|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$850.89 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$1,897.14
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$2,044.69
|
| Rate for Payer: ASR Commercial |
$2,044.69
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.18
|
| Rate for Payer: BCN Commercial |
$1,634.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| 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 |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,107.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,044.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$1,897.14
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| 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 |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| 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 |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,477.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,854.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
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 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 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 |
$28.06 |
| Max. Negotiated Rate |
$311.10 |
| Rate for Payer: Aetna Commercial |
$279.99
|
| Rate for Payer: Aetna Medicare |
$52.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.44
|
| Rate for Payer: ASR ASR |
$301.77
|
| Rate for Payer: ASR Commercial |
$301.77
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$52.35
|
| Rate for Payer: BCBS Trust/PPO |
$254.76
|
| Rate for Payer: BCCCP Commercial |
$67.27
|
| Rate for Payer: BCN Commercial |
$241.20
|
| Rate for Payer: BCN Medicare Advantage |
$52.35
|
| 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 |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$311.10
|
| Rate for Payer: Healthscope Whirlpool |
$301.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.35
|
| Rate for Payer: Mclaren Commercial |
$279.99
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Mclaren Medicare |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.97
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: Nomi Health Commercial |
$255.10
|
| Rate for Payer: PACE Medicare |
$49.73
|
| Rate for Payer: PACE SWMI |
$52.35
|
| Rate for Payer: PHP Commercial |
$57.58
|
| Rate for Payer: PHP Medicaid |
$28.06
|
| Rate for Payer: PHP Medicare Advantage |
$52.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.89
|
| Rate for Payer: Priority Health Medicare |
$52.35
|
| Rate for Payer: Priority Health Narrow Network |
$133.51
|
| Rate for Payer: Railroad Medicare Medicare |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.35
|
| Rate for Payer: UHC Exchange |
$81.14
|
| Rate for Payer: UHC Medicare Advantage |
$52.35
|
| Rate for Payer: UHCCP DNSP |
$52.35
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: VA VA |
$52.35
|
|
|
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 LVAD INSERTION
|
Facility
|
OP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$0.01 |
| 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: 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 |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| 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 |
$354.83 |
| Max. Negotiated Rate |
$2,832.80 |
| Rate for Payer: Aetna Commercial |
$2,549.52
|
| Rate for Payer: Aetna Medicare |
$662.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$827.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$827.50
|
| Rate for Payer: ASR ASR |
$2,747.82
|
| Rate for Payer: ASR Commercial |
$2,747.82
|
| Rate for Payer: BCBS Complete |
$372.57
|
| Rate for Payer: BCBS MAPPO |
$662.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,319.78
|
| Rate for Payer: BCN Commercial |
$2,196.27
|
| Rate for Payer: BCN Medicare Advantage |
$662.00
|
| 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 |
$662.00
|
| Rate for Payer: Healthscope Commercial |
$2,832.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,747.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$662.00
|
| Rate for Payer: Mclaren Commercial |
$2,549.52
|
| Rate for Payer: Mclaren Medicaid |
$354.83
|
| Rate for Payer: Mclaren Medicare |
$662.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.10
|
| Rate for Payer: Meridian Medicaid |
$372.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$761.30
|
| 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 |
$628.90
|
| Rate for Payer: PACE SWMI |
$662.00
|
| Rate for Payer: PHP Commercial |
$728.20
|
| Rate for Payer: PHP Medicaid |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.49
|
| Rate for Payer: Priority Health Medicare |
$662.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,151.59
|
| Rate for Payer: Railroad Medicare Medicare |
$662.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,492.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.00
|
| Rate for Payer: UHC Exchange |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$662.00
|
| Rate for Payer: UHCCP DNSP |
$662.00
|
| Rate for Payer: UHCCP Medicaid |
$354.83
|
| Rate for Payer: VA VA |
$662.00
|
|
|
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
|
IP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,430.03 |
| Max. Negotiated Rate |
$2,200.05 |
| Rate for Payer: Aetna Commercial |
$1,980.04
|
| Rate for Payer: ASR ASR |
$2,134.05
|
| Rate for Payer: ASR Commercial |
$2,134.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,792.82
|
| Rate for Payer: BCN Commercial |
$1,705.70
|
| 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: Healthscope Commercial |
$2,200.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,134.05
|
| Rate for Payer: Mclaren Commercial |
$1,980.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.04
|
|
|
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 |
$255.81 |
| Max. Negotiated Rate |
$2,200.05 |
| Rate for Payer: Aetna Commercial |
$1,980.04
|
| Rate for Payer: Aetna Medicare |
$477.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.56
|
| Rate for Payer: ASR ASR |
$2,134.05
|
| Rate for Payer: ASR Commercial |
$2,134.05
|
| Rate for Payer: BCBS Complete |
$268.60
|
| Rate for Payer: BCBS MAPPO |
$477.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.62
|
