|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.07
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$12.39
|
| Rate for Payer: PHP Medicaid |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.97
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$16.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Exchange |
$17.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.26
|
| Rate for Payer: UHCCP DNSP |
$11.26
|
| Rate for Payer: UHCCP Medicaid |
$6.04
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
|
|
HC LTC ROOM AND BOARD
|
Facility
|
IP
|
$377.40
|
|
| Hospital Charge Code |
11000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$245.31 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: ASR ASR |
$366.08
|
| Rate for Payer: ASR Commercial |
$366.08
|
| Rate for Payer: BCBS Trust/PPO |
$307.54
|
| Rate for Payer: BCN Commercial |
$292.60
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cofinity Commercial |
$354.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.92
|
| Rate for Payer: Healthscope Commercial |
$377.40
|
| Rate for Payer: Healthscope Whirlpool |
$366.08
|
| Rate for Payer: Mclaren Commercial |
$339.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.79
|
| Rate for Payer: Nomi Health Commercial |
$309.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.11
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,032.65 |
| Max. Negotiated Rate |
$12,357.92 |
| Rate for Payer: Aetna Commercial |
$11,122.13
|
| Rate for Payer: ASR ASR |
$11,987.18
|
| Rate for Payer: ASR Commercial |
$11,987.18
|
| Rate for Payer: BCBS Trust/PPO |
$10,070.47
|
| Rate for Payer: BCN Commercial |
$9,581.10
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$11,616.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Healthscope Commercial |
$12,357.92
|
| Rate for Payer: Healthscope Whirlpool |
$11,987.18
|
| Rate for Payer: Mclaren Commercial |
$11,122.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$10,133.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,874.97
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$12,357.92 |
| Rate for Payer: Aetna Commercial |
$11,122.13
|
| Rate for Payer: Aetna Medicare |
$3,136.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: ASR ASR |
$11,987.18
|
| Rate for Payer: ASR Commercial |
$11,987.18
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCBS Trust/PPO |
$10,119.90
|
| Rate for Payer: BCN Commercial |
$9,581.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$11,616.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$12,357.92
|
| Rate for Payer: Healthscope Whirlpool |
$11,987.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,136.90
|
| Rate for Payer: Mclaren Commercial |
$11,122.13
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$10,133.49
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$3,450.59
|
| Rate for Payer: PHP Medicaid |
$1,681.38
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,828.01
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health Narrow Network |
$8,662.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,874.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Exchange |
$4,862.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP DNSP |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,681.38
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Aetna Commercial |
$71.55
|
| Rate for Payer: Aetna Medicare |
$39.75
|
| Rate for Payer: ASR ASR |
$77.11
|
| Rate for Payer: ASR Commercial |
$77.11
|
| Rate for Payer: BCBS Complete |
$31.80
|
| Rate for Payer: BCBS Trust/PPO |
$65.10
|
| Rate for Payer: BCN Commercial |
$61.64
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$74.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$79.50
|
| Rate for Payer: Healthscope Whirlpool |
$77.11
|
| Rate for Payer: Mclaren Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: Nomi Health Commercial |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.66
|
| Rate for Payer: Priority Health Narrow Network |
$55.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.96
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Aetna Commercial |
$71.55
|
| Rate for Payer: ASR ASR |
$77.11
|
| Rate for Payer: ASR Commercial |
$77.11
|
| Rate for Payer: BCBS Trust/PPO |
$64.78
|
| Rate for Payer: BCN Commercial |
$61.64
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$74.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$79.50
|
| Rate for Payer: Healthscope Whirlpool |
$77.11
|
| Rate for Payer: Mclaren Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: Nomi Health Commercial |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.96
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: ASR Commercial |
$726.08
|
| Rate for Payer: BCBS Trust/PPO |
$609.99
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: ASR Commercial |
$726.08
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS Trust/PPO |
