|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
OP
|
$53.78
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna Commercial |
$48.40
|
| Rate for Payer: Aetna Medicare |
$26.89
|
| Rate for Payer: ASR ASR |
$52.17
|
| Rate for Payer: ASR Commercial |
$52.17
|
| Rate for Payer: BCBS Complete |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$44.04
|
| Rate for Payer: BCN Commercial |
$41.70
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$50.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$53.78
|
| Rate for Payer: Healthscope Whirlpool |
$52.17
|
| Rate for Payer: Mclaren Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.12
|
| Rate for Payer: Priority Health Narrow Network |
$37.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.33
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
IP
|
$379.75
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$246.84 |
| Max. Negotiated Rate |
$379.75 |
| Rate for Payer: Aetna Commercial |
$341.77
|
| Rate for Payer: ASR ASR |
$368.36
|
| Rate for Payer: ASR Commercial |
$368.36
|
| Rate for Payer: BCBS Trust/PPO |
$309.46
|
| Rate for Payer: BCN Commercial |
$294.42
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cofinity Commercial |
$356.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.80
|
| Rate for Payer: Healthscope Commercial |
$379.75
|
| Rate for Payer: Healthscope Whirlpool |
$368.36
|
| Rate for Payer: Mclaren Commercial |
$341.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.79
|
| Rate for Payer: Nomi Health Commercial |
$311.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.18
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
OP
|
$379.75
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.27 |
| Max. Negotiated Rate |
$379.75 |
| Rate for Payer: Aetna Commercial |
$341.77
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: ASR ASR |
$368.36
|
| Rate for Payer: ASR Commercial |
$368.36
|
| Rate for Payer: BCBS Complete |
$104.23
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$310.98
|
| Rate for Payer: BCN Commercial |
$294.42
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cofinity Commercial |
$356.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$379.75
|
| Rate for Payer: Healthscope Whirlpool |
$368.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$185.20
|
| Rate for Payer: Mclaren Commercial |
$341.77
|
| Rate for Payer: Mclaren Medicaid |
$99.27
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: Meridian Medicaid |
$104.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.79
|
| Rate for Payer: Nomi Health Commercial |
$311.39
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$203.72
|
| Rate for Payer: PHP Medicaid |
$99.27
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.74
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health Narrow Network |
$266.20
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.20
|
| Rate for Payer: UHC Exchange |
$287.06
|
| Rate for Payer: UHC Medicare Advantage |
$185.20
|
| Rate for Payer: UHCCP DNSP |
$185.20
|
| Rate for Payer: UHCCP Medicaid |
$99.27
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
OP
|
$600.31
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$600.31 |
| Rate for Payer: Aetna Commercial |
$540.28
|
| Rate for Payer: Aetna Medicare |
$300.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.00
|
| Rate for Payer: ASR ASR |
$582.30
|
| Rate for Payer: ASR Commercial |
$582.30
|
| Rate for Payer: BCBS Complete |
$168.84
|
| Rate for Payer: BCBS MAPPO |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$491.59
|
| Rate for Payer: BCN Commercial |
$465.42
|
| Rate for Payer: BCN Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$480.25
|
| Rate for Payer: Cash Price |
$480.25
|
| Rate for Payer: Cofinity Commercial |
$564.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$600.31
|
| Rate for Payer: Healthscope Whirlpool |
$582.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$540.28
|
| Rate for Payer: Mclaren Medicaid |
$160.80
|
| Rate for Payer: Mclaren Medicare |
$300.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.00
|
| Rate for Payer: Meridian Medicaid |
$168.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.26
|
| Rate for Payer: Nomi Health Commercial |
$492.25
|
| Rate for Payer: PACE Medicare |
$285.00
|
| Rate for Payer: PACE SWMI |
$300.00
|
| Rate for Payer: PHP Commercial |
$330.00
|
| Rate for Payer: PHP Medicaid |
$160.80
|
| Rate for Payer: PHP Medicare Advantage |
$300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.99
|
| Rate for Payer: Priority Health Medicare |
$300.00
|
| Rate for Payer: Priority Health Narrow Network |
$420.82
|
| Rate for Payer: Railroad Medicare Medicare |
$300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.00
|
| Rate for Payer: UHC Exchange |
$465.00
|
| Rate for Payer: UHC Medicare Advantage |
$300.00
|
| Rate for Payer: UHCCP DNSP |
$300.00
|
| Rate for Payer: UHCCP Medicaid |
$160.80
|
| Rate for Payer: VA VA |
$300.00
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
IP
|
$600.31
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$600.31 |
| Rate for Payer: Aetna Commercial |
$540.28
|
| Rate for Payer: ASR ASR |
$582.30
|
| Rate for Payer: ASR Commercial |
$582.30
|
| Rate for Payer: BCBS Trust/PPO |
$489.19
|
| Rate for Payer: BCN Commercial |
$465.42
|
| Rate for Payer: Cash Price |
$480.25
|
| Rate for Payer: Cofinity Commercial |
$564.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.25
|
| Rate for Payer: Healthscope Commercial |
$600.31
|
| Rate for Payer: Healthscope Whirlpool |
$582.30
|
| Rate for Payer: Mclaren Commercial |
$540.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.26
|
| Rate for Payer: Nomi Health Commercial |
$492.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.27
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
OP
|
$648.17
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$648.17 |
| Rate for Payer: Aetna Commercial |
$583.35
|
| Rate for Payer: Aetna Medicare |
$121.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.04
|
| Rate for Payer: ASR ASR |
$628.72
|
| Rate for Payer: ASR Commercial |
$628.72
|
| Rate for Payer: BCBS Complete |
$68.45
|
| Rate for Payer: BCBS MAPPO |
$121.63