| Rate for Payer: BCN Commercial |
$1,705.70
|
| Rate for Payer: BCN Medicare Advantage |
$477.25
|
| 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 |
$477.25
|
| Rate for Payer: Healthscope Commercial |
$2,200.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,134.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$477.25
|
| Rate for Payer: Mclaren Commercial |
$1,980.04
|
| Rate for Payer: Mclaren Medicaid |
$255.81
|
| Rate for Payer: Mclaren Medicare |
$477.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.11
|
| Rate for Payer: Meridian Medicaid |
$268.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.84
|
| 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 |
$453.39
|
| Rate for Payer: PACE SWMI |
$477.25
|
| Rate for Payer: PHP Commercial |
$524.98
|
| Rate for Payer: PHP Medicaid |
$255.81
|
| Rate for Payer: PHP Medicare Advantage |
$477.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$872.92
|
| Rate for Payer: Priority Health Medicare |
$477.25
|
| Rate for Payer: Priority Health Narrow Network |
$698.34
|
| Rate for Payer: Railroad Medicare Medicare |
$477.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.25
|
| Rate for Payer: UHC Exchange |
$739.74
|
| Rate for Payer: UHC Medicare Advantage |
$477.25
|
| Rate for Payer: UHCCP DNSP |
$477.25
|
| Rate for Payer: UHCCP Medicaid |
$255.81
|
| Rate for Payer: VA VA |
$477.25
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$9,273.79
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,027.96 |
| Max. Negotiated Rate |
$9,273.79 |
| Rate for Payer: Aetna Commercial |
$8,346.41
|
| Rate for Payer: ASR ASR |
$8,995.58
|
| Rate for Payer: ASR Commercial |
$8,995.58
|
| Rate for Payer: BCBS Trust/PPO |
$7,557.21
|
| Rate for Payer: BCN Commercial |
$7,189.97
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cofinity Commercial |
$8,717.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,419.03
|
| Rate for Payer: Healthscope Commercial |
$9,273.79
|
| Rate for Payer: Healthscope Whirlpool |
$8,995.58
|
| Rate for Payer: Mclaren Commercial |
$8,346.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,882.72
|
| Rate for Payer: Nomi Health Commercial |
$7,604.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,027.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,160.94
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$9,273.79
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,709.52 |
| Max. Negotiated Rate |
$9,273.79 |
| Rate for Payer: Aetna Commercial |
$8,346.41
|
| Rate for Payer: Aetna Medicare |
$4,636.90
|
| Rate for Payer: ASR ASR |
$8,995.58
|
| Rate for Payer: ASR Commercial |
$8,995.58
|
| Rate for Payer: BCBS Complete |
$3,709.52
|
| Rate for Payer: BCBS Trust/PPO |
$7,594.31
|
| Rate for Payer: BCN Commercial |
$7,189.97
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cofinity Commercial |
$8,717.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,419.03
|
| Rate for Payer: Healthscope Commercial |
$9,273.79
|
| Rate for Payer: Healthscope Whirlpool |
$8,995.58
|
| Rate for Payer: Mclaren Commercial |
$8,346.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,882.72
|
| Rate for Payer: Nomi Health Commercial |
$7,604.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,027.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,125.69
|
| Rate for Payer: Priority Health Narrow Network |
$6,500.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,160.94
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,588.43
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,332.48 |
| Max. Negotiated Rate |
$3,588.43 |
| Rate for Payer: Aetna Commercial |
$3,229.59
|
| Rate for Payer: ASR ASR |
$3,480.78
|
| Rate for Payer: ASR Commercial |
$3,480.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,924.21
|
| Rate for Payer: BCN Commercial |
$2,782.11
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cofinity Commercial |
$3,373.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,870.74
|
| Rate for Payer: Healthscope Commercial |
$3,588.43
|
| Rate for Payer: Healthscope Whirlpool |
$3,480.78
|
| Rate for Payer: Mclaren Commercial |
$3,229.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,050.17
|
| Rate for Payer: Nomi Health Commercial |
$2,942.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,157.82
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,588.43
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,229.59
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,480.78
|
| Rate for Payer: ASR Commercial |
$3,480.78
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,938.57
|
| Rate for Payer: BCN Commercial |
$2,782.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cofinity Commercial |
$3,373.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,870.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,588.43
|
| Rate for Payer: Healthscope Whirlpool |
$3,480.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,229.59
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,050.17
|
| Rate for Payer: Nomi Health Commercial |
$2,942.51
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,144.18
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,515.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,157.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$30.90
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: ASR ASR |
$33.30
|
| Rate for Payer: ASR Commercial |
$33.30
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$28.11
|
| Rate for Payer: BCN Commercial |
$26.62
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$32.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Whirlpool |
$33.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.49
|
| Rate for Payer: Mclaren Commercial |
$30.90
|
| Rate for Payer: Mclaren Medicaid |
$8.30
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: Nomi Health Commercial |
$28.15
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.04
|
| Rate for Payer: PHP Medicaid |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.04
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$27.23
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UHC Medicare Advantage |
$15.49
|
| Rate for Payer: UHCCP DNSP |
$15.49
|
| Rate for Payer: UHCCP Medicaid |
$8.30
