|
HC RAPID HIV ANTIBODY
|
Facility
|
IP
|
$150.70
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$150.70 |
| Rate for Payer: Aetna Commercial |
$135.63
|
| Rate for Payer: ASR ASR |
$146.18
|
| Rate for Payer: BCBS Trust/PPO |
$116.84
|
| Rate for Payer: BCN Commercial |
$116.84
|
| Rate for Payer: Cash Price |
$120.56
|
| Rate for Payer: Cofinity Commercial |
$141.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.56
|
| Rate for Payer: Healthscope Commercial |
$150.70
|
| Rate for Payer: Healthscope Whirlpool |
$146.18
|
| Rate for Payer: Mclaren Commercial |
$135.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.62
|
|
|
HC RAPID INFLUENZA A & B SCREEN
|
Facility
|
OP
|
$76.40
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
30600174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$121.61 |
| Rate for Payer: Aetna Commercial |
$68.76
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.69
|
| Rate for Payer: ASR ASR |
$74.11
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS MAPPO |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$59.23
|
| Rate for Payer: BCN Commercial |
$59.23
|
| Rate for Payer: BCN Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$61.12
|
| Rate for Payer: Cash Price |
$61.12
|
| Rate for Payer: Cofinity Commercial |
$71.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Healthscope Whirlpool |
$74.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.55
|
| Rate for Payer: Mclaren Commercial |
$68.76
|
| Rate for Payer: Mclaren Medicaid |
$9.05
|
| Rate for Payer: Mclaren Medicare |
$16.55
|
| Rate for Payer: Meridian Medicaid |
$9.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.94
|
| Rate for Payer: PACE Medicare |
$15.72
|
| Rate for Payer: PACE SWMI |
$16.55
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Medicaid |
$9.05
|
| Rate for Payer: PHP Medicare Advantage |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$16.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.23
|
| Rate for Payer: UHC Medicare Advantage |
$17.05
|
| Rate for Payer: VA VA |
$16.55
|
|
|
HC RAPID INFLUENZA A & B SCREEN
|
Facility
|
IP
|
$76.40
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
30600174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna Commercial |
$68.76
|
| Rate for Payer: ASR ASR |
$74.11
|
| Rate for Payer: BCBS Trust/PPO |
$59.23
|
| Rate for Payer: BCN Commercial |
$59.23
|
| Rate for Payer: Cash Price |
$61.12
|
| Rate for Payer: Cofinity Commercial |
$71.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.12
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Healthscope Whirlpool |
$74.11
|
| Rate for Payer: Mclaren Commercial |
$68.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.23
|
|
|
HC RAPID INFUSER
|
Facility
|
OP
|
$1,404.36
|
|
| Hospital Charge Code |
27000294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$561.74 |
| Max. Negotiated Rate |
$1,404.36 |
| Rate for Payer: Aetna Commercial |
$1,263.92
|
| Rate for Payer: ASR ASR |
$1,362.23
|
| Rate for Payer: BCBS Complete |
$561.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.80
|
| Rate for Payer: BCN Commercial |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,123.49
|
| Rate for Payer: Cofinity Commercial |
$1,320.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.49
|
| Rate for Payer: Healthscope Commercial |
$1,404.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,362.23
|
| Rate for Payer: Mclaren Commercial |
$1,263.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,193.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,277.97
|
| Rate for Payer: Priority Health Narrow Network |
$997.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,235.84
|
|
|
HC RAPID INFUSER
|
Facility
|
IP
|
$1,404.36
|
|
| Hospital Charge Code |
27000294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$983.05 |
| Max. Negotiated Rate |
$1,404.36 |
| Rate for Payer: Aetna Commercial |
$1,263.92
|
| Rate for Payer: ASR ASR |
$1,362.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.80
|
| Rate for Payer: BCN Commercial |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,123.49
|
| Rate for Payer: Cofinity Commercial |
$1,320.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.49
|
| Rate for Payer: Healthscope Commercial |
$1,404.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,362.23
|
| Rate for Payer: Mclaren Commercial |
$1,263.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,193.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,235.84
|
|
|
HC RAPID MALARIA ASSAY
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.07
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicaid |
$8.79
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC RAPID MALARIA ASSAY
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC RAPID STREP SCREEN.
