|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| 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 MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.89 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$1,927.87
|
| 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 |
$2,077.82
|
| Rate for Payer: ASR Commercial |
$2,077.82
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,754.15
|
| Rate for Payer: BCN Commercial |
$1,660.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$2,013.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,142.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,077.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$1,927.87
|
| 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 |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| 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 |
$1,392.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.89
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,501.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,885.03
|
| 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 MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
IP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,392.35 |
| Max. Negotiated Rate |
$2,142.08 |
| Rate for Payer: Aetna Commercial |
$1,927.87
|
| Rate for Payer: ASR ASR |
$2,077.82
|
| Rate for Payer: ASR Commercial |
$2,077.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,745.58
|
| Rate for Payer: BCN Commercial |
$1,660.75
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$2,013.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Healthscope Commercial |
$2,142.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,077.82
|
| Rate for Payer: Mclaren Commercial |
$1,927.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,885.03
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$78.65
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
OP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$242.35 |
| Rate for Payer: Aetna Commercial |
$218.12
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$235.08
|
| Rate for Payer: ASR Commercial |
$235.08
|
| Rate for Payer: BCBS Complete |
$86.39
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$198.46
|
| Rate for Payer: BCN Commercial |
$187.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$227.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$242.35
|
| Rate for Payer: Healthscope Whirlpool |
$235.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$218.12
|
| Rate for Payer: Mclaren Medicaid |
$82.28
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$86.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: Nomi Health Commercial |
$198.73
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$237.92
|
| Rate for Payer: UHC Medicare Advantage |
$153.50
|
| Rate for Payer: UHCCP DNSP |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$82.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
IP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$242.35 |
| Rate for Payer: Aetna Commercial |
$218.12
|
| Rate for Payer: ASR ASR |
$235.08
|
| Rate for Payer: ASR Commercial |
$235.08
|
| Rate for Payer: BCBS Trust/PPO |
$197.49
|
| Rate for Payer: BCN Commercial |
$187.89
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$227.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Healthscope Commercial |
$242.35
|
| Rate for Payer: Healthscope Whirlpool |
$235.08
|
| Rate for Payer: Mclaren Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: Nomi Health Commercial |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.27
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
OP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$122.63 |
| Rate for Payer: Aetna Commercial |
$110.37
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$118.95
|
| Rate for Payer: ASR Commercial |
$118.95
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$100.42
|
| Rate for Payer: BCN Commercial |
$95.08
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$122.63
|
| Rate for Payer: Healthscope Whirlpool |
$118.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$110.37
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.45
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$85.96
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
IP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.71 |
| Max. Negotiated Rate |
$122.63 |
| Rate for Payer: Aetna Commercial |
$110.37
|
| Rate for Payer: ASR ASR |
$118.95
|
| Rate for Payer: ASR Commercial |
$118.95
|
| Rate for Payer: BCBS Trust/PPO |
$99.93
|
| Rate for Payer: BCN Commercial |
$95.08
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$115.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$122.63
|
| Rate for Payer: Healthscope Whirlpool |
$118.95
|
| Rate for Payer: Mclaren Commercial |
$110.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.91
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
OP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$338.23 |
| Rate for Payer: Aetna Commercial |
$304.41
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$328.08
|
| Rate for Payer: ASR Commercial |
$328.08
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$276.98
|
| Rate for Payer: BCN Commercial |
$262.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$317.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$338.23
|
| Rate for Payer: Healthscope Whirlpool |
$328.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.89
|
| Rate for Payer: Mclaren Commercial |
$304.41
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$277.35
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Medicaid |
$6.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.36
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$237.10
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
| Rate for Payer: UHCCP DNSP |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.37
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
IP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$219.85 |
| Max. Negotiated Rate |
$338.23 |
| Rate for Payer: Aetna Commercial |
$304.41
|
| Rate for Payer: ASR ASR |
$328.08
|
| Rate for Payer: ASR Commercial |
$328.08
|
| Rate for Payer: BCBS Trust/PPO |
$275.62
|
| Rate for Payer: BCN Commercial |
$262.23
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$317.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Healthscope Commercial |
$338.23
|
| Rate for Payer: Healthscope Whirlpool |
$328.08
|
| Rate for Payer: Mclaren Commercial |
$304.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$277.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.64
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
IP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$233.06 |
| Max. Negotiated Rate |
$358.56 |
| Rate for Payer: Aetna Commercial |
$322.70
|
| Rate for Payer: ASR ASR |
$347.80
|
| Rate for Payer: ASR Commercial |
$347.80
|
| Rate for Payer: BCBS Trust/PPO |
$292.19
|
| Rate for Payer: BCN Commercial |
$277.99
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$337.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Healthscope Commercial |
$358.56
|
| Rate for Payer: Healthscope Whirlpool |
$347.80
|
| Rate for Payer: Mclaren Commercial |
$322.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$294.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.53
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
OP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$358.56 |
| Rate for Payer: Aetna Commercial |
$322.70
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$347.80
|
| Rate for Payer: ASR Commercial |
$347.80
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$293.62
|
| Rate for Payer: BCN Commercial |