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$30.90
|
| Rate for Payer: ASR ASR |
$33.30
|
| Rate for Payer: ASR Commercial |
$33.30
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCN Commercial |
$26.62
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$32.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Whirlpool |
$33.30
|
| Rate for Payer: Mclaren Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: Nomi Health Commercial |
$28.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.21
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: ASR ASR |
$58.37
|
| Rate for Payer: ASR Commercial |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$49.04
|
| Rate for Payer: BCN Commercial |
$46.66
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$60.18
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Mclaren Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.15
|
| Rate for Payer: Nomi Health Commercial |
$49.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.96
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$58.37
|
| Rate for Payer: ASR Commercial |
$58.37
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$49.28
|
| Rate for Payer: BCN Commercial |
$46.66
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$60.18
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$54.16
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.15
|
| Rate for Payer: Nomi Health Commercial |
$49.35
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.73
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$42.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$12.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.78
|
| Rate for Payer: UHCCP DNSP |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$162.18
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$162.18 |
| Rate for Payer: Aetna Commercial |
$145.96
|
| Rate for Payer: Aetna Medicare |
$17.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: ASR ASR |
$157.31
|
| Rate for Payer: ASR Commercial |
$157.31
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$132.81
|
| Rate for Payer: BCN Commercial |
$125.74
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cofinity Commercial |
$152.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$162.18
|
| Rate for Payer: Healthscope Whirlpool |
$157.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$145.96
|
| Rate for Payer: Mclaren Medicaid |
$9.13
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Medicaid |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.85
|
| Rate for Payer: Nomi Health Commercial |
$132.99
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: PHP Medicaid |
$9.13
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.70
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Exchange |
$26.40
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP DNSP |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.13
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$162.18
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.42 |
| Max. Negotiated Rate |
$162.18 |
| Rate for Payer: Aetna Commercial |
$145.96
|
| Rate for Payer: ASR ASR |
$157.31
|
| Rate for Payer: ASR Commercial |
$157.31
|
| Rate for Payer: BCBS Trust/PPO |
$132.16
|
| Rate for Payer: BCN Commercial |
$125.74
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cofinity Commercial |
$152.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.74
|
| Rate for Payer: Healthscope Commercial |
$162.18
|
| Rate for Payer: Healthscope Whirlpool |
$157.31
|
| Rate for Payer: Mclaren Commercial |
$145.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.85
|
| Rate for Payer: Nomi Health Commercial |
$132.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.72
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
IP
|
$88.74
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$88.74 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: ASR ASR |
$86.08
|
| Rate for Payer: ASR Commercial |
$86.08
|
| Rate for Payer: BCBS Trust/PPO |
$72.31
|
| Rate for Payer: BCN Commercial |
$68.80
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.08
|
| Rate for Payer: Mclaren Commercial |
$79.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.09
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$88.74
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$88.74 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$86.08
|
| Rate for Payer: ASR Commercial |
$86.08
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$72.67
|
| Rate for Payer: BCN Commercial |
$68.80
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$79.87
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.70
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.42
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$72.42 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: ASR ASR |
$70.25
|
| Rate for Payer: ASR Commercial |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$59.02
|
| Rate for Payer: BCN Commercial |
$56.15
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$68.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$72.42
|
| Rate for Payer: Healthscope Whirlpool |
$70.25
|
| Rate for Payer: Mclaren Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.56
|
| Rate for Payer: Nomi Health Commercial |
$59.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.73
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$72.42 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$70.25
|
| Rate for Payer: ASR Commercial |
$70.25
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$59.30
|
| Rate for Payer: BCN Commercial |
$56.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$68.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$72.42
|
| Rate for Payer: Healthscope Whirlpool |
$70.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$65.18
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.56
|
| Rate for Payer: Nomi Health Commercial |
$59.38
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: PHP Medicaid |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.02
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$13.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP DNSP |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$4.95
|
|
