial |
$112.57
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$121.33
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$103.13
|
| Rate for Payer: BCN Commercial |
$103.13
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$100.06
|
| Rate for Payer: Cash Price |
$100.06
|
| Rate for Payer: Cofinity Commercial |
$117.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$121.33
|
| Rate for Payer: Healthscope Whirlpool |
$125.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$112.57
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.32
|
| Rate for Payer: Nomi Health Commercial |
$102.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.81
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.60
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$87.68
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
IP
|
$125.08
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$93.81 |
| Max. Negotiated Rate |
$125.08 |
| Rate for Payer: Aetna Commercial |
$112.57
|
| Rate for Payer: ASR ASR |
$121.33
|
| Rate for Payer: BCBS Trust/PPO |
$102.72
|
| Rate for Payer: BCN Commercial |
$102.72
|
| Rate for Payer: Cash Price |
$100.06
|
| Rate for Payer: Cofinity Commercial |
$117.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.06
|
| Rate for Payer: Healthscope Commercial |
$121.33
|
| Rate for Payer: Healthscope Whirlpool |
$125.08
|
| Rate for Payer: Mclaren Commercial |
$112.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.32
|
| Rate for Payer: Nomi Health Commercial |
$102.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.07
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
OP
|
$344.99
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$344.99 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$334.64
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$284.44
|
| Rate for Payer: BCN Commercial |
$284.44
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$275.99
|
| Rate for Payer: Cash Price |
$275.99
|
| Rate for Payer: Cofinity Commercial |
$324.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$334.64
|
| Rate for Payer: Healthscope Whirlpool |
$344.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.89
|
| Rate for Payer: Mclaren Commercial |
$310.49
|
| Rate for Payer: Mclaren Medicaid |
$11.89
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.24
|
| Rate for Payer: Nomi Health Commercial |
$282.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.74
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Medicaid |
$6.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$302.28
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$241.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.89
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UHC Medicaid |
$6.22
|
| Rate for Payer: UHCCP DNSP |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.22
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
IP
|
$344.99
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$258.74 |
| Max. Negotiated Rate |
$344.99 |
| Rate for Payer: Aetna Commercial |
$310.49
|
| Rate for Payer: ASR ASR |
$334.64
|
| Rate for Payer: BCBS Trust/PPO |
$283.31
|
| Rate for Payer: BCN Commercial |
$283.31
|
| Rate for Payer: Cash Price |
$275.99
|
| Rate for Payer: Cofinity Commercial |
$324.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.99
|
| Rate for Payer: Healthscope Commercial |
$334.64
|
| Rate for Payer: Healthscope Whirlpool |
$344.99
|
| Rate for Payer: Mclaren Commercial |
$310.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.24
|
| Rate for Payer: Nomi Health Commercial |
$282.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.59
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
OP
|
$365.73
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$365.73 |
| Rate for Payer: Aetna Commercial |
$329.16
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$354.76
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$301.54
|
| Rate for Payer: BCN Commercial |
$301.54
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$292.58
|
| Rate for Payer: Cash Price |
$292.58
|
| Rate for Payer: Cofinity Commercial |
$343.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$354.76
|
| Rate for Payer: Healthscope Whirlpool |
$365.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.89
|
| Rate for Payer: Mclaren Commercial |
$329.16
|
| Rate for Payer: Mclaren Medicaid |
$11.89
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.87
|
| Rate for Payer: Nomi Health Commercial |
$299.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.30
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Medicaid |
$6.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$320.45
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.89
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UHC Medicaid |
$6.22
|
| Rate for Payer: UHCCP DNSP |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.22
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
IP
|
$365.73
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$274.30 |
| Max. Negotiated Rate |
$365.73 |
| Rate for Payer: Aetna Commercial |
$329.16
|
| Rate for Payer: ASR ASR |
$354.76
|
| Rate for Payer: BCBS Trust/PPO |
$300.34
|
| Rate for Payer: BCN Commercial |
$300.34
|
| Rate for Payer: Cash Price |
$292.58
|
| Rate for Payer: Cofinity Commercial |
$343.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.58
|
| Rate for Payer: Healthscope Commercial |
$354.76
|
| Rate for Payer: Healthscope Whirlpool |
$365.73
|
| Rate for Payer: Mclaren Commercial |
$329.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.87
|
| Rate for Payer: Nomi Health Commercial |
$299.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.84
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
OP
|
$2,002.77
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.23 |
| Max. Negotiated Rate |
$2,002.77 |
| Rate for Payer: Aetna Commercial |
$1,802.49
|
| Rate for Payer: Aetna Medicare |
$759.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$949.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$949.41
|
| Rate for Payer: ASR ASR |
$1,942.69
|
| Rate for Payer: BCBS Complete |
$417.13
|
| Rate for Payer: BCBS MAPPO |
$759.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.28
|
| Rate for Payer: BCN Commercial |
$1,651.28
|
| Rate for Payer: BCN Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$1,602.22
|
| Rate for Payer: Cash Price |
$1,602.22
|
| Rate for Payer: Cofinity Commercial |
