|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
OP
|
$1,532.20
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$612.88 |
| Max. Negotiated Rate |
$1,532.20 |
| Rate for Payer: Aetna Commercial |
$1,378.98
|
| Rate for Payer: Aetna Medicare |
$766.10
|
| Rate for Payer: ASR ASR |
$1,486.23
|
| Rate for Payer: ASR Commercial |
$1,486.23
|
| Rate for Payer: BCBS Complete |
$612.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.72
|
| Rate for Payer: BCN Commercial |
$1,187.91
|
| Rate for Payer: Cash Price |
$1,225.76
|
| Rate for Payer: Cofinity Commercial |
$1,440.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,225.76
|
| Rate for Payer: Healthscope Commercial |
$1,532.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,486.23
|
| Rate for Payer: Mclaren Commercial |
$1,378.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,302.37
|
| Rate for Payer: Nomi Health Commercial |
$1,256.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,342.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,074.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,348.34
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
IP
|
$3,693.88
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,401.02 |
| Max. Negotiated Rate |
$3,693.88 |
| Rate for Payer: Aetna Commercial |
$3,324.49
|
| Rate for Payer: ASR ASR |
$3,583.06
|
| Rate for Payer: ASR Commercial |
$3,583.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,010.14
|
| Rate for Payer: BCN Commercial |
$2,863.87
|
| Rate for Payer: Cash Price |
$2,955.10
|
| Rate for Payer: Cofinity Commercial |
$3,472.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,955.10
|
| Rate for Payer: Healthscope Commercial |
$3,693.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,583.06
|
| Rate for Payer: Mclaren Commercial |
$3,324.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,139.80
|
| Rate for Payer: Nomi Health Commercial |
$3,028.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.61
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
OP
|
$3,693.88
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,477.55 |
| Max. Negotiated Rate |
$3,693.88 |
| Rate for Payer: Aetna Commercial |
$3,324.49
|
| Rate for Payer: Aetna Medicare |
$1,846.94
|
| Rate for Payer: ASR ASR |
$3,583.06
|
| Rate for Payer: ASR Commercial |
$3,583.06
|
| Rate for Payer: BCBS Complete |
$1,477.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,024.92
|
| Rate for Payer: BCN Commercial |
$2,863.87
|
| Rate for Payer: Cash Price |
$2,955.10
|
| Rate for Payer: Cofinity Commercial |
$3,472.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,955.10
|
| Rate for Payer: Healthscope Commercial |
$3,693.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,583.06
|
| Rate for Payer: Mclaren Commercial |
$3,324.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,139.80
|
| Rate for Payer: Nomi Health Commercial |
$3,028.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,236.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,589.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.61
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
OP
|
$373.32
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.34 |
| Max. Negotiated Rate |
$373.32 |
| Rate for Payer: Aetna Commercial |
$335.99
|
| Rate for Payer: Aetna Medicare |
$121.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.39
|
| Rate for Payer: ASR ASR |
$362.12
|
| Rate for Payer: ASR Commercial |
$362.12
|
| Rate for Payer: BCBS Complete |
$68.61
|
| Rate for Payer: BCBS MAPPO |
$121.91
|
| Rate for Payer: BCBS Trust/PPO |
$305.71
|
| Rate for Payer: BCN Commercial |
$289.43
|
| Rate for Payer: BCN Medicare Advantage |
$121.91
|
| Rate for Payer: Cash Price |
$298.66
|
| Rate for Payer: Cash Price |
$298.66
|
| Rate for Payer: Cofinity Commercial |
$350.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.91
|
| Rate for Payer: Healthscope Commercial |
$373.32
|
| Rate for Payer: Healthscope Whirlpool |
$362.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$121.91
|
| Rate for Payer: Mclaren Commercial |
$335.99
|
| Rate for Payer: Mclaren Medicaid |
$65.34
|
| Rate for Payer: Mclaren Medicare |
$121.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.01
|
| Rate for Payer: Meridian Medicaid |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.32
|
| Rate for Payer: Nomi Health Commercial |
$306.12
|
| Rate for Payer: PACE Medicare |
$115.81
|
| Rate for Payer: PACE SWMI |
$121.91
|
| Rate for Payer: PHP Commercial |
$134.10
|
| Rate for Payer: PHP Medicaid |
$65.34
|
| Rate for Payer: PHP Medicare Advantage |
$121.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.10
|
| Rate for Payer: Priority Health Medicare |
$121.91
|
| Rate for Payer: Priority Health Narrow Network |
$261.70
|
| Rate for Payer: Railroad Medicare Medicare |
$121.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.91
|
| Rate for Payer: UHC Exchange |
$188.96
|
| Rate for Payer: UHC Medicare Advantage |
$121.91
|
| Rate for Payer: UHCCP DNSP |
$121.91
|
| Rate for Payer: UHCCP Medicaid |
$65.34
|
| Rate for Payer: VA VA |
$121.91
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
IP
|
$373.32
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$242.66 |
| Max. Negotiated Rate |
$373.32 |
| Rate for Payer: Aetna Commercial |
$335.99
|
| Rate for Payer: ASR ASR |
$362.12
|
| Rate for Payer: ASR Commercial |
$362.12
|
| Rate for Payer: BCBS Trust/PPO |
$304.22
|
| Rate for Payer: BCN Commercial |
$289.43
|
| Rate for Payer: Cash Price |
$298.66
|
| Rate for Payer: Cofinity Commercial |
$350.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.66
|
| Rate for Payer: Healthscope Commercial |
$373.32
|
| Rate for Payer: Healthscope Whirlpool |
$362.12
|
| Rate for Payer: Mclaren Commercial |
$335.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.32
|
| Rate for Payer: Nomi Health Commercial |
$306.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.52
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
IP
|
$388.07
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$388.07 |
| Rate for Payer: Aetna Commercial |
$349.26
|
| Rate for Payer: ASR ASR |
$376.43
|
| Rate for Payer: ASR Commercial |
$376.43
|
| Rate for Payer: BCBS Trust/PPO |
$316.24
|
| Rate for Payer: BCN Commercial |
$300.87
|
| Rate for Payer: Cash Price |
$310.46
|
| Rate for Payer: Cofinity Commercial |
