HC VAP CHOLESTEROL CMPT
|
Facility
|
OP
|
$20.40
|
|
Service Code
|
CPT 84478
|
Hospital Charge Code |
30100445
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$3.14 |
Max. Negotiated Rate |
$29.76 |
Rate for Payer: Aetna Commercial |
$18.36
|
Rate for Payer: Aetna Medicare |
$5.74
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.18
|
Rate for Payer: Amish Plain Church Group Commercial |
$7.18
|
Rate for Payer: ASR ASR |
$19.79
|
Rate for Payer: BCBS Complete |
$3.30
|
Rate for Payer: BCBS MAPPO |
$5.74
|
Rate for Payer: BCBS Trust/PPO |
$15.82
|
Rate for Payer: BCN Commercial |
$15.82
|
Rate for Payer: BCN Medicare Advantage |
$5.74
|
Rate for Payer: Cash Price |
$16.32
|
Rate for Payer: Cash Price |
$16.32
|
Rate for Payer: Cofinity Commercial |
$19.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
Rate for Payer: Healthscope Commercial |
$20.40
|
Rate for Payer: Healthscope Whirlpool |
$19.79
|
Rate for Payer: Humana Choice PPO Medicare |
$5.74
|
Rate for Payer: Mclaren Commercial |
$18.36
|
Rate for Payer: Mclaren Medicaid |
$3.14
|
Rate for Payer: Mclaren Medicare |
$5.74
|
Rate for Payer: Meridian Medicaid |
$3.30
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.03
|
Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
Rate for Payer: PACE Medicare |
$5.45
|
Rate for Payer: PACE SWMI |
$5.74
|
Rate for Payer: PHP Commercial |
$6.31
|
Rate for Payer: PHP Medicaid |
$3.14
|
Rate for Payer: PHP Medicare Advantage |
$5.74
|
Rate for Payer: Priority Health Choice Medicaid |
$3.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.76
|
Rate for Payer: Priority Health Medicare |
$5.74
|
Rate for Payer: Priority Health Narrow Network |
$23.81
|
Rate for Payer: Railroad Medicare Medicare |
$5.74
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
Rate for Payer: UHC Medicare Advantage |
$5.91
|
Rate for Payer: VA VA |
$5.74
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
OP
|
$216.24
|
|
Service Code
|
CPT 90716
|
Hospital Charge Code |
63600084
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$86.50 |
Max. Negotiated Rate |
$216.24 |
Rate for Payer: Aetna Commercial |
$194.62
|
Rate for Payer: ASR ASR |
$209.75
|
Rate for Payer: BCBS Complete |
$86.50
|
Rate for Payer: BCBS Trust/PPO |
$167.65
|
Rate for Payer: BCN Commercial |
$167.65
|
Rate for Payer: Cash Price |
$172.99
|
Rate for Payer: Cofinity Commercial |
$203.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$172.99
|
Rate for Payer: Healthscope Commercial |
$216.24
|
Rate for Payer: Healthscope Whirlpool |
$209.75
|
Rate for Payer: Mclaren Commercial |
$194.62
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.78
|
Rate for Payer: Priority Health Narrow Network |
$153.53
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.29
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
IP
|
$216.24
|
|
Service Code
|
CPT 90716
|
Hospital Charge Code |
63600084
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$151.37 |
Max. Negotiated Rate |
$216.24 |
Rate for Payer: Aetna Commercial |
$194.62
|
Rate for Payer: ASR ASR |
$209.75
|
Rate for Payer: BCBS Trust/PPO |
$167.65
|
Rate for Payer: BCN Commercial |
$167.65
|
Rate for Payer: Cash Price |
$172.99
|
Rate for Payer: Cofinity Commercial |
$203.27
|
Rate for Payer: Encore Health Key Benefits Commercial |
$172.99
|
Rate for Payer: Healthscope Commercial |
$216.24
|
Rate for Payer: Healthscope Whirlpool |
$209.75
|
Rate for Payer: Mclaren Commercial |
$194.62
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.29
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$43.86
|
|
Service Code
|
CPT 86787
|
Hospital Charge Code |
30200327
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$30.70 |
Max. Negotiated Rate |
$43.86 |
Rate for Payer: Aetna Commercial |
$39.47
|
Rate for Payer: ASR ASR |
$42.54
|
Rate for Payer: BCBS Trust/PPO |
$34.00
|
Rate for Payer: BCN Commercial |
