|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$245.38
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$220.84
|
| Rate for Payer: ASR ASR |
$238.02
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$190.24
|
| Rate for Payer: BCN Commercial |
$190.24
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$230.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Healthscope Whirlpool |
$238.02
|
| Rate for Payer: Mclaren Commercial |
$220.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.59
|
| Rate for Payer: Priority Health Narrow Network |
$112.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.93
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$245.38
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$220.84
|
| Rate for Payer: ASR ASR |
$238.02
|
| Rate for Payer: BCBS Trust/PPO |
$190.24
|
| Rate for Payer: BCN Commercial |
$190.24
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$230.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Healthscope Whirlpool |
$238.02
|
| Rate for Payer: Mclaren Commercial |
$220.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.93
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$33.95
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$33.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$31.50
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| 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 |
$11.72
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$24.85
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.80
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: ASR ASR |
$33.95
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$33.95
|
| Rate for Payer: Mclaren Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.80
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$116.28
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna Commercial |
$104.65
|
| Rate for Payer: ASR ASR |
$112.79
|
| Rate for Payer: BCBS Trust/PPO |
$90.15
|
| Rate for Payer: BCN Commercial |
$90.15
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Healthscope Commercial |
$116.28
|
| Rate for Payer: Healthscope Whirlpool |
$112.79
|
| Rate for Payer: Mclaren Commercial |
$104.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.33
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$116.28
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna Commercial |
$104.65
|
| 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 |
$112.79
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$90.15
|
| Rate for Payer: BCN Commercial |
$90.15
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$116.28
|
| Rate for Payer: Healthscope Whirlpool |
$112.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$104.65
|
| Rate for Payer: Mclaren Medicaid |
$28.00
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Medicaid |
$29.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| 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 |
$28.00
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.81
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$82.56
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.33
|
| Rate for Payer: UHC Medicare Advantage |
$52.73
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$103.02
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$103.02 |
| Rate for Payer: Aetna Commercial |
$92.72
|
| Rate for Payer: ASR ASR |
$99.93
|
| Rate for Payer: BCBS Trust/PPO |
$79.87
|
| Rate for Payer: BCN Commercial |
$79.87
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$96.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Healthscope Commercial |
$103.02
|
| Rate for Payer: Healthscope Whirlpool |
$99.93
|
| Rate for Payer: Mclaren Commercial |
$92.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.66
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$103.02 |
| Rate for Payer: Aetna Commercial |
$92.72
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$99.93
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$79.87
|
| Rate for Payer: BCN Commercial |
$79.87
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$96.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$103.02
|
| Rate for Payer: Healthscope Whirlpool |
$99.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$92.72
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| 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 |
$11.72
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.75
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$73.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.66
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.35
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| 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 |
$80.51
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$64.35
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Mclaren Medicaid |
$28.00
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Medicaid |
$29.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| 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 |
$28.00
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.53
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$58.93
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
| Rate for Payer: UHC Medicare Advantage |
$52.73
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$74.23
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna Commercial |
$66.81
|
| Rate for Payer: Aetna Medicare |
$46.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.72
|
| Rate for Payer: ASR ASR |