$612.98
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.87
|
| Rate for Payer: Priority Health Narrow Network |
$524.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$824.74
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$888.89
|
| Rate for Payer: ASR Commercial |
$888.89
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$750.42
|
| Rate for Payer: BCN Commercial |
$710.47
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$861.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$916.38
|
| Rate for Payer: Healthscope Whirlpool |
$888.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$824.74
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$751.43
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$802.93
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$642.38
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.65 |
| Max. Negotiated Rate |
$916.38 |
| Rate for Payer: Aetna Commercial |
$824.74
|
| Rate for Payer: ASR ASR |
$888.89
|
| Rate for Payer: ASR Commercial |
$888.89
|
| Rate for Payer: BCBS Trust/PPO |
$746.76
|
| Rate for Payer: BCN Commercial |
$710.47
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$861.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Healthscope Commercial |
$916.38
|
| Rate for Payer: Healthscope Whirlpool |
$888.89
|
| Rate for Payer: Mclaren Commercial |
$824.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$751.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.41
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$771.00 |
| Rate for Payer: Aetna Commercial |
$693.90
|
| Rate for Payer: ASR ASR |
$747.87
|
| Rate for Payer: ASR Commercial |
$747.87
|
| Rate for Payer: BCBS Trust/PPO |
$628.29
|
| Rate for Payer: BCN Commercial |
$597.76
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$724.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Healthscope Commercial |
$771.00
|
| Rate for Payer: Healthscope Whirlpool |
$747.87
|
| Rate for Payer: Mclaren Commercial |
$693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$632.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.48
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$693.90
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$747.87
|
| Rate for Payer: ASR Commercial |
$747.87
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$631.37
|
| Rate for Payer: BCN Commercial |
$597.76
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$724.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$771.00
|
| Rate for Payer: Healthscope Whirlpool |
$747.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$693.90
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$632.22
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$675.55
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$540.47
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
IP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,370.15 |
| Max. Negotiated Rate |
$2,107.93 |
| Rate for Payer: Aetna Commercial |
$1,897.14
|
| Rate for Payer: ASR ASR |
$2,044.69
|
| Rate for Payer: ASR Commercial |
$2,044.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,717.75
|
| Rate for Payer: BCN Commercial |
$1,634.28
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,981.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Healthscope Commercial |
$2,107.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,044.69
|
| Rate for Payer: Mclaren Commercial |
$1,897.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: Nomi Health Commercial |
$1,728.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,854.98
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,897.14
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,044.69
|
| Rate for Payer: ASR Commercial |
$2,044.69
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.18
|
| Rate for Payer: BCN Commercial |
$1,634.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,981.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,107.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,044.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,897.14
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: Nomi Health Commercial |
$1,728.50
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,846.97
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,477.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,854.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$158.30
|
| Rate for Payer: ASR Commercial |
$158.30
|
| Rate for Payer: BCBS Trust/PPO |
$132.99
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$163.20
|
| Rate for Payer: Healthscope Whirlpool |
$158.30
|
| Rate for Payer: Mclaren Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.62
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$146.88
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: ASR ASR |
$158.30
|
| Rate for Payer: ASR Commercial |