$34.00
|
Rate for Payer: Cash Price |
$35.09
|
Rate for Payer: Cofinity Commercial |
$41.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
Rate for Payer: Healthscope Commercial |
$43.86
|
Rate for Payer: Healthscope Whirlpool |
$42.54
|
Rate for Payer: Mclaren Commercial |
$39.47
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$43.86
|
|
Service Code
|
CPT 86787
|
Hospital Charge Code |
30200327
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$7.05 |
Max. Negotiated Rate |
$97.49 |
Rate for Payer: Aetna Commercial |
$39.47
|
Rate for Payer: Aetna Medicare |
$12.88
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
Rate for Payer: ASR ASR |
$42.54
|
Rate for Payer: BCBS Complete |
$7.40
|
Rate for Payer: BCBS MAPPO |
$12.88
|
Rate for Payer: BCBS Trust/PPO |
$34.00
|
Rate for Payer: BCN Commercial |
$34.00
|
Rate for Payer: BCN Medicare Advantage |
$12.88
|
Rate for Payer: Cash Price |
$35.09
|
Rate for Payer: Cash Price |
$35.09
|
Rate for Payer: Cofinity Commercial |
$41.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
Rate for Payer: Healthscope Commercial |
$43.86
|
Rate for Payer: Healthscope Whirlpool |
$42.54
|
Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
Rate for Payer: Mclaren Commercial |
$39.47
|
Rate for Payer: Mclaren Medicaid |
$7.05
|
Rate for Payer: Mclaren Medicare |
$12.88
|
Rate for Payer: Meridian Medicaid |
$7.40
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
Rate for Payer: PACE Medicare |
$12.24
|
Rate for Payer: PACE SWMI |
$12.88
|
Rate for Payer: PHP Commercial |
$14.17
|
Rate for Payer: PHP Medicaid |
$7.05
|
Rate for Payer: PHP Medicare Advantage |
$12.88
|
Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.49
|
Rate for Payer: Priority Health Medicare |
$12.88
|
Rate for Payer: Priority Health Narrow Network |
$77.99
|
Rate for Payer: Railroad Medicare Medicare |
$12.88
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
Rate for Payer: UHC Medicare Advantage |
$13.27
|
Rate for Payer: VA VA |
$12.88
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$79.00
|
|
Service Code
|
CPT 86787
|
Hospital Charge Code |
30200326
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$7.05 |
Max. Negotiated Rate |
$97.49 |
Rate for Payer: Aetna Commercial |
$71.10
|
Rate for Payer: Aetna Medicare |
$12.88
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
Rate for Payer: ASR ASR |
$76.63
|
Rate for Payer: BCBS Complete |
$7.40
|
Rate for Payer: BCBS MAPPO |
$12.88
|
Rate for Payer: BCBS Trust/PPO |
$61.25
|
Rate for Payer: BCN Commercial |
$61.25
|
Rate for Payer: BCN Medicare Advantage |
$12.88
|
Rate for Payer: Cash Price |
$63.20
|
Rate for Payer: Cash Price |
$63.20
|
Rate for Payer: Cofinity Commercial |
$74.26
|
Rate for Payer: Encore Health Key Benefits Commercial |
$63.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
Rate for Payer: Healthscope Commercial |
$79.00
|
Rate for Payer: Healthscope Whirlpool |
$76.63
|
Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
Rate for Payer: Mclaren Commercial |
$71.10
|
Rate for Payer: Mclaren Medicaid |
$7.05
|
Rate for Payer: Mclaren Medicare |
$12.88
|
Rate for Payer: Meridian Medicaid |
$7.40
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.15
|
Rate for Payer: PACE Medicare |
$12.24
|
Rate for Payer: PACE SWMI |
$12.88
|
Rate for Payer: PHP Commercial |
$14.17
|
Rate for Payer: PHP Medicaid |
$7.05
|
Rate for Payer: PHP Medicare Advantage |
$12.88
|
Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.49
|
Rate for Payer: Priority Health Medicare |
$12.88
|
Rate for Payer: Priority Health Narrow Network |
$77.99
|
Rate for Payer: Railroad Medicare Medicare |
$12.88
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.52
|
Rate for Payer: UHC Medicare Advantage |
$13.27
|
Rate for Payer: VA VA |
$12.88
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$79.00
|
|
Service Code
|