|
| Rate for Payer: BCBS Trust/PPO |
$530.79
|
| Rate for Payer: BCN Commercial |
$502.53
|
| Rate for Payer: BCN Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$518.54
|
| Rate for Payer: Cash Price |
$518.54
|
| Rate for Payer: Cofinity Commercial |
$609.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.63
|
| Rate for Payer: Healthscope Commercial |
$648.17
|
| Rate for Payer: Healthscope Whirlpool |
$628.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$121.63
|
| Rate for Payer: Mclaren Commercial |
$583.35
|
| Rate for Payer: Mclaren Medicaid |
$65.19
|
| Rate for Payer: Mclaren Medicare |
$121.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.71
|
| Rate for Payer: Meridian Medicaid |
$68.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.94
|
| Rate for Payer: Nomi Health Commercial |
$531.50
|
| Rate for Payer: PACE Medicare |
$115.55
|
| Rate for Payer: PACE SWMI |
$121.63
|
| Rate for Payer: PHP Commercial |
$133.79
|
| Rate for Payer: PHP Medicaid |
$65.19
|
| Rate for Payer: PHP Medicare Advantage |
$121.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.93
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health Narrow Network |
$454.37
|
| Rate for Payer: Railroad Medicare Medicare |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.63
|
| Rate for Payer: UHC Exchange |
$188.53
|
| Rate for Payer: UHC Medicare Advantage |
$121.63
|
| Rate for Payer: UHCCP DNSP |
$121.63
|
| Rate for Payer: UHCCP Medicaid |
$65.19
|
| Rate for Payer: VA VA |
$121.63
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
IP
|
$648.17
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$421.31 |
| Max. Negotiated Rate |
$648.17 |
| Rate for Payer: Aetna Commercial |
$583.35
|
| Rate for Payer: ASR ASR |
$628.72
|
| Rate for Payer: ASR Commercial |
$628.72
|
| Rate for Payer: BCBS Trust/PPO |
$528.19
|
| Rate for Payer: BCN Commercial |
$502.53
|
| Rate for Payer: Cash Price |
$518.54
|
| Rate for Payer: Cofinity Commercial |
$609.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.54
|
| Rate for Payer: Healthscope Commercial |
$648.17
|
| Rate for Payer: Healthscope Whirlpool |
$628.72
|
| Rate for Payer: Mclaren Commercial |
$583.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.94
|
| Rate for Payer: Nomi Health Commercial |
$531.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.39
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$399.64
|
| Rate for Payer: ASR Commercial |
$399.64
|
| Rate for Payer: BCBS Complete |
$51.59
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$337.39
|
| Rate for Payer: BCN Commercial |
$319.42
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$387.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$412.00
|
| Rate for Payer: Healthscope Whirlpool |
$399.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$370.80
|
| Rate for Payer: Mclaren Medicaid |
$49.13
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$51.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.20
|
| Rate for Payer: Nomi Health Commercial |
$337.84
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.99
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$288.81
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.66
|
| Rate for Payer: UHC Exchange |
$142.07
|
| Rate for Payer: UHC Medicare Advantage |
$91.66
|
| Rate for Payer: UHCCP DNSP |
$91.66
|
| Rate for Payer: UHCCP Medicaid |
$49.13
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: ASR ASR |
$399.64
|
| Rate for Payer: ASR Commercial |
$399.64
|
| Rate for Payer: BCBS Trust/PPO |
$335.74
|
| Rate for Payer: BCN Commercial |
$319.42
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$387.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.60
|
| Rate for Payer: Healthscope Commercial |
$412.00
|
| Rate for Payer: Healthscope Whirlpool |
$399.64
|
| Rate for Payer: Mclaren Commercial |
$370.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.20
|
| Rate for Payer: Nomi Health Commercial |
$337.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.56
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
IP
|
$2,364.72
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,537.07 |
| Max. Negotiated Rate |
$2,364.72 |
| Rate for Payer: Aetna Commercial |
$2,128.25
|
| Rate for Payer: ASR ASR |
$2,293.78
|
| Rate for Payer: ASR Commercial |
$2,293.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,927.01
|
| Rate for Payer: BCN Commercial |
$1,833.37
|
| Rate for Payer: Cash Price |
$1,891.78
|
| Rate for Payer: Cofinity Commercial |
$2,222.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,891.78
|
| Rate for Payer: Healthscope Commercial |
$2,364.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,293.78
|
| Rate for Payer: Mclaren Commercial |
$2,128.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,010.01
|
| Rate for Payer: Nomi Health Commercial |
$1,939.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,080.95
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
OP
|
$2,364.72
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,364.72 |
| Rate for Payer: Aetna Commercial |
$2,128.25
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,293.78
|
| Rate for Payer: ASR Commercial |
$2,293.78
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.47
|
| Rate for Payer: BCN Commercial |
$1,833.37
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,891.78
|
| Rate for Payer: Cash Price |
$1,891.78
|
| Rate for Payer: Cofinity Commercial |
$2,222.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,891.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,364.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,293.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,128.25
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,010.01
|
| Rate for Payer: Nomi Health Commercial |
$1,939.07
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,071.97
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,657.67
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,080.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
IP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,371.79 |
| Max. Negotiated Rate |
$2,110.45 |
| Rate for Payer: Aetna Commercial |
$1,899.40
|
| Rate for Payer: ASR ASR |