$72.00
|
| Rate for Payer: BCBS Complete |
$26.99
|
| Rate for Payer: BCBS MAPPO |
$46.98
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| Rate for Payer: BCN Commercial |
$57.55
|
| Rate for Payer: BCN Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$59.38
|
| Rate for Payer: Cash Price |
$59.38
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$74.23
|
| Rate for Payer: Healthscope Whirlpool |
$72.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.98
|
| Rate for Payer: Mclaren Commercial |
$66.81
|
| Rate for Payer: Mclaren Medicaid |
$25.70
|
| Rate for Payer: Mclaren Medicare |
$46.98
|
| Rate for Payer: Meridian Medicaid |
$26.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.10
|
| Rate for Payer: PACE Medicare |
$44.63
|
| Rate for Payer: PACE SWMI |
$46.98
|
| Rate for Payer: PHP Commercial |
$51.68
|
| Rate for Payer: PHP Medicaid |
$25.70
|
| Rate for Payer: PHP Medicare Advantage |
$46.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$46.98
|
| Rate for Payer: Priority Health Narrow Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.32
|
| Rate for Payer: UHC Medicare Advantage |
$48.39
|
| Rate for Payer: VA VA |
$46.98
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
IP
|
$74.23
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.96 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Aetna Commercial |
$66.81
|
| Rate for Payer: ASR ASR |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| Rate for Payer: BCN Commercial |
$57.55
|
| Rate for Payer: Cash Price |
$59.38
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.38
|
| Rate for Payer: Healthscope Commercial |
$74.23
|
| Rate for Payer: Healthscope Whirlpool |
$72.00
|
| Rate for Payer: Mclaren Commercial |
$66.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.32
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$59.60
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.72 |
| Max. Negotiated Rate |
$59.60 |
| Rate for Payer: Aetna Commercial |
$53.64
|
| Rate for Payer: ASR ASR |
$57.81
|
| Rate for Payer: BCBS Trust/PPO |
$46.21
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Whirlpool |
$57.81
|
| Rate for Payer: Mclaren Commercial |
$53.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.45
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$59.60
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna Commercial |
$53.64
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: ASR ASR |
$57.81
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$46.21
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Whirlpool |
$57.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.73
|
| Rate for Payer: Mclaren Commercial |
$53.64
|
| Rate for Payer: Mclaren Medicaid |
$20.64
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Medicaid |
$21.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.66
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Medicaid |
$20.64
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.45
|
| Rate for Payer: UHC Medicare Advantage |
$38.86
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,500.53
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,450.37 |
| Max. Negotiated Rate |
$3,500.53 |
| Rate for Payer: Aetna Commercial |
$3,150.48
|
| Rate for Payer: ASR ASR |
$3,395.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,713.96
|
| Rate for Payer: BCN Commercial |
$2,713.96
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cofinity Commercial |
$3,290.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.42
|
| Rate for Payer: Healthscope Commercial |
$3,500.53
|
| Rate for Payer: Healthscope Whirlpool |
$3,395.51
|
| Rate for Payer: Mclaren Commercial |
$3,150.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,080.47
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
OP
|
$3,500.53
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$508.36 |
| Max. Negotiated Rate |
$3,500.53 |
| Rate for Payer: Aetna Commercial |
$3,150.48
|
| Rate for Payer: Aetna Medicare |
$929.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,161.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,161.70
|
| Rate for Payer: ASR ASR |
$3,395.51
|
| Rate for Payer: BCBS Complete |
$533.82
|
| Rate for Payer: BCBS MAPPO |
$929.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,713.96
|
| Rate for Payer: BCN Commercial |
$2,713.96
|
| Rate for Payer: BCN Medicare Advantage |
$929.36
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cofinity Commercial |
$3,290.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.36
|
| Rate for Payer: Healthscope Commercial |
$3,500.53
|
| Rate for Payer: Healthscope Whirlpool |
$3,395.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$929.36
|
| Rate for Payer: Mclaren Commercial |
$3,150.48
|
| Rate for Payer: Mclaren Medicaid |
$508.36
|
| Rate for Payer: Mclaren Medicare |
$929.36
|
| Rate for Payer: Meridian Medicaid |
$533.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$975.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.45
|
| Rate for Payer: PACE Medicare |
$882.89
|
| Rate for Payer: PACE SWMI |
$929.36
|
| Rate for Payer: PHP Commercial |
$1,022.30
|
| Rate for Payer: PHP Medicaid |
$508.36
|
| Rate for Payer: PHP Medicare Advantage |
$929.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,185.48
|
| Rate for Payer: Priority Health Medicare |
$929.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,485.38
|
| Rate for Payer: Railroad Medicare Medicare |
$929.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,080.47
