|
HC MYCOPLASMA PNEUMO AB IGG & IGM
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200310
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Aetna Commercial |
$21.33
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: ASR ASR |
$22.99
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCN Commercial |
$19.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$22.99
|
| Rate for Payer: Healthscope Whirlpool |
$23.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$21.33
|
| Rate for Payer: Mclaren Medicaid |
$13.24
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$7.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Nomi Health Commercial |
$19.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$14.56
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.98
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$52.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP DNSP |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC MYCOPLASMA PNEUMO AB IGG & IGM
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200310
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Aetna Commercial |
$21.33
|
| Rate for Payer: ASR ASR |
$22.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.46
|
| Rate for Payer: BCN Commercial |
$19.46
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$22.99
|
| Rate for Payer: Healthscope Whirlpool |
$23.70
|
| Rate for Payer: Mclaren Commercial |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Nomi Health Commercial |
$19.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.86
|
|
|
HC MYCOPLASMA PNEUMONIAE DNA PCR
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
30600162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$168.55 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: BCBS Trust/PPO |
$184.55
|
| Rate for Payer: BCN Commercial |
$184.55
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$217.99
|
| Rate for Payer: Healthscope Whirlpool |
$224.73
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC MYCOPLASMA PNEUMONIAE DNA PCR
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
30600162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| 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 |
$217.99
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$185.29
|
| Rate for Payer: BCN Commercial |
$185.29
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$217.99
|
| Rate for Payer: Healthscope Whirlpool |
$224.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| 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 |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| 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 |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$196.91
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$157.54
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MYD88 L265P GENE MUTATION ANALYSIS
|
Facility
|
OP
|
$657.95
|
|
|
Service Code
|
CPT 81305
|
| Hospital Charge Code |
30000111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$657.95 |
| Rate for Payer: Aetna Commercial |
$592.15
|
| Rate for Payer: Aetna Medicare |
$175.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.25
|
| Rate for Payer: ASR ASR |
$638.21
|
| Rate for Payer: BCBS Complete |
$96.33
|
| Rate for Payer: BCBS MAPPO |
$175.40
|
| Rate for Payer: BCBS Trust/PPO |
$542.48
|
| Rate for Payer: BCN Commercial |
$542.48
|
| Rate for Payer: BCN Medicare Advantage |
$175.40
|
| Rate for Payer: Cash Price |
$526.36
|
| Rate for Payer: Cash Price |
$526.36
|
| Rate for Payer: Cofinity Commercial |
$618.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.40
|
| Rate for Payer: Healthscope Commercial |
$638.21
|
| Rate for Payer: Healthscope Whirlpool |
$657.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$175.40
|
| Rate for Payer: Mclaren Commercial |
$592.15
|
| Rate for Payer: Mclaren Medicaid |
$175.40
|
| Rate for Payer: Mclaren Medicare |
$175.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.17
|
| Rate for Payer: Meridian Medicaid |
$96.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.26
|
| Rate for Payer: Nomi Health Commercial |
$539.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.46
|
| Rate for Payer: PACE Medicare |
$166.63
|
| Rate for Payer: PACE SWMI |
$175.40
|
| Rate for Payer: PHP Commercial |
$192.94
|
| Rate for Payer: PHP Medicaid |
$94.01
|
| Rate for Payer: PHP Medicare Advantage |
$175.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$221.40
|
| Rate for Payer: Priority Health Medicare |
$175.40
|
| Rate for Payer: Priority Health Narrow Network |
$177.12
|
| Rate for Payer: Railroad Medicare Medicare |
$175.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.40
|
| Rate for Payer: UHC Exchange |
$271.87
|
| Rate for Payer: UHC Medicaid |
$91.73
|
| Rate for Payer: UHCCP DNSP |
$175.40
|
| Rate for Payer: UHCCP Medicaid |
$91.73
|
| Rate for Payer: VA VA |
$175.40
|
|
|
HC MYD88 L265P GENE MUTATION ANALYSIS
|
Facility
|
IP
|
$657.95
|
|
|
Service Code
|
CPT 81305
|
| Hospital Charge Code |
30000111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$493.46 |
| Max. Negotiated Rate |
$657.95 |
| Rate for Payer: Aetna Commercial |
$592.15
|
| Rate for Payer: ASR ASR |
$638.21
|
| Rate for Payer: BCBS Trust/PPO |
$540.31
|
| Rate for Payer: BCN Commercial |
$540.31
|
| Rate for Payer: Cash Price |
$526.36
|
| Rate for Payer: Cofinity Commercial |
$618.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.36
|
| Rate for Payer: Healthscope Commercial |
$638.21
|
| Rate for Payer: Healthscope Whirlpool |
$657.95
|
| Rate for Payer: Mclaren Commercial |
$592.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.26
|
| Rate for Payer: Nomi Health Commercial |
$539.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.00
|
|
|
HC MYELODYSPLASTIC SYNDROME
|
Facility
|
IP
|
$127.35
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000132
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$127.35 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: ASR ASR |
$123.53
|
| Rate for Payer: BCBS Trust/PPO |
$104.58
|
| Rate for Payer: BCN Commercial |
$104.58
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Healthscope Commercial |
$123.53
|
| Rate for Payer: Healthscope Whirlpool |
$127.35
|
| Rate for Payer: Mclaren Commercial |
$114.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$104.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.07