|
Facility
|
OP
|
$60.49
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
30600176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$60.49 |
| Rate for Payer: Aetna Commercial |
$54.44
|
| Rate for Payer: Aetna Medicare |
$16.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.66
|
| Rate for Payer: ASR ASR |
$58.68
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$46.90
|
| Rate for Payer: BCN Commercial |
$46.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.53
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.53
|
| Rate for Payer: Healthscope Commercial |
$60.49
|
| Rate for Payer: Healthscope Whirlpool |
$58.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.53
|
| Rate for Payer: Mclaren Commercial |
$54.44
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.53
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.42
|
| Rate for Payer: PACE Medicare |
$15.70
|
| Rate for Payer: PACE SWMI |
$16.53
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.05
|
| Rate for Payer: Priority Health Medicare |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$42.95
|
| Rate for Payer: Railroad Medicare Medicare |
$16.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.23
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: VA VA |
$16.53
|
|
|
HC RAPID STREP SCREEN.
|
Facility
|
IP
|
$60.49
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
30600176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$60.49 |
| Rate for Payer: Aetna Commercial |
$54.44
|
| Rate for Payer: ASR ASR |
$58.68
|
| Rate for Payer: BCBS Trust/PPO |
$46.90
|
| Rate for Payer: BCN Commercial |
$46.90
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.39
|
| Rate for Payer: Healthscope Commercial |
$60.49
|
| Rate for Payer: Healthscope Whirlpool |
$58.68
|
| Rate for Payer: Mclaren Commercial |
$54.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.23
|
|
|
HC RAVAS CTO/DES
|
Facility
|
OP
|
$29,091.52
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,645.28 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: Aetna Medicare |
$15,586.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,586.58
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Commercial |
$17,145.24
|
| Rate for Payer: PHP Medicaid |
$8,525.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,306.60
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$6,645.28
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,600.54
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
HC RAVAS CTO/DES
|
Facility
|
IP
|
$29,091.52
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,364.06 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,600.54
|
|
|
HC RAVAS CTO/STENT
|
Facility
|
OP
|
$29,091.52
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: Aetna Medicare |
$9,778.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$10,756.56
|
| Rate for Payer: PHP Medicaid |
$5,348.94
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,600.54
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC RAVAS CTO/STENT
|
Facility
|
IP
|
$29,091.52
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,364.06 |
| Max. Negotiated Rate |
$29,091.52 |
| Rate for Payer: Aetna Commercial |
$26,182.37
|
| Rate for Payer: ASR ASR |
$28,218.77
|
| Rate for Payer: BCBS Trust/PPO |
$22,554.66
|
| Rate for Payer: BCN Commercial |
$22,554.66
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$27,346.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,273.22
|
| Rate for Payer: Healthscope Commercial |
$29,091.52
|
| Rate for Payer: Healthscope Whirlpool |
$28,218.77
|
| Rate for Payer: Mclaren Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,600.54
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
IP
|
$711.37
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$497.96 |
| Max. Negotiated Rate |
$711.37 |
| Rate for Payer: Aetna Commercial |
$640.23
|
| Rate for Payer: ASR ASR |
$690.03
|
| Rate for Payer: BCBS Trust/PPO |
$551.53
|
| Rate for Payer: BCN Commercial |
$551.53
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cofinity Commercial |
$668.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.10
|
| Rate for Payer: Healthscope Commercial |
$711.37
|
| Rate for Payer: Healthscope Whirlpool |
$690.03
|
| Rate for Payer: Mclaren Commercial |
$640.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$604.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$626.01
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
OP
|
$711.37
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$711.37 |
| Rate for Payer: Aetna Commercial |
$640.23
|
| Rate for Payer: Aetna Medicare |
$168.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.86
|
| Rate for Payer: ASR ASR |
$690.03
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: BCBS MAPPO |
$168.69
|
| Rate for Payer: BCBS Trust/PPO |
$551.53
|
| Rate for Payer: BCN Commercial |
$551.53
|
| Rate for Payer: BCN Medicare Advantage |
$168.69