|
| Rate for Payer: UHC Medicare Advantage |
$957.24
|
| Rate for Payer: VA VA |
$929.36
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
IP
|
$403.61
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$282.53 |
| Max. Negotiated Rate |
$403.61 |
| Rate for Payer: Aetna Commercial |
$363.25
|
| Rate for Payer: ASR ASR |
$391.50
|
| Rate for Payer: BCBS Trust/PPO |
$312.92
|
| Rate for Payer: BCN Commercial |
$312.92
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$379.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.89
|
| Rate for Payer: Healthscope Commercial |
$403.61
|
| Rate for Payer: Healthscope Whirlpool |
$391.50
|
| Rate for Payer: Mclaren Commercial |
$363.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.18
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
OP
|
$403.61
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$160.90 |
| Max. Negotiated Rate |
$403.61 |
| Rate for Payer: Aetna Commercial |
$363.25
|
| Rate for Payer: ASR ASR |
$391.50
|
| Rate for Payer: BCBS Complete |
$161.44
|
| Rate for Payer: BCBS Trust/PPO |
$312.92
|
| Rate for Payer: BCN Commercial |
$312.92
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$379.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.89
|
| Rate for Payer: Healthscope Commercial |
$403.61
|
| Rate for Payer: Healthscope Whirlpool |
$391.50
|
| Rate for Payer: Mclaren Commercial |
$363.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.13
|
| Rate for Payer: Priority Health Narrow Network |
$160.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.18
|
|
|
HC TCOM SUBS DAY
|
Facility
|
OP
|
$309.94
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$309.94 |
| Rate for Payer: Aetna Commercial |
$278.95
|
| Rate for Payer: ASR ASR |
$300.64
|
| Rate for Payer: BCBS Complete |
$123.98
|
| Rate for Payer: BCBS Trust/PPO |
$240.30
|
| Rate for Payer: BCN Commercial |
$240.30
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cofinity Commercial |
$291.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$309.94
|
| Rate for Payer: Healthscope Whirlpool |
$300.64
|
| Rate for Payer: Mclaren Commercial |
$278.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.13
|
| Rate for Payer: Priority Health Narrow Network |
$160.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.75
|
|
|
HC TCOM SUBS DAY
|
Facility
|
IP
|
$309.94
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$216.96 |
| Max. Negotiated Rate |
$309.94 |
| Rate for Payer: Aetna Commercial |
$278.95
|
| Rate for Payer: ASR ASR |
$300.64
|
| Rate for Payer: BCBS Trust/PPO |
$240.30
|
| Rate for Payer: BCN Commercial |
$240.30
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cofinity Commercial |
$291.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$309.94
|
| Rate for Payer: Healthscope Whirlpool |
$300.64
|
| Rate for Payer: Mclaren Commercial |
$278.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.75
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$4,970.09
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,479.06 |
| Max. Negotiated Rate |
$4,970.09 |
| Rate for Payer: Aetna Commercial |
$4,473.08
|
| Rate for Payer: ASR ASR |
$4,820.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,853.31
|
| Rate for Payer: BCN Commercial |
$3,853.31
|
| Rate for Payer: Cash Price |
$3,976.07
|
| Rate for Payer: Cofinity Commercial |
$4,671.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.07
|
| Rate for Payer: Healthscope Commercial |
$4,970.09
|
| Rate for Payer: Healthscope Whirlpool |
$4,820.99
|
| Rate for Payer: Mclaren Commercial |
$4,473.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,224.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,479.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,373.68
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,851.87
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$268.23 |
| Max. Negotiated Rate |
$1,851.87 |
| Rate for Payer: Aetna Commercial |
$1,666.68
|
| Rate for Payer: Aetna Medicare |
$490.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: ASR ASR |
$1,796.31
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.75
|
| Rate for Payer: BCN Commercial |
$1,435.75
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,740.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$1,851.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,796.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$490.37
|
| Rate for Payer: Mclaren Commercial |
$1,666.68
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$539.41
|
| Rate for Payer: PHP Medicaid |
$268.23
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,685.20
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,314.83
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,629.65
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: VA VA |
$490.37
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,851.87
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,296.31 |
| Max. Negotiated Rate |
$1,851.87 |
| Rate for Payer: Aetna Commercial |
$1,666.68
|
| Rate for Payer: ASR ASR |
$1,796.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.75
|
| Rate for Payer: BCN Commercial |
$1,435.75
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,740.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.50
|
| Rate for Payer: Healthscope Commercial |
$1,851.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,796.31
|
| Rate for Payer: Mclaren Commercial |
$1,666.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,629.65
|
|