CPT 86787
|
Hospital Charge Code |
30200326
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$55.30 |
Max. Negotiated Rate |
$79.00 |
Rate for Payer: Aetna Commercial |
$71.10
|
Rate for Payer: ASR ASR |
$76.63
|
Rate for Payer: BCBS Trust/PPO |
$61.25
|
Rate for Payer: BCN Commercial |
$61.25
|
Rate for Payer: Cash Price |
$63.20
|
Rate for Payer: Cofinity Commercial |
$74.26
|
Rate for Payer: Encore Health Key Benefits Commercial |
$63.20
|
Rate for Payer: Healthscope Commercial |
$79.00
|
Rate for Payer: Healthscope Whirlpool |
$76.63
|
Rate for Payer: Mclaren Commercial |
$71.10
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.15
|
Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.52
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
OP
|
$107.10
|
|
Service Code
|
CPT 87798
|
Hospital Charge Code |
30600167
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$19.19 |
Max. Negotiated Rate |
$107.10 |
Rate for Payer: Aetna Commercial |
$96.39
|
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 |
$103.89
|
Rate for Payer: BCBS Complete |
$20.16
|
Rate for Payer: BCBS MAPPO |
$35.09
|
Rate for Payer: BCBS Trust/PPO |
$83.03
|
Rate for Payer: BCN Commercial |
$83.03
|
Rate for Payer: BCN Medicare Advantage |
$35.09
|
Rate for Payer: Cash Price |
$85.68
|
Rate for Payer: Cash Price |
$85.68
|
Rate for Payer: Cofinity Commercial |
$100.67
|
Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
Rate for Payer: Healthscope Commercial |
$107.10
|
Rate for Payer: Healthscope Whirlpool |
$103.89
|
Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
Rate for Payer: Mclaren Commercial |
$96.39
|
Rate for Payer: Mclaren Medicaid |
$19.19
|
Rate for Payer: Mclaren Medicare |
$35.09
|
Rate for Payer: Meridian Medicaid |
$20.16
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
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 |
$19.19
|
Rate for Payer: PHP Medicare Advantage |
$35.09
|
Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.46
|
Rate for Payer: Priority Health Medicare |
$35.09
|
Rate for Payer: Priority Health Narrow Network |
$76.04
|
Rate for Payer: Railroad Medicare Medicare |
$35.09
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
Rate for Payer: UHC Medicare Advantage |
$36.14
|
Rate for Payer: VA VA |
$35.09
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
IP
|
$107.10
|
|
Service Code
|
CPT 87798
|
Hospital Charge Code |
30600167
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$74.97 |
Max. Negotiated Rate |
$107.10 |
Rate for Payer: Aetna Commercial |
$96.39
|
Rate for Payer: ASR ASR |
$103.89
|
Rate for Payer: BCBS Trust/PPO |
$83.03
|
Rate for Payer: BCN Commercial |
$83.03
|
Rate for Payer: Cash Price |
$85.68
|
Rate for Payer: Cofinity Commercial |
$100.67
|
Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
Rate for Payer: Healthscope Commercial |
$107.10
|
Rate for Payer: Healthscope Whirlpool |
$103.89
|
Rate for Payer: Mclaren Commercial |
$96.39
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
OP
|
$55.00
|
|
Service Code
|
CPT 87798
|
Hospital Charge Code |
30600278
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$19.19 |
Max. Negotiated Rate |
$55.00 |
Rate for Payer: Aetna Commercial |
$49.50
|
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 |
$53.35
|
Rate for Payer: BCBS Complete |
$20.16
|
Rate for Payer: BCBS MAPPO |
$35.09
|
Rate for Payer: BCBS Trust/PPO |
$42.64
|
Rate for Payer: BCN Commercial |
$42.64
|
Rate for Payer: BCN Medicare Advantage |
$35.09
|
Rate for Payer: Cash Price |
$44.00
|
Rate for Payer: Cash Price |
$44.00
|
Rate for Payer: Cofinity Commercial |
$51.70
|
Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
Rate for Payer: Healthscope Commercial |
$55.00
|
Rate for Payer: Healthscope Whirlpool |
$53.35
|
Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
Rate for Payer: Mclaren Commercial |
$49.50
|