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cofinity Commercial |
$668.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.69
|
| Rate for Payer: Healthscope Commercial |
$711.37
|
| Rate for Payer: Healthscope Whirlpool |
$690.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$168.69
|
| Rate for Payer: Mclaren Commercial |
$640.23
|
| Rate for Payer: Mclaren Medicaid |
$92.27
|
| Rate for Payer: Mclaren Medicare |
$168.69
|
| Rate for Payer: Meridian Medicaid |
$96.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$604.66
|
| Rate for Payer: PACE Medicare |
$160.26
|
| Rate for Payer: PACE SWMI |
$168.69
|
| Rate for Payer: PHP Commercial |
$185.56
|
| Rate for Payer: PHP Medicaid |
$92.27
|
| Rate for Payer: PHP Medicare Advantage |
$168.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$168.69
|
| Rate for Payer: Priority Health Narrow Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$168.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$626.01
|
| Rate for Payer: UHC Medicare Advantage |
$173.75
|
| Rate for Payer: VA VA |
$168.69
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$862.71 |
| Max. Negotiated Rate |
$1,232.44 |
| Rate for Payer: Aetna Commercial |
$1,109.20
|
| Rate for Payer: ASR ASR |
$1,195.47
|
| Rate for Payer: BCBS Trust/PPO |
$955.51
|
| Rate for Payer: BCN Commercial |
$955.51
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,158.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$985.95
|
| Rate for Payer: Healthscope Commercial |
$1,232.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.47
|
| Rate for Payer: Mclaren Commercial |
$1,109.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.55
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$1,232.44 |
| Rate for Payer: Aetna Commercial |
$1,109.20
|
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.42
|
| Rate for Payer: ASR ASR |
$1,195.47
|
| Rate for Payer: BCBS Complete |
$135.29
|
| Rate for Payer: BCBS MAPPO |
$235.54
|
| Rate for Payer: BCBS Trust/PPO |
$955.51
|
| Rate for Payer: BCN Commercial |
$955.51
|
| Rate for Payer: BCN Medicare Advantage |
$235.54
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,158.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$985.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.54
|
| Rate for Payer: Healthscope Commercial |
$1,232.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.54
|
| Rate for Payer: Mclaren Commercial |
$1,109.20
|
| Rate for Payer: Mclaren Medicaid |
$128.84
|
| Rate for Payer: Mclaren Medicare |
$235.54
|
| Rate for Payer: Meridian Medicaid |
$135.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PACE Medicare |
$223.76
|
| Rate for Payer: PACE SWMI |
$235.54
|
| Rate for Payer: PHP Commercial |
$259.09
|
| Rate for Payer: PHP Medicaid |
$128.84
|
| Rate for Payer: PHP Medicare Advantage |
$235.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.99
|
| Rate for Payer: Priority Health Medicare |
$235.54
|
| Rate for Payer: Priority Health Narrow Network |
$407.19
|
| Rate for Payer: Railroad Medicare Medicare |
$235.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.55
|
| Rate for Payer: UHC Medicare Advantage |
$242.61
|
| Rate for Payer: VA VA |
$235.54
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
IP
|
$199.97
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$139.98 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$179.97
|
| Rate for Payer: ASR ASR |
$193.97
|
| Rate for Payer: BCBS Trust/PPO |
$155.04
|
| Rate for Payer: BCN Commercial |
$155.04
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cofinity Commercial |
$187.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.98
|
| Rate for Payer: Healthscope Commercial |
$199.97
|
| Rate for Payer: Healthscope Whirlpool |
$193.97
|
| Rate for Payer: Mclaren Commercial |
$179.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.97
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
OP
|
$199.97
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$179.97
|
| Rate for Payer: Aetna Medicare |
$71.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.04
|
| Rate for Payer: ASR ASR |
$193.97
|
| Rate for Payer: BCBS Complete |
$40.91
|
| Rate for Payer: BCBS MAPPO |
$71.23
|
| Rate for Payer: BCBS Trust/PPO |
$155.04
|
| Rate for Payer: BCN Commercial |
$155.04
|
| Rate for Payer: BCN Medicare Advantage |
$71.23
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cofinity Commercial |
$187.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.23
|
| Rate for Payer: Healthscope Commercial |
$199.97
|
| Rate for Payer: Healthscope Whirlpool |
$193.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.23
|
| Rate for Payer: Mclaren Commercial |
$179.97
|
| Rate for Payer: Mclaren Medicaid |
$38.96
|
| Rate for Payer: Mclaren Medicare |
$71.23
|
| Rate for Payer: Meridian Medicaid |
$40.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$74.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.97
|
| Rate for Payer: PACE Medicare |
$67.67
|