|
|
|
HC MYELODYSPLASTIC SYNDROME
|
Facility
|
OP
|
$127.35
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000132
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$127.35 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: ASR ASR |
$123.53
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$105.00
|
| Rate for Payer: BCN Commercial |
$105.00
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$123.53
|
| Rate for Payer: Healthscope Whirlpool |
$127.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$114.61
|
| Rate for Payer: Mclaren Medicaid |
$21.42
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$104.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$111.58
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$89.27
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC MYELODYSPLASTIC SYNDROME CMPT
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000025
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$82.79
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
HC MYELODYSPLASTIC SYNDROME CMPT
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000025
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$83.13
|
| Rate for Payer: BCN Commercial |
$83.13
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Mclaren Medicaid |
$21.42
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.34
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$70.67
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC MYELODYSPLASTIC SYNDROME FISH
|
Facility
|
OP
|
$178.29
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$178.29 |
| Rate for Payer: Aetna Commercial |
$160.46
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$172.94
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$147.00
|
| Rate for Payer: BCN Commercial |
$147.00
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$167.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$172.94
|
| Rate for Payer: Healthscope Whirlpool |
$178.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$160.46
|
| Rate for Payer: Mclaren Medicaid |
$51.19
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.55
|
| Rate for Payer: Nomi Health Commercial |
$146.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.72
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$156.22
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.98
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicaid |
$26.77
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$26.77
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC MYELODYSPLASTIC SYNDROME FISH
|
Facility
|
IP
|
$178.29
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.72 |
| Max. Negotiated Rate |
$178.29 |
| Rate for Payer: Aetna Commercial |
$160.46
|
| Rate for Payer: ASR ASR |
$172.94
|
| Rate for Payer: BCBS Trust/PPO |
$146.41
|
| Rate for Payer: BCN Commercial |
$146.41
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$167.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$172.94
|
| Rate for Payer: Healthscope Whirlpool |
$178.29
|
| Rate for Payer: Mclaren Commercial |
$160.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.55
|
| Rate for Payer: Nomi Health Commercial |
$146.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.90
|
|
|
HC MYELOID BLAST PANEL
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100016
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: Aetna Medicare |
$19.71
|
| Rate for Payer: ASR ASR |
$51.68
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$43.93
|
| Rate for Payer: BCN Commercial |
$43.93
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Whirlpool |
$53.28
|
| Rate for Payer: Mclaren Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Nomi Health Commercial |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.89
|
|
|
HC MYELOID BLAST PANEL
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100016
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: ASR ASR |
$51.68
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Whirlpool |
$53.28
|
| Rate for Payer: Mclaren Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Nomi Health Commercial |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.89
|
|
|
HC MYELOID BLAST PANEL CMPT
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100017
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: ASR ASR |
$51.68
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Whirlpool |
$53.28
|
| Rate for Payer: Mclaren Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Nomi Health Commercial |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.89
|
|
|
HC MYELOID BLAST PANEL CMPT
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100017
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: Aetna Medicare |
$19.71
|
| Rate for Payer: ASR ASR |
$51.68
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$43.93
|
| Rate for Payer: BCN Commercial |
$43.93
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Whirlpool |
$53.28
|
| Rate for Payer: Mclaren Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Nomi Health Commercial |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.89
|
|
|
HC MYELOPEROXIDASE AB (HC ANCA VACULITIS PANEL MPO PR3)
|
Facility
|
OP
|
$30.77
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$29.85
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.37
|
| Rate for Payer: BCN Commercial |
$25.37
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$28.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$30.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$27.69
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC MYELOPEROXIDASE AB (HC ANCA VACULITIS PANEL MPO PR3)
|
Facility
|
IP
|
$30.77
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: ASR ASR |
$29.85
|
| Rate for Payer: BCBS Trust/PPO |
$25.27
|
| Rate for Payer: BCN Commercial |
$25.27
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$28.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$30.77
|
| Rate for Payer: Mclaren Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.08
|
|
|
HC MYOBLOC PER 100U (RIMABOTULINUMTOXINB)
|
Facility
|
IP
|
$35.39
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
63600172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$35.39 |
| Rate for Payer: Aetna Commercial |
$31.85
|
| Rate for Payer: ASR ASR |
$34.33
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCN Commercial |