Rate for Payer: Mclaren Medicaid |
$19.19
|
Rate for Payer: Mclaren Medicare |
$35.09
|
Rate for Payer: Meridian Medicaid |
$20.16
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
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 |
$19.19
|
Rate for Payer: PHP Medicare Advantage |
$35.09
|
Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.05
|
Rate for Payer: Priority Health Medicare |
$35.09
|
Rate for Payer: Priority Health Narrow Network |
$39.05
|
Rate for Payer: Railroad Medicare Medicare |
$35.09
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.40
|
Rate for Payer: UHC Medicare Advantage |
$36.14
|
Rate for Payer: VA VA |
$35.09
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
IP
|
$55.00
|
|
Service Code
|
CPT 87798
|
Hospital Charge Code |
30600278
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$38.50 |
Max. Negotiated Rate |
$55.00 |
Rate for Payer: Aetna Commercial |
$49.50
|
Rate for Payer: ASR ASR |
$53.35
|
Rate for Payer: BCBS Trust/PPO |
$42.64
|
Rate for Payer: BCN Commercial |
$42.64
|
Rate for Payer: Cash Price |
$44.00
|
Rate for Payer: Cofinity Commercial |
$51.70
|
Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
Rate for Payer: Healthscope Commercial |
$55.00
|
Rate for Payer: Healthscope Whirlpool |
$53.35
|
Rate for Payer: Mclaren Commercial |
$49.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.40
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$200.40
|
|
Service Code
|
CPT 36909
|
Hospital Charge Code |
36100533
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$80.16 |
Max. Negotiated Rate |
$200.40 |
Rate for Payer: Aetna Commercial |
$180.36
|
Rate for Payer: ASR ASR |
$194.39
|
Rate for Payer: BCBS Complete |
$80.16
|
Rate for Payer: BCBS Trust/PPO |
$155.37
|
Rate for Payer: BCN Commercial |
$155.37
|
Rate for Payer: Cash Price |
$160.32
|
Rate for Payer: Cofinity Commercial |
$188.38
|
Rate for Payer: Encore Health Key Benefits Commercial |
$160.32
|
Rate for Payer: Healthscope Commercial |
$200.40
|
Rate for Payer: Healthscope Whirlpool |
$194.39
|
Rate for Payer: Mclaren Commercial |
$180.36
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$140.28
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.36
|
Rate for Payer: Priority Health Narrow Network |
$142.28
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.35
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$200.40
|
|
Service Code
|
CPT 36909
|
Hospital Charge Code |
36100533
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$140.28 |
Max. Negotiated Rate |
$200.40 |
Rate for Payer: Aetna Commercial |
$180.36
|
Rate for Payer: ASR ASR |
$194.39
|
Rate for Payer: BCBS Trust/PPO |
$155.37
|
Rate for Payer: BCN Commercial |
$155.37
|
Rate for Payer: Cash Price |
$160.32
|
Rate for Payer: Cofinity Commercial |
$188.38
|
Rate for Payer: Encore Health Key Benefits Commercial |
$160.32
|
Rate for Payer: Healthscope Commercial |
$200.40
|
Rate for Payer: Healthscope Whirlpool |
$194.39
|
Rate for Payer: Mclaren Commercial |
$180.36
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$140.28
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.35
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,269.02
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27800033
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$907.61 |
Max. Negotiated Rate |
$2,269.02 |
Rate for Payer: Aetna Commercial |
$2,042.12
|
Rate for Payer: ASR ASR |
$2,200.95
|
Rate for Payer: BCBS Complete |
$907.61
|
Rate for Payer: BCBS Trust/PPO |
$1,759.17
|
Rate for Payer: BCN Commercial |
$1,759.17
|
Rate for Payer: Cash Price |
$1,815.22
|
Rate for Payer: Cofinity Commercial |
$2,132.88
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,815.22
|
Rate for Payer: Healthscope Commercial |
$2,269.02
|
Rate for Payer: Healthscope Whirlpool |
$2,200.95
|
Rate for Payer: Mclaren Commercial |
$2,042.12