$2,047.14
|
| Rate for Payer: ASR Commercial |
$2,047.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.81
|
| Rate for Payer: BCN Commercial |
$1,636.23
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,983.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Healthscope Commercial |
$2,110.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,047.14
|
| Rate for Payer: Mclaren Commercial |
$1,899.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$1,730.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,857.20
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
OP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,110.45 |
| Rate for Payer: Aetna Commercial |
$1,899.40
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$2,047.14
|
| Rate for Payer: ASR Commercial |
$2,047.14
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.25
|
| Rate for Payer: BCN Commercial |
$1,636.23
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,983.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,110.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,047.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,899.40
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$1,730.57
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,849.18
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.43
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,857.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
IP
|
$3,090.30
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,008.69 |
| Max. Negotiated Rate |
$3,090.30 |
| Rate for Payer: Aetna Commercial |
$2,781.27
|
| Rate for Payer: ASR ASR |
$2,997.59
|
| Rate for Payer: ASR Commercial |
$2,997.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,518.29
|
| Rate for Payer: BCN Commercial |
$2,395.91
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cofinity Commercial |
$2,904.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.24
|
| Rate for Payer: Healthscope Commercial |
$3,090.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,997.59
|
| Rate for Payer: Mclaren Commercial |
$2,781.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,626.76
|
| Rate for Payer: Nomi Health Commercial |
$2,534.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,008.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,719.46
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
OP
|
$3,090.30
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$3,090.30 |
| Rate for Payer: Aetna Commercial |
$2,781.27
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,997.59
|
| Rate for Payer: ASR Commercial |
$2,997.59
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,530.65
|
| Rate for Payer: BCN Commercial |
$2,395.91
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cofinity Commercial |
$2,904.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$3,090.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,997.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,781.27
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,626.76
|
| Rate for Payer: Nomi Health Commercial |
$2,534.05
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,008.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,707.72
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,166.30
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,719.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MRA HEAD WO CON
|
Facility
|
OP
|
$1,809.20
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,809.20 |
| Rate for Payer: Aetna Commercial |
$1,628.28
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,754.92
|
| Rate for Payer: ASR Commercial |
$1,754.92
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.55
|
| Rate for Payer: BCN Commercial |
$1,402.67
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cofinity Commercial |
$1,700.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,447.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,809.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,754.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,628.28
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.82
|
| Rate for Payer: Nomi Health Commercial |
$1,483.54
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,585.22
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,268.25
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,592.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MRA HEAD WO CON
|
Facility
|
IP
|
$1,809.20
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,175.98 |
| Max. Negotiated Rate |
$1,809.20 |
| Rate for Payer: Aetna Commercial |
$1,628.28
|
| Rate for Payer: ASR ASR |
$1,754.92
|
| Rate for Payer: ASR Commercial |
$1,754.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.32
|
| Rate for Payer: BCN Commercial |
$1,402.67
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cofinity Commercial |
$1,700.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,447.36
|
| Rate for Payer: Healthscope Commercial |
$1,809.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,754.92
|
| Rate for Payer: Mclaren Commercial |
$1,628.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.82
|
| Rate for Payer: Nomi Health Commercial |
$1,483.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,592.10
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
IP
|
$3,052.80
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,984.32 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,747.52
|
| Rate for Payer: ASR ASR |
$2,961.22
|
| Rate for Payer: ASR Commercial |
$2,961.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,487.73
|
| Rate for Payer: BCN Commercial |
$2,366.84
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,869.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Healthscope Commercial |
$3,052.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,961.22
|
| Rate for Payer: Mclaren Commercial |
$2,747.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: Nomi Health Commercial |
$2,503.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,686.46
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
OP
|
$3,052.80
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,747.52
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,961.22
|
