|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| 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 |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| 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 |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| 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 |
$30.43
|
| 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 |
$41.20
|
| 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 LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$259.72 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$251.93
|
| Rate for Payer: ASR Commercial |
$251.93
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$212.68
|
| Rate for Payer: BCN Commercial |
$201.36
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$244.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$259.72
|
| Rate for Payer: Healthscope Whirlpool |
$251.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$233.75
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$212.97
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.57
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$182.06
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$26.28
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$259.72 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: ASR ASR |
$251.93
|
| Rate for Payer: ASR Commercial |
$251.93
|
| Rate for Payer: BCBS Trust/PPO |
$211.65
|
| Rate for Payer: BCN Commercial |
$201.36
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$244.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Healthscope Commercial |
$259.72
|
| Rate for Payer: Healthscope Whirlpool |
$251.93
|
| Rate for Payer: Mclaren Commercial |
$233.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$212.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.55
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$280.09 |
| Rate for Payer: Aetna Commercial |
$252.08
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$271.69
|
| Rate for Payer: ASR Commercial |
$271.69
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$229.37
|
| Rate for Payer: BCN Commercial |
$217.15
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$263.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$280.09
|
| Rate for Payer: Healthscope Whirlpool |
$271.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$252.08
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$229.67
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.41
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$196.34
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$26.28
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$280.09 |
| Rate for Payer: Aetna Commercial |
$252.08
|
| Rate for Payer: ASR ASR |
$271.69
|
| Rate for Payer: ASR Commercial |
$271.69
|
| Rate for Payer: BCBS Trust/PPO |
$228.25
|
| Rate for Payer: BCN Commercial |
$217.15
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$263.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Healthscope Commercial |
$280.09
|
| Rate for Payer: Healthscope Whirlpool |
$271.69
|
| Rate for Payer: Mclaren Commercial |
$252.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$229.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.48
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
IP
|
$235.62
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$153.15 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Aetna Commercial |
$212.06
|
| Rate for Payer: ASR ASR |
$228.55
|
| Rate for Payer: ASR Commercial |
$228.55
|
| Rate for Payer: BCBS Trust/PPO |
$192.01
|
| Rate for Payer: BCN Commercial |
$182.68
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cofinity Commercial |
$221.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.50
|
| Rate for Payer: Healthscope Commercial |
$235.62
|
| Rate for Payer: Healthscope Whirlpool |
$228.55
|
| Rate for Payer: Mclaren Commercial |
$212.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.28
|
| Rate for Payer: Nomi Health Commercial |
$193.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.35
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
OP
|
$235.62
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Aetna Commercial |
$212.06
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$228.55
|
| Rate for Payer: ASR Commercial |
$228.55
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$192.95
|
| Rate for Payer: BCN Commercial |
$182.68
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cofinity Commercial |
$221.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$235.62
|
| Rate for Payer: Healthscope Whirlpool |
$228.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$212.06
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.28
|
| Rate for Payer: Nomi Health Commercial |
$193.21
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.45
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$165.17
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$26.28
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
OP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$259.72 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$251.93
|
| Rate for Payer: ASR Commercial |
$251.93
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$212.68
|
| Rate for Payer: BCN Commercial |
$201.36
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$244.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$259.72
|
| Rate for Payer: Healthscope Whirlpool |
$251.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$233.75
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$212.97
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.57
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$182.06
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$26.28
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
IP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$259.72 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: ASR ASR |
$251.93
|
| Rate for Payer: ASR Commercial |
$251.93
|
| Rate for Payer: BCBS Trust/PPO |
$211.65
|
| Rate for Payer: BCN Commercial |
$201.36
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$244.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Healthscope Commercial |
$259.72
|
| Rate for Payer: Healthscope Whirlpool |
$251.93
|
| Rate for Payer: Mclaren Commercial |
$233.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$212.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.55
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
OP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$280.09 |
| Rate for Payer: Aetna Commercial |
$252.08
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$271.69
|
| Rate for Payer: ASR Commercial |
$271.69
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$229.37
|
| Rate for Payer: BCN Commercial |
$217.15
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$263.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$280.09
|
| Rate for Payer: Healthscope Whirlpool |
$271.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$252.08
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$229.67
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.41
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$196.34
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$26.28
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
IP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$280.09 |
| Rate for Payer: Aetna Commercial |
$252.08
|
| Rate for Payer: ASR ASR |
$271.69
|
| Rate for Payer: ASR Commercial |
$271.69
|
| Rate for Payer: BCBS Trust/PPO |
$228.25
|
| Rate for Payer: BCN Commercial |
$217.15
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$263.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Healthscope Commercial |