| Rate for Payer: PACE SWMI |
$71.23
|
| Rate for Payer: PHP Commercial |
$78.35
|
| Rate for Payer: PHP Medicaid |
$38.96
|
| Rate for Payer: PHP Medicare Advantage |
$71.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.97
|
| Rate for Payer: Priority Health Medicare |
$71.23
|
| Rate for Payer: Priority Health Narrow Network |
$141.98
|
| Rate for Payer: Railroad Medicare Medicare |
$71.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.97
|
| Rate for Payer: UHC Medicare Advantage |
$73.37
|
| Rate for Payer: VA VA |
$71.23
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
OP
|
$153.93
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$61.57 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$138.54
|
| Rate for Payer: ASR ASR |
$149.31
|
| Rate for Payer: BCBS Complete |
$61.57
|
| Rate for Payer: BCBS Trust/PPO |
$119.34
|
| Rate for Payer: BCN Commercial |
$119.34
|
| Rate for Payer: Cash Price |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$144.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.14
|
| Rate for Payer: Healthscope Commercial |
$153.93
|
| Rate for Payer: Healthscope Whirlpool |
$149.31
|
| Rate for Payer: Mclaren Commercial |
$138.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.08
|
| Rate for Payer: Priority Health Narrow Network |
$109.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.46
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
IP
|
$153.93
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$138.54
|
| Rate for Payer: ASR ASR |
$149.31
|
| Rate for Payer: BCBS Trust/PPO |
$119.34
|
| Rate for Payer: BCN Commercial |
$119.34
|
| Rate for Payer: Cash Price |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$144.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.14
|
| Rate for Payer: Healthscope Commercial |
$153.93
|
| Rate for Payer: Healthscope Whirlpool |
$149.31
|
| Rate for Payer: Mclaren Commercial |
$138.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.46
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
IP
|
$363.41
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$254.39 |
| Max. Negotiated Rate |
$363.41 |
| Rate for Payer: Aetna Commercial |
$327.07
|
| Rate for Payer: ASR ASR |
$352.51
|
| Rate for Payer: BCBS Trust/PPO |
$281.75
|
| Rate for Payer: BCN Commercial |
$281.75
|
| Rate for Payer: Cash Price |
$290.73
|
| Rate for Payer: Cofinity Commercial |
$341.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.73
|
| Rate for Payer: Healthscope Commercial |
$363.41
|
| Rate for Payer: Healthscope Whirlpool |
$352.51
|
| Rate for Payer: Mclaren Commercial |
$327.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.80
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
OP
|
$363.41
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$363.41 |
| Rate for Payer: Aetna Commercial |
$327.07
|
| Rate for Payer: ASR ASR |
$352.51
|
| Rate for Payer: BCBS Complete |
$145.36
|
| Rate for Payer: BCBS Trust/PPO |
$281.75
|
| Rate for Payer: BCN Commercial |
$281.75
|
| Rate for Payer: Cash Price |
$290.73
|
| Rate for Payer: Cofinity Commercial |
$341.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.73
|
| Rate for Payer: Healthscope Commercial |
$363.41
|
| Rate for Payer: Healthscope Whirlpool |
$352.51
|
| Rate for Payer: Mclaren Commercial |
$327.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.70
|
| Rate for Payer: Priority Health Narrow Network |
$258.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.80
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
IP
|
$180.23
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$126.16 |
| Max. Negotiated Rate |
$180.23 |
| Rate for Payer: Aetna Commercial |
$162.21
|
| Rate for Payer: ASR ASR |
$174.82
|
| Rate for Payer: BCBS Trust/PPO |
$139.73
|
| Rate for Payer: BCN Commercial |
$139.73
|
| Rate for Payer: Cash Price |
$144.18
|
| Rate for Payer: Cofinity Commercial |
$169.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.18
|
| Rate for Payer: Healthscope Commercial |
$180.23
|
| Rate for Payer: Healthscope Whirlpool |
$174.82
|
| Rate for Payer: Mclaren Commercial |
$162.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.60
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
OP
|
$180.23
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$180.23 |
| Rate for Payer: Aetna Commercial |
$162.21
|
| Rate for Payer: ASR ASR |
$174.82
|
| Rate for Payer: BCBS Complete |
$72.09
|
| Rate for Payer: BCBS Trust/PPO |
$139.73
|
| Rate for Payer: BCN Commercial |
$139.73
|
| Rate for Payer: Cash Price |
$144.18
|
| Rate for Payer: Cofinity Commercial |
$169.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.18
|
| Rate for Payer: Healthscope Commercial |
$180.23
|
| Rate for Payer: Healthscope Whirlpool |
$174.82
|
| Rate for Payer: Mclaren Commercial |
$162.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.01
|
| Rate for Payer: Priority Health Narrow Network |
$127.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.60
|
|