$277.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$337.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$358.56
|
| Rate for Payer: Healthscope Whirlpool |
$347.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.89
|
| Rate for Payer: Mclaren Commercial |
$322.70
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$294.02
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Medicaid |
$6.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.17
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$251.35
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Exchange |
$18.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
| Rate for Payer: UHCCP DNSP |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.37
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
IP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,276.28 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$1,767.15
|
| Rate for Payer: ASR ASR |
$1,904.60
|
| Rate for Payer: ASR Commercial |
$1,904.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,600.06
|
| Rate for Payer: BCN Commercial |
$1,522.30
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,845.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Healthscope Commercial |
$1,963.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.60
|
| Rate for Payer: Mclaren Commercial |
$1,767.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.98
|
| Rate for Payer: Nomi Health Commercial |
$1,610.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.88
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
OP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$407.11 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$1,767.15
|
| Rate for Payer: Aetna Medicare |
$759.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$949.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$949.41
|
| Rate for Payer: ASR ASR |
$1,904.60
|
| Rate for Payer: ASR Commercial |
$1,904.60
|
| Rate for Payer: BCBS Complete |
$427.46
|
| Rate for Payer: BCBS MAPPO |
$759.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,607.91
|
| Rate for Payer: BCN Commercial |
$1,522.30
|
| Rate for Payer: BCN Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,845.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.53
|
| Rate for Payer: Healthscope Commercial |
$1,963.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$759.53
|
| Rate for Payer: Mclaren Commercial |
$1,767.15
|
| Rate for Payer: Mclaren Medicaid |
$407.11
|
| Rate for Payer: Mclaren Medicare |
$759.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.51
|
| Rate for Payer: Meridian Medicaid |
$427.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.98
|
| Rate for Payer: Nomi Health Commercial |
$1,610.07
|
| Rate for Payer: PACE Medicare |
$721.55
|
| Rate for Payer: PACE SWMI |
$759.53
|
| Rate for Payer: PHP Commercial |
$835.48
|
| Rate for Payer: PHP Medicaid |
$407.11
|
| Rate for Payer: PHP Medicare Advantage |
$759.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,720.42
|
| Rate for Payer: Priority Health Medicare |
$759.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.41
|
| Rate for Payer: Railroad Medicare Medicare |
$759.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.53
|
| Rate for Payer: UHC Exchange |
$1,177.27
|
| Rate for Payer: UHC Medicare Advantage |
$759.53
|
| Rate for Payer: UHCCP DNSP |
$759.53
|
| Rate for Payer: UHCCP Medicaid |
$407.11
|
| Rate for Payer: VA VA |
$759.53
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
IP
|
$10.78
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: ASR ASR |
$10.46
|
| Rate for Payer: ASR Commercial |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.78
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Commercial |
$10.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$10.78
|
| Rate for Payer: Healthscope Whirlpool |
$10.46
|
| Rate for Payer: Mclaren Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.16
|
| Rate for Payer: Nomi Health Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.49
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$10.46
|
| Rate for Payer: ASR Commercial |
$10.46
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.83
|
| Rate for Payer: BCN Commercial |
$8.36
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Commercial |
$10.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$10.78
|
| Rate for Payer: Healthscope Whirlpool |
$10.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$9.70
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.16
|
| Rate for Payer: Nomi Health Commercial |
$8.84
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.25
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$109.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MDI TREATMENT
|
Facility
|
IP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| Rate for Payer: ASR ASR |
$145.18
|
| Rate for Payer: ASR Commercial |
$145.18
|
| Rate for Payer: BCBS Trust/PPO |
$121.97
|
| Rate for Payer: BCN Commercial |
$116.04
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Healthscope Commercial |
$149.67
|
| Rate for Payer: Healthscope Whirlpool |
$145.18
|
| Rate for Payer: Mclaren Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$122.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.71
|
|
|
HC MDI TREATMENT
|
Facility
|
OP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| Rate for Payer: Aetna Medicare |
$199.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: ASR ASR |
$145.18
|
| Rate for Payer: ASR Commercial |
$145.18
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$122.56
|
| Rate for Payer: BCN Commercial |
$116.04
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$149.67
|
| Rate for Payer: Healthscope Whirlpool |
$145.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.28
|
| Rate for Payer: Mclaren Commercial |
$134.70
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$122.73
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$219.21
|
| Rate for Payer: PHP Medicaid |
$106.81
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.29
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$92.23
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP DNSP |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
OP
|
$491.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$491.10 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$476.37
|
| Rate for Payer: ASR Commercial |
$476.37
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$402.16
|
| Rate for Payer: BCN Commercial |
$380.75
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$461.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Whirlpool |
$476.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$441.99
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.44
|
| Rate for Payer: Nomi Health Commercial |
$402.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.30
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
IP
|
$491.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$319.22 |
| Max. Negotiated Rate |
$491.10 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: ASR ASR |
$476.37
|
| Rate for Payer: ASR Commercial |
$476.37
|
| Rate for Payer: BCBS Trust/PPO |
$400.20
|
| Rate for Payer: BCN Commercial |
$380.75
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$461.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Whirlpool |
$476.37
|
| Rate for Payer: Mclaren Commercial |
$441.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.44
|
| Rate for Payer: Nomi Health Commercial |
$402.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.17
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$153.73 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$41.75
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$122.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