$158.30
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$133.64
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$163.20
|
| Rate for Payer: Healthscope Whirlpool |
$158.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.98
|
| Rate for Payer: Mclaren Commercial |
$146.88
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Medicaid |
$9.64
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$114.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$27.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP DNSP |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$9.64
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
IP
|
$311.10
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.22 |
| Max. Negotiated Rate |
$311.10 |
| Rate for Payer: Aetna Commercial |
$279.99
|
| Rate for Payer: ASR ASR |
$301.77
|
| Rate for Payer: ASR Commercial |
$301.77
|
| Rate for Payer: BCBS Trust/PPO |
$253.52
|
| Rate for Payer: BCN Commercial |
$241.20
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$292.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.88
|
| Rate for Payer: Healthscope Commercial |
$311.10
|
| Rate for Payer: Healthscope Whirlpool |
$301.77
|
| Rate for Payer: Mclaren Commercial |
$279.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: Nomi Health Commercial |
$255.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.77
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
OP
|
$311.10
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$311.10 |
| Rate for Payer: Aetna Commercial |
$279.99
|
| Rate for Payer: Aetna Medicare |
$52.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.14
|
| Rate for Payer: ASR ASR |
$301.77
|
| Rate for Payer: ASR Commercial |
$301.77
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$52.11
|
| Rate for Payer: BCBS Trust/PPO |
$254.76
|
| Rate for Payer: BCN Commercial |
$241.20
|
| Rate for Payer: BCN Medicare Advantage |
$52.11
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$292.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$311.10
|
| Rate for Payer: Healthscope Whirlpool |
$301.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.11
|
| Rate for Payer: Mclaren Commercial |
$279.99
|
| Rate for Payer: Mclaren Medicaid |
$27.93
|
| Rate for Payer: Mclaren Medicare |
$52.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.72
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: Nomi Health Commercial |
$255.10
|
| Rate for Payer: PACE Medicare |
$49.50
|
| Rate for Payer: PACE SWMI |
$52.11
|
| Rate for Payer: PHP Commercial |
$57.32
|
| Rate for Payer: PHP Medicaid |
$27.93
|
| Rate for Payer: PHP Medicare Advantage |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.59
|
| Rate for Payer: Priority Health Medicare |
$52.11
|
| Rate for Payer: Priority Health Narrow Network |
$218.08
|
| Rate for Payer: Railroad Medicare Medicare |
$52.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.11
|
| Rate for Payer: UHC Exchange |
$80.77
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
| Rate for Payer: UHCCP DNSP |
$52.11
|
| Rate for Payer: UHCCP Medicaid |
$27.93
|
| Rate for Payer: VA VA |
$52.11
|
|
|
HC LVAD INSERTION
|
Facility
|
OP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,289.46 |
| Max. Negotiated Rate |
$3,223.64 |
| Rate for Payer: Aetna Commercial |
$2,901.28
|
| Rate for Payer: Aetna Medicare |
$1,611.82
|
| Rate for Payer: ASR ASR |
$3,126.93
|
| Rate for Payer: ASR Commercial |
$3,126.93
|
| Rate for Payer: BCBS Complete |
$1,289.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,639.84
|
| Rate for Payer: BCN Commercial |
$2,499.29
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cofinity Commercial |
$3,030.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.91
|
| Rate for Payer: Healthscope Commercial |
$3,223.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,126.93
|
| Rate for Payer: Mclaren Commercial |
$2,901.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,740.09
|
| Rate for Payer: Nomi Health Commercial |
$2,643.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,824.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,259.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,836.80
|
|
|
HC LVAD INSERTION
|
Facility
|
IP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,095.37 |
| Max. Negotiated Rate |
$3,223.64 |
| Rate for Payer: Aetna Commercial |
$2,901.28
|
| Rate for Payer: ASR ASR |
$3,126.93
|
| Rate for Payer: ASR Commercial |
$3,126.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,626.94
|
| Rate for Payer: BCN Commercial |
$2,499.29
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cofinity Commercial |
$3,030.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.91
|
| Rate for Payer: Healthscope Commercial |
$3,223.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,126.93
|
| Rate for Payer: Mclaren Commercial |