$29.06
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cofinity Commercial |
$33.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.31
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Whirlpool |
$35.39
|
| Rate for Payer: Mclaren Commercial |
$31.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.08
|
| Rate for Payer: Nomi Health Commercial |
$29.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.14
|
|
|
HC MYOBLOC PER 100U (RIMABOTULINUMTOXINB)
|
Facility
|
OP
|
$35.39
|
|
|
Service Code
|
HCPCS J0587
|
| Hospital Charge Code |
63600172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$35.39 |
| Rate for Payer: Aetna Commercial |
$31.85
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: ASR ASR |
$34.33
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$29.18
|
| Rate for Payer: BCN Commercial |
$29.18
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cash Price |
$28.31
|
| Rate for Payer: Cofinity Commercial |
$33.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Whirlpool |
$35.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$31.85
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Meridian Medicaid |
$7.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.08
|
| Rate for Payer: Nomi Health Commercial |
$29.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$14.61
|
| Rate for Payer: PHP Medicaid |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.79
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow Network |
$11.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.28
|
| Rate for Payer: UHC Exchange |
$20.58
|
| Rate for Payer: UHC Medicaid |
$6.95
|
| Rate for Payer: UHCCP DNSP |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$6.95
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC MYOGLOBIN SERUM
|
Facility
|
IP
|
$148.88
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
30100303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$133.99
|
| Rate for Payer: ASR ASR |
$144.41
|
| Rate for Payer: BCBS Trust/PPO |
$122.26
|
| Rate for Payer: BCN Commercial |
$122.26
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Healthscope Commercial |
$144.41
|
| Rate for Payer: Healthscope Whirlpool |
$148.88
|
| Rate for Payer: Mclaren Commercial |
$133.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.01
|
|
|
HC MYOGLOBIN SERUM
|
Facility
|
OP
|
$148.88
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
30100303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$230.01 |
| Rate for Payer: Aetna Commercial |
$133.99
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.15
|
| Rate for Payer: ASR ASR |
$144.41
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$122.75
|
| Rate for Payer: BCN Commercial |
$122.75
|
| Rate for Payer: BCN Medicare Advantage |
$12.92
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$144.41
|
| Rate for Payer: Healthscope Whirlpool |
$148.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.92
|
| Rate for Payer: Mclaren Commercial |
$133.99
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| Rate for Payer: Mclaren Medicare |
$12.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.57
|
| Rate for Payer: Meridian Medicaid |
$7.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: PACE Medicare |
$12.27
|
| Rate for Payer: PACE SWMI |
$12.92
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Medicaid |
$6.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.01
|
| Rate for Payer: Priority Health Medicare |
$12.92
|
| Rate for Payer: Priority Health Narrow Network |
$184.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.92
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicaid |
$6.76
|
| Rate for Payer: UHCCP DNSP |
$12.92
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: VA VA |
$12.92
|
|
|
HC MYOGLOBIN SERUM.
|
Facility
|
IP
|
$55.18
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
30100664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$55.18 |
| Rate for Payer: Aetna Commercial |
$49.66
|
| Rate for Payer: ASR ASR |
$53.52
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$53.52
|
| Rate for Payer: Healthscope Whirlpool |
$55.18
|
| Rate for Payer: Mclaren Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Nomi Health Commercial |
$45.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.56
|
|
|
HC MYOGLOBIN SERUM.
|
Facility
|
OP
|
$55.18
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
30100664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$230.01 |
| Rate for Payer: Aetna Commercial |
$49.66
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.15
|
| Rate for Payer: ASR ASR |
$53.52
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$45.50
|
| Rate for Payer: BCN Commercial |
$45.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.92
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$53.52
|
| Rate for Payer: Healthscope Whirlpool |
$55.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.92
|
| Rate for Payer: Mclaren Commercial |
$49.66
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| Rate for Payer: Mclaren Medicare |
$12.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.57
|
| Rate for Payer: Meridian Medicaid |
$7.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Nomi Health Commercial |
$45.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PACE Medicare |
$12.27
|
| Rate for Payer: PACE SWMI |
$12.92
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Medicaid |
$6.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.01
|
| Rate for Payer: Priority Health Medicare |
$12.92
|
| Rate for Payer: Priority Health Narrow Network |
$184.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.92
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicaid |
$6.76
|
| Rate for Payer: UHCCP DNSP |
$12.92
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: VA VA |
$12.92
|
|
|
HC MYOGLOBIN URINE
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
30100302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$44.89
|
| Rate for Payer: ASR ASR |
$48.38
|
| Rate for Payer: BCBS Trust/PPO |
$40.96
|
| Rate for Payer: BCN Commercial |
$40.96
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$46.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Healthscope Whirlpool |
$49.88
|
| Rate for Payer: Mclaren Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.89
|
|