$1,882.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.53
|
| Rate for Payer: Healthscope Commercial |
$1,942.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,002.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$759.53
|
| Rate for Payer: Mclaren Commercial |
$1,802.49
|
| Rate for Payer: Mclaren Medicaid |
$759.53
|
| Rate for Payer: Mclaren Medicare |
$759.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.51
|
| Rate for Payer: Meridian Medicaid |
$417.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$835.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,702.35
|
| Rate for Payer: Nomi Health Commercial |
$1,642.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,502.08
|
| Rate for Payer: PACE Medicare |
$721.55
|
| Rate for Payer: PACE SWMI |
$759.53
|
| Rate for Payer: PHP Commercial |
$835.48
|
| Rate for Payer: PHP Medicaid |
$407.11
|
| Rate for Payer: PHP Medicare Advantage |
$759.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,754.83
|
| Rate for Payer: Priority Health Medicare |
$759.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,403.94
|
| Rate for Payer: Railroad Medicare Medicare |
$759.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,762.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$759.53
|
| Rate for Payer: UHC Exchange |
$1,177.27
|
| Rate for Payer: UHC Medicaid |
$397.23
|
| Rate for Payer: UHCCP DNSP |
$759.53
|
| Rate for Payer: UHCCP Medicaid |
$397.23
|
| Rate for Payer: VA VA |
$759.53
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
IP
|
$2,002.77
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,502.08 |
| Max. Negotiated Rate |
$2,002.77 |
| Rate for Payer: Aetna Commercial |
$1,802.49
|
| Rate for Payer: ASR ASR |
$1,942.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.67
|
| Rate for Payer: BCN Commercial |
$1,644.67
|
| Rate for Payer: Cash Price |
$1,602.22
|
| Rate for Payer: Cofinity Commercial |
$1,882.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.22
|
| Rate for Payer: Healthscope Commercial |
$1,942.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,002.77
|
| Rate for Payer: Mclaren Commercial |
$1,802.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,702.35
|
| Rate for Payer: Nomi Health Commercial |
$1,642.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,502.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,762.44
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$10.67
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$9.07
|
| Rate for Payer: BCN Commercial |
$9.07
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Healthscope Whirlpool |
$11.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$9.90
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: ASR ASR |
$10.67
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$10.67
|
| Rate for Payer: Healthscope Whirlpool |
$11.00
|
| Rate for Payer: Mclaren Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.68
|
|
|
HC MDI TREATMENT
|
Facility
|
OP
|
$152.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$101.68 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$137.39
|
| Rate for Payer: Aetna Medicare |
$218.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: ASR ASR |
$148.08
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$125.87
|
| Rate for Payer: BCN Commercial |
$125.87
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cofinity Commercial |
$143.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$148.08
|
| Rate for Payer: Healthscope Whirlpool |
$152.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$137.39
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$119.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Nomi Health Commercial |
$125.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.50
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$240.01
|
| Rate for Payer: PHP Medicaid |
$116.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.10
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health Narrow Network |
$101.68
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$338.19
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP DNSP |
$218.19
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC MDI TREATMENT
|
Facility
|
IP
|
$152.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$152.66 |
| Rate for Payer: Aetna Commercial |
$137.39
|
| Rate for Payer: ASR ASR |
$148.08
|
| Rate for Payer: BCBS Trust/PPO |
$125.36
|
| Rate for Payer: BCN Commercial |
$125.36
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cofinity Commercial |
$143.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.13
|
| Rate for Payer: Healthscope Commercial |
$148.08
|
| Rate for Payer: Healthscope Whirlpool |
$152.66
|
| Rate for Payer: Mclaren Commercial |
$137.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Nomi Health Commercial |
$125.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.34
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
OP
|
$500.92
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$500.92 |
| Rate for Payer: Aetna Commercial |
$450.83
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$485.89
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$413.01
|
| Rate for Payer: BCN Commercial |
$413.01
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$400.74
|
| Rate for Payer: Cash Price |
$400.74
|
| Rate for Payer: Cofinity Commercial |
$470.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$485.89
|
| Rate for Payer: Healthscope Whirlpool |
$500.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$450.83
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.78
|
| Rate for Payer: Nomi Health Commercial |
$410.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.69
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$438.91
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$351.14
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
IP
|
$500.92
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$375.69 |
| Max. Negotiated Rate |
$500.92 |
| Rate for Payer: Aetna Commercial |
$450.83
|
| Rate for Payer: ASR ASR |
$485.89
|
| Rate for Payer: BCBS Trust/PPO |
$411.36
|
| Rate for Payer: BCN Commercial |
$411.36
|
| Rate for Payer: Cash Price |
$400.74
|
| Rate for Payer: Cofinity Commercial |
$470.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.74
|
| Rate for Payer: Healthscope Commercial |
$485.89
|
| Rate for Payer: Healthscope Whirlpool |
$500.92
|
| Rate for Payer: Mclaren Commercial |
$450.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.78