$2,901.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,740.09
|
| Rate for Payer: Nomi Health Commercial |
$2,643.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,836.80
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
OP
|
$2,832.80
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$2,832.80 |
| Rate for Payer: Aetna Commercial |
$2,549.52
|
| Rate for Payer: Aetna Medicare |
$658.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.70
|
| Rate for Payer: ASR ASR |
$2,747.82
|
| Rate for Payer: ASR Commercial |
$2,747.82
|
| Rate for Payer: BCBS Complete |
$370.86
|
| Rate for Payer: BCBS MAPPO |
$658.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,319.78
|
| Rate for Payer: BCN Commercial |
$2,196.27
|
| Rate for Payer: BCN Medicare Advantage |
$658.96
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cofinity Commercial |
$2,662.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.96
|
| Rate for Payer: Healthscope Commercial |
$2,832.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,747.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$658.96
|
| Rate for Payer: Mclaren Commercial |
$2,549.52
|
| Rate for Payer: Mclaren Medicaid |
$353.20
|
| Rate for Payer: Mclaren Medicare |
$658.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.91
|
| Rate for Payer: Meridian Medicaid |
$370.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.88
|
| Rate for Payer: Nomi Health Commercial |
$2,322.90
|
| Rate for Payer: PACE Medicare |
$626.01
|
| Rate for Payer: PACE SWMI |
$658.96
|
| Rate for Payer: PHP Commercial |
$724.86
|
| Rate for Payer: PHP Medicaid |
$353.20
|
| Rate for Payer: PHP Medicare Advantage |
$658.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,482.10
|
| Rate for Payer: Priority Health Medicare |
$658.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,985.79
|
| Rate for Payer: Railroad Medicare Medicare |
$658.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.96
|
| Rate for Payer: UHC Exchange |
$1,021.39
|
| Rate for Payer: UHC Medicare Advantage |
$658.96
|
| Rate for Payer: UHCCP DNSP |
$658.96
|
| Rate for Payer: UHCCP Medicaid |
$353.20
|
| Rate for Payer: VA VA |
$658.96
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
IP
|
$2,832.80
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,841.32 |
| Max. Negotiated Rate |
$2,832.80 |
| Rate for Payer: Aetna Commercial |
$2,549.52
|
| Rate for Payer: ASR ASR |
$2,747.82
|
| Rate for Payer: ASR Commercial |
$2,747.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.45
|
| Rate for Payer: BCN Commercial |
$2,196.27
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cofinity Commercial |
$2,662.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.24
|
| Rate for Payer: Healthscope Commercial |
$2,832.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,747.82
|
| Rate for Payer: Mclaren Commercial |
$2,549.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.88
|
| Rate for Payer: Nomi Health Commercial |
$2,322.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.86
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$254.63 |
| Max. Negotiated Rate |
$2,200.05 |
| Rate for Payer: Aetna Commercial |
$1,980.05
|
| Rate for Payer: Aetna Medicare |
$475.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.83
|
| Rate for Payer: ASR ASR |
$2,134.05
|
| Rate for Payer: ASR Commercial |
$2,134.05
|
| Rate for Payer: BCBS Complete |
$267.36
|
| Rate for Payer: BCBS MAPPO |
$475.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.62
|
| Rate for Payer: BCN Commercial |
$1,705.70
|
| Rate for Payer: BCN Medicare Advantage |
$475.06
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$2,068.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.06
|
| Rate for Payer: Healthscope Commercial |
$2,200.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,134.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$475.06
|
| Rate for Payer: Mclaren Commercial |
$1,980.05
|
| Rate for Payer: Mclaren Medicaid |
$254.63
|
| Rate for Payer: Mclaren Medicare |
$475.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.81
|
| Rate for Payer: Meridian Medicaid |
$267.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: PACE Medicare |
$451.31
|
| Rate for Payer: PACE SWMI |
$475.06
|
| Rate for Payer: PHP Commercial |
$522.57
|
| Rate for Payer: PHP Medicaid |
$254.63
|
| Rate for Payer: PHP Medicare Advantage |
$475.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,927.68
|
| Rate for Payer: Priority Health Medicare |
$475.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.24
|
| Rate for Payer: Railroad Medicare Medicare |
$475.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.06
|
| Rate for Payer: UHC Exchange |
$736.34
|
| Rate for Payer: UHC Medicare Advantage |
$475.06
|
| Rate for Payer: UHCCP DNSP |
$475.06
|
| Rate for Payer: UHCCP Medicaid |
$254.63
|
| Rate for Payer: VA VA |
$475.06
|
|