$364.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.46
|
| Rate for Payer: Healthscope Commercial |
$388.07
|
| Rate for Payer: Healthscope Whirlpool |
$376.43
|
| Rate for Payer: Mclaren Commercial |
$349.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.86
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.50
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
OP
|
$388.07
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$388.07 |
| Rate for Payer: Aetna Commercial |
$349.26
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$376.43
|
| Rate for Payer: ASR Commercial |
$376.43
|
| Rate for Payer: BCBS Complete |
$51.59
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$317.79
|
| Rate for Payer: BCN Commercial |
$300.87
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$310.46
|
| Rate for Payer: Cash Price |
$310.46
|
| Rate for Payer: Cofinity Commercial |
$364.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$388.07
|
| Rate for Payer: Healthscope Whirlpool |
$376.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$349.26
|
| Rate for Payer: Mclaren Medicaid |
$49.13
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$51.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.86
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.03
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$272.04
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.66
|
| Rate for Payer: UHC Exchange |
$142.07
|
| Rate for Payer: UHC Medicare Advantage |
$91.66
|
| Rate for Payer: UHCCP DNSP |
$91.66
|
| Rate for Payer: UHCCP Medicaid |
$49.13
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
OP
|
$108.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| 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 |
$104.88
|
| Rate for Payer: ASR Commercial |
$104.88
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$88.54
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$101.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$108.12
|
| Rate for Payer: Healthscope Whirlpool |
$104.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$97.31
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$88.66
|
| 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 |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.73
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$75.79
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
IP
|
$108.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| Rate for Payer: ASR ASR |
$104.88
|
| Rate for Payer: ASR Commercial |
$104.88
|
| Rate for Payer: BCBS Trust/PPO |
$88.11
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$101.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Healthscope Commercial |
$108.12
|
| Rate for Payer: Healthscope Whirlpool |
$104.88
|
| Rate for Payer: Mclaren Commercial |
$97.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$88.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.15
|
|
|
HC JET VENT INITIAL DAY
|
Facility
|
OP
|
$2,576.21
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$2,576.21 |
| Rate for Payer: Aetna Commercial |
$2,318.59
|
| Rate for Payer: Aetna Medicare |
$644.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: ASR ASR |
$2,498.92
|
| Rate for Payer: ASR Commercial |
$2,498.92
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,109.66
|
| Rate for Payer: BCN Commercial |
$1,997.34
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$2,060.97
|
| Rate for Payer: Cash Price |
$2,060.97
|
| Rate for Payer: Cofinity Commercial |
$2,421.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$2,576.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,498.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$2,318.59
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,189.78
|
| Rate for Payer: Nomi Health Commercial |
$2,112.49
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$709.24
|
| Rate for Payer: PHP Medicaid |
$345.59
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,674.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,257.28
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,805.92
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,267.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$999.38
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP DNSP |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$345.59
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC JET VENT INITIAL DAY
|
Facility
|
IP
|
$2,576.21
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,674.54 |
| Max. Negotiated Rate |
$2,576.21 |
| Rate for Payer: Aetna Commercial |
$2,318.59
|
| Rate for Payer: ASR ASR |
$2,498.92
|
| Rate for Payer: ASR Commercial |
$2,498.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,099.35
|
| Rate for Payer: BCN Commercial |
$1,997.34
|
| Rate for Payer: Cash Price |
$2,060.97
|
| Rate for Payer: Cofinity Commercial |
$2,421.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.97
|
| Rate for Payer: Healthscope Commercial |
$2,576.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,498.92
|
| Rate for Payer: Mclaren Commercial |
$2,318.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,189.78
|
| Rate for Payer: Nomi Health Commercial |
$2,112.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,674.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,267.06
|
|
|
HC JET VENT SUB DAY
|
Facility
|
IP
|
$1,897.80
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,233.57 |
| Max. Negotiated Rate |
$1,897.80 |
| Rate for Payer: Aetna Commercial |
$1,708.02
|
| Rate for Payer: ASR ASR |
$1,840.87
|
| Rate for Payer: ASR Commercial |
$1,840.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.52
|
| Rate for Payer: BCN Commercial |
$1,471.36
|
| Rate for Payer: Cash Price |
$1,518.24
|
| Rate for Payer: Cofinity Commercial |
$1,783.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,518.24
|
| Rate for Payer: Healthscope Commercial |
$1,897.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,840.87
|
| Rate for Payer: Mclaren Commercial |
$1,708.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.13
|
| Rate for Payer: Nomi Health Commercial |
$1,556.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,670.06
|
|
|
HC JET VENT SUB DAY
|
Facility
|
OP
|
$1,897.80
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,897.80 |
| Rate for Payer: Aetna Commercial |