$280.09
|
| Rate for Payer: Healthscope Whirlpool |
$271.69
|
| Rate for Payer: Mclaren Commercial |
$252.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$229.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.48
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$269.28 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: Aetna Medicare |
$336.60
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Complete |
$269.28
|
| Rate for Payer: BCBS Trust/PPO |
$551.28
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Narrow Network |
$471.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
IP
|
$3,730.85
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.05 |
| Max. Negotiated Rate |
$3,730.85 |
| Rate for Payer: Aetna Commercial |
$3,357.76
|
| Rate for Payer: ASR ASR |
$3,618.92
|
| Rate for Payer: ASR Commercial |
$3,618.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,040.27
|
| Rate for Payer: BCN Commercial |
$2,892.53
|
| Rate for Payer: Cash Price |
$2,984.68
|
| Rate for Payer: Cofinity Commercial |
$3,507.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,984.68
|
| Rate for Payer: Healthscope Commercial |
$3,730.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,618.92
|
| Rate for Payer: Mclaren Commercial |
$3,357.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,171.22
|
| Rate for Payer: Nomi Health Commercial |
$3,059.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,283.15
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$3,730.85
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$3,730.85 |
| Rate for Payer: Aetna Commercial |
$3,357.76
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$3,618.92
|
| Rate for Payer: ASR Commercial |
$3,618.92
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,055.19
|
| Rate for Payer: BCN Commercial |
$2,892.53
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,984.68
|
| Rate for Payer: Cash Price |
$2,984.68
|
| Rate for Payer: Cofinity Commercial |
$3,507.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,984.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$3,730.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,618.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$3,357.76
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,171.22
|
| Rate for Payer: Nomi Health Commercial |
$3,059.30
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,268.97
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,615.33
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,283.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.05 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna Commercial |
$1,239.30
|
| Rate for Payer: ASR ASR |
$1,335.69
|
| Rate for Payer: ASR Commercial |
$1,335.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.12
|
| Rate for Payer: BCN Commercial |
$1,067.59
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,294.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.69
|
| Rate for Payer: Mclaren Commercial |
$1,239.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,129.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.76
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna Commercial |
$1,239.30
|
| Rate for Payer: Aetna Medicare |
$498.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: ASR ASR |
$1,335.69
|
| Rate for Payer: ASR Commercial |
$1,335.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.63
|
| Rate for Payer: BCN Commercial |
$1,067.59
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,294.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$498.95
|
| Rate for Payer: Mclaren Commercial |
$1,239.30
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,129.14
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$548.84
|
| Rate for Payer: PHP Medicaid |
$267.44
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,206.53
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$965.28
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$773.37
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP DNSP |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC LYSIS OF LABIAL LESION(S)
|
Facility
|
OP
|
$7,784.64
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$7,784.64 |
| Rate for Payer: Aetna Commercial |
$7,006.18
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$7,551.10
|
| Rate for Payer: ASR Commercial |
$7,551.10
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$6,374.84
|
| Rate for Payer: BCN Commercial |
$6,035.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$6,227.71
|
| Rate for Payer: Cash Price |
$6,227.71
|
| Rate for Payer: Cofinity Commercial |
$7,317.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,227.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$7,784.64
|
| Rate for Payer: Healthscope Whirlpool |
$7,551.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$7,006.18
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,616.94
|
| Rate for Payer: Nomi Health Commercial |
$6,383.40
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,820.90
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$5,457.03
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,850.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC LYSIS OF LABIAL LESION(S)
|
Facility
|
IP
|
$7,784.64
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,060.02 |
| Max. Negotiated Rate |
$7,784.64 |
| Rate for Payer: Aetna Commercial |
$7,006.18
|
| Rate for Payer: ASR ASR |
$7,551.10
|
| Rate for Payer: ASR Commercial |
$7,551.10
|
| Rate for Payer: BCBS Trust/PPO |
$6,343.70
|
| Rate for Payer: BCN Commercial |
$6,035.43
|
| Rate for Payer: Cash Price |
$6,227.71
|
| Rate for Payer: Cofinity Commercial |
$7,317.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,227.71
|
| Rate for Payer: Healthscope Commercial |
$7,784.64
|
| Rate for Payer: Healthscope Whirlpool |
$7,551.10
|
| Rate for Payer: Mclaren Commercial |
$7,006.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,616.94
|
| Rate for Payer: Nomi Health Commercial |
$6,383.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,850.48
|
|
|
HC LYSOZYME (MURAMIDASE)
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
30500108
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: ASR Commercial |
$63.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.20
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC LYSOZYME (MURAMIDASE)
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
30500108
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: Aetna Medicare |
$18.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: ASR Commercial |
$63.32
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.75
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PACE Medicare |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$20.62
|
| Rate for Payer: PHP Medicaid |
$10.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$18.75
|
| Rate for Payer: Priority Health Narrow Network |
$45.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.75
|
| Rate for Payer: UHC Exchange |
$29.06
|
| Rate for Payer: UHC Medicare Advantage |
$18.75
|
| Rate for Payer: UHCCP DNSP |
$18.75
|
| Rate for Payer: UHCCP Medicaid |
$10.05
|
| Rate for Payer: VA VA |
$18.75
|
|
|
HC MAC/REGIONAL PER MINUTE
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
37000025
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: ASR ASR |
$13.58
|
| Rate for Payer: ASR Commercial |
$13.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCN Commercial |
$10.85
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$14.00
|
| Rate for Payer: Healthscope Whirlpool |
$13.58
|
| Rate for Payer: Mclaren Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Nomi Health Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.32
|
|