| Rate for Payer: ASR Commercial |
$2,961.22
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,499.94
|
| Rate for Payer: BCN Commercial |
$2,366.84
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,869.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$3,052.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,961.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,747.52
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: Nomi Health Commercial |
$2,503.30
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,674.86
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,140.01
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,686.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
OP
|
$1,412.55
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,412.55 |
| Rate for Payer: Aetna Commercial |
$1,271.30
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,370.17
|
| Rate for Payer: ASR Commercial |
$1,370.17
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.74
|
| Rate for Payer: BCN Commercial |
$1,095.15
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cofinity Commercial |
$1,327.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,412.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,271.30
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.67
|
| Rate for Payer: Nomi Health Commercial |
$1,158.29
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.68
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$990.20
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
IP
|
$1,412.55
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$918.16 |
| Max. Negotiated Rate |
$1,412.55 |
| Rate for Payer: Aetna Commercial |
$1,271.30
|
| Rate for Payer: ASR ASR |
$1,370.17
|
| Rate for Payer: ASR Commercial |
$1,370.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.09
|
| Rate for Payer: BCN Commercial |
$1,095.15
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cofinity Commercial |
$1,327.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.04
|
| Rate for Payer: Healthscope Commercial |
$1,412.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.17
|
| Rate for Payer: Mclaren Commercial |
$1,271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.67
|
| Rate for Payer: Nomi Health Commercial |
$1,158.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.04
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
IP
|
$1,857.93
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,207.65 |
| Max. Negotiated Rate |
$1,857.93 |
| Rate for Payer: Aetna Commercial |
$1,672.14
|
| Rate for Payer: ASR ASR |
$1,802.19
|
| Rate for Payer: ASR Commercial |
$1,802.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,514.03
|
| Rate for Payer: BCN Commercial |
$1,440.45
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cofinity Commercial |
$1,746.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.34
|
| Rate for Payer: Healthscope Commercial |
$1,857.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,802.19
|
| Rate for Payer: Mclaren Commercial |
$1,672.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.24
|
| Rate for Payer: Nomi Health Commercial |
$1,523.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,634.98
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
OP
|
$1,857.93
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$743.17 |
| Max. Negotiated Rate |
$1,857.93 |
| Rate for Payer: Aetna Commercial |
$1,672.14
|
| Rate for Payer: Aetna Medicare |
$928.97
|
| Rate for Payer: ASR ASR |
$1,802.19
|
| Rate for Payer: ASR Commercial |
$1,802.19
|
| Rate for Payer: BCBS Complete |
$743.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,521.46
|
| Rate for Payer: BCN Commercial |
$1,440.45
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cofinity Commercial |
$1,746.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.34
|
| Rate for Payer: Healthscope Commercial |
$1,857.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,802.19
|
| Rate for Payer: Mclaren Commercial |
$1,672.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.24
|
| Rate for Payer: Nomi Health Commercial |
$1,523.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,627.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,302.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,634.98
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
IP
|
$1,548.26
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,006.37 |
| Max. Negotiated Rate |
$1,548.26 |
| Rate for Payer: Aetna Commercial |
$1,393.43
|
| Rate for Payer: ASR ASR |
$1,501.81
|
| Rate for Payer: ASR Commercial |
$1,501.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.68
|
| Rate for Payer: BCN Commercial |
$1,200.37
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cofinity Commercial |
$1,455.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.61
|
| Rate for Payer: Healthscope Commercial |
$1,548.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,501.81
|
| Rate for Payer: Mclaren Commercial |
$1,393.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.02
|
| Rate for Payer: Nomi Health Commercial |
$1,269.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.47
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
OP
|
$1,548.26
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$619.30 |
| Max. Negotiated Rate |
$1,548.26 |
| Rate for Payer: Aetna Commercial |
$1,393.43
|
| Rate for Payer: Aetna Medicare |
$774.13
|
| Rate for Payer: ASR ASR |
$1,501.81
|
| Rate for Payer: ASR Commercial |
$1,501.81
|
| Rate for Payer: BCBS Complete |
$619.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.87
|
| Rate for Payer: BCN Commercial |
$1,200.37
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cofinity Commercial |
$1,455.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.61
|
| Rate for Payer: Healthscope Commercial |
$1,548.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,501.81
|
| Rate for Payer: Mclaren Commercial |
$1,393.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.02
|
| Rate for Payer: Nomi Health Commercial |
$1,269.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,356.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,085.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.47
|
|