$1,708.02
|
| Rate for Payer: Aetna Medicare |
$644.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: ASR ASR |
$1,840.87
|
| Rate for Payer: ASR Commercial |
$1,840.87
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.11
|
| Rate for Payer: BCN Commercial |
$1,471.36
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,518.24
|
| Rate for Payer: Cash Price |
$1,518.24
|
| Rate for Payer: Cofinity Commercial |
$1,783.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,518.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,897.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,840.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$644.76
|
| Rate for Payer: Mclaren Commercial |
$1,708.02
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.13
|
| Rate for Payer: Nomi Health Commercial |
$1,556.20
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$709.24
|
| Rate for Payer: PHP Medicaid |
$345.59
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,662.85
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,330.36
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,670.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$999.38
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP DNSP |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$345.59
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$11.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$11.11 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: ASR ASR |
$10.78
|
| Rate for Payer: ASR Commercial |
$10.78
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$9.10
|
| Rate for Payer: BCN Commercial |
$8.61
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$11.11
|
| Rate for Payer: Healthscope Whirlpool |
$10.78
|
| Rate for Payer: Mclaren Commercial |
$10.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.44
|
| Rate for Payer: Nomi Health Commercial |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.73
|
| Rate for Payer: Priority Health Narrow Network |
$7.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.78
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$11.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$11.11 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: ASR ASR |
$10.78
|
| Rate for Payer: ASR Commercial |
$10.78
|
| Rate for Payer: BCBS Trust/PPO |
$9.05
|
| Rate for Payer: BCN Commercial |
$8.61
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$11.11
|
| Rate for Payer: Healthscope Whirlpool |
$10.78
|
| Rate for Payer: Mclaren Commercial |
$10.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.44
|
| Rate for Payer: Nomi Health Commercial |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.78
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$212.87
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.37 |
| Max. Negotiated Rate |
$212.87 |
| Rate for Payer: Aetna Commercial |
$191.58
|
| Rate for Payer: ASR ASR |
$206.48
|
| Rate for Payer: ASR Commercial |
$206.48
|
| Rate for Payer: BCBS Trust/PPO |
$173.47
|
| Rate for Payer: BCN Commercial |
$165.04
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$200.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$212.87
|
| Rate for Payer: Healthscope Whirlpool |
$206.48
|
| Rate for Payer: Mclaren Commercial |
$191.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.33
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$212.87
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$212.87 |
| Rate for Payer: Aetna Commercial |
$191.58
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$206.48
|
| Rate for Payer: ASR Commercial |
$206.48
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$174.32
|
| Rate for Payer: BCN Commercial |
$165.04
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$200.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$212.87
|
| Rate for Payer: Healthscope Whirlpool |
$206.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$191.58
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.52
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$149.22
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: ASR ASR |
$75.10
|
| Rate for Payer: ASR Commercial |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$63.09
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Whirlpool |
$75.10
|
| Rate for Payer: Mclaren Commercial |
$69.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.13
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$75.10
|
| Rate for Payer: ASR Commercial |
$75.10
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Whirlpool |
$75.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$69.68
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.84
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$54.27
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$36.82 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: ASR ASR |
$35.72
|
| Rate for Payer: ASR Commercial |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$30.00
|
| Rate for Payer: BCN Commercial |
$28.55
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$34.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Whirlpool |
$35.72
|
| Rate for Payer: Mclaren Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: Nomi Health Commercial |
$30.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.40
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$36.82 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: ASR ASR |
$35.72
|
| Rate for Payer: ASR Commercial |
$35.72
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$28.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$34.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Whirlpool |
$35.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.52
|
| Rate for Payer: Mclaren Commercial |
$33.14
|
| Rate for Payer: Mclaren Medicaid |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: Nomi Health Commercial |
$30.19
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$4.97
|
| Rate for Payer: PHP Medicaid |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.26
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$25.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Exchange |
$7.01
|
| Rate for Payer: UHC Medicare Advantage |
$4.52
|
| Rate for Payer: UHCCP DNSP |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$2.42
|
| Rate for Payer: VA VA |
$4.52
|
|