|
| Rate for Payer: Nomi Health Commercial |
$410.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.81
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: ASR ASR |
$50.44
|
| Rate for Payer: BCBS Trust/PPO |
$42.70
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$48.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$52.00
|
| Rate for Payer: Mclaren Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.76
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| 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 |
$50.44
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.87
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$48.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$52.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$46.80
|
| Rate for Payer: Mclaren Medicaid |
$12.88
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| 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 |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC MECHANICAL REMOVAL OBSTRC CVD
|
Facility
|
OP
|
$1,599.40
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
36100143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$2,431.16 |
| Rate for Payer: Aetna Commercial |
$1,439.46
|
| Rate for Payer: Aetna Medicare |
$1,568.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: ASR ASR |
$1,551.42
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.71
|
| Rate for Payer: BCN Commercial |
$1,318.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,279.52
|
| Rate for Payer: Cash Price |
$1,279.52
|
| Rate for Payer: Cofinity Commercial |
$1,503.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,279.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$1,551.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,599.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.49
|
| Rate for Payer: Mclaren Commercial |
$1,439.46
|
| Rate for Payer: Mclaren Medicaid |
$1,568.49
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$861.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,359.49
|
| Rate for Payer: Nomi Health Commercial |
$1,311.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.55
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,725.34
|
| Rate for Payer: PHP Medicaid |
$840.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,401.39
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,121.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,407.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Exchange |
$2,431.16
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP DNSP |
$1,568.49
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC MECHANICAL REMOVAL OBSTRC CVD
|
Facility
|
IP
|
$1,599.40
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
36100143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,199.55 |
| Max. Negotiated Rate |
$1,599.40 |
| Rate for Payer: Aetna Commercial |
$1,439.46
|
| Rate for Payer: ASR ASR |
$1,551.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,313.43
|
| Rate for Payer: BCN Commercial |
$1,313.43
|
| Rate for Payer: Cash Price |
$1,279.52
|
| Rate for Payer: Cofinity Commercial |
$1,503.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,279.52
|
| Rate for Payer: Healthscope Commercial |
$1,551.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,599.40
|
| Rate for Payer: Mclaren Commercial |
$1,439.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,359.49
|
| Rate for Payer: Nomi Health Commercial |
$1,311.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,407.47
|
|
|
HC MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTION
|
Facility
|
IP
|
$3,021.82
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
36100142
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,266.36 |
| Max. Negotiated Rate |
$3,021.82 |
| Rate for Payer: Aetna Commercial |
$2,719.64
|
| Rate for Payer: ASR ASR |
$2,931.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,481.52
|
| Rate for Payer: BCN Commercial |
$2,481.52
|
| Rate for Payer: Cash Price |
$2,417.46
|
| Rate for Payer: Cofinity Commercial |
$2,840.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,417.46
|
| Rate for Payer: Healthscope Commercial |
$2,931.17
|
| Rate for Payer: Healthscope Whirlpool |
$3,021.82
|
| Rate for Payer: Mclaren Commercial |
$2,719.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,568.55
|
| Rate for Payer: Nomi Health Commercial |
$2,477.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,266.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,659.20
|
|
|
HC MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTION
|
Facility
|
OP
|
$3,021.82
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
36100142
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$2,719.64
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$2,931.17
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,491.49
|
| Rate for Payer: BCN Commercial |
$2,491.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,417.46
|
| Rate for Payer: Cash Price |
$2,417.46
|
| Rate for Payer: Cofinity Commercial |
$2,840.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,417.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$2,931.17
|
| Rate for Payer: Healthscope Whirlpool |
$3,021.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$2,719.64
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,568.55
|
| Rate for Payer: Nomi Health Commercial |
$2,477.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,266.36
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,647.72
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,118.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,659.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC MECH CHEST WALL OSCILLATION
|
Facility
|
IP
|
$327.02
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$245.26 |
| Max. Negotiated Rate |
$327.02 |
| Rate for Payer: Aetna Commercial |
$294.32
|
| Rate for Payer: ASR ASR |
$317.21
|
| Rate for Payer: BCBS Trust/PPO |
$268.55
|
| Rate for Payer: BCN Commercial |
$268.55
|
| Rate for Payer: Cash Price |
$261.62
|
| Rate for Payer: Cofinity Commercial |
$307.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.62
|
| Rate for Payer: Healthscope Commercial |
$317.21
|
| Rate for Payer: Healthscope Whirlpool |
$327.02
|
| Rate for Payer: Mclaren Commercial |
$294.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.97
|
| Rate for Payer: Nomi Health Commercial |
$268.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.78
|
|