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.67
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,588.31
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,064.81
|
Rate for Payer: Priority Health Narrow Network |
$1,611.00
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,996.74
|
|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,269.02
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27800033
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,588.31 |
Max. Negotiated Rate |
$2,269.02 |
Rate for Payer: Aetna Commercial |
$2,042.12
|
Rate for Payer: ASR ASR |
$2,200.95
|
Rate for Payer: BCBS Trust/PPO |
$1,759.17
|
Rate for Payer: BCN Commercial |
$1,759.17
|
Rate for Payer: Cash Price |
$1,815.22
|
Rate for Payer: Cofinity Commercial |
$2,132.88
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,815.22
|
Rate for Payer: Healthscope Commercial |
$2,269.02
|
Rate for Payer: Healthscope Whirlpool |
$2,200.95
|
Rate for Payer: Mclaren Commercial |
$2,042.12
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.67
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,588.31
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,996.74
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$82.62
|
|
Service Code
|
CPT 84586
|
Hospital Charge Code |
30100456
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$19.33 |
Max. Negotiated Rate |
$82.62 |
Rate for Payer: Aetna Commercial |
$74.36
|
Rate for Payer: Aetna Medicare |
$35.33
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
Rate for Payer: ASR ASR |
$80.14
|
Rate for Payer: BCBS Complete |
$20.29
|
Rate for Payer: BCBS MAPPO |
$35.33
|
Rate for Payer: BCBS Trust/PPO |
$64.06
|
Rate for Payer: BCN Commercial |
$64.06
|
Rate for Payer: BCN Medicare Advantage |
$35.33
|
Rate for Payer: Cash Price |
$66.10
|
Rate for Payer: Cash Price |
$66.10
|
Rate for Payer: Cofinity Commercial |
$77.66
|
Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
Rate for Payer: Healthscope Commercial |
$82.62
|
Rate for Payer: Healthscope Whirlpool |
$80.14
|
Rate for Payer: Humana Choice PPO Medicare |
$35.33
|
Rate for Payer: Mclaren Commercial |
$74.36
|
Rate for Payer: Mclaren Medicaid |
$19.33
|
Rate for Payer: Mclaren Medicare |
$35.33
|
Rate for Payer: Meridian Medicaid |
$20.29
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.10
|
Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
Rate for Payer: PACE Medicare |
$33.56
|
Rate for Payer: PACE SWMI |
$35.33
|
Rate for Payer: PHP Commercial |
$38.86
|
Rate for Payer: PHP Medicaid |
$19.33
|
Rate for Payer: PHP Medicare Advantage |
$35.33
|
Rate for Payer: Priority Health Choice Medicaid |
$19.33
|
Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.18
|
Rate for Payer: Priority Health Medicare |
$35.33
|
Rate for Payer: Priority Health Narrow Network |
$58.66
|
Rate for Payer: Railroad Medicare Medicare |
$35.33
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
Rate for Payer: UHC Medicare Advantage |
$36.39
|
Rate for Payer: VA VA |
$35.33
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$82.62
|
|
Service Code
|
CPT 84586
|
Hospital Charge Code |
30100456
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$57.83 |
Max. Negotiated Rate |
$82.62 |
Rate for Payer: Aetna Commercial |
$74.36
|
Rate for Payer: ASR ASR |
$80.14
|
Rate for Payer: BCBS Trust/PPO |
$64.06
|
Rate for Payer: BCN Commercial |
$64.06
|
Rate for Payer: Cash Price |
$66.10
|
Rate for Payer: Cofinity Commercial |
$77.66
|
Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
Rate for Payer: Healthscope Commercial |
$82.62
|
Rate for Payer: Healthscope Whirlpool |
$80.14
|
Rate for Payer: Mclaren Commercial |
$74.36
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
IP
|
$73.44
|
|
Service Code
|
CPT 97016
|
Hospital Charge Code |
43000017
|
Hospital Revenue Code
|
430
|
Min. Negotiated Rate |
$51.41 |
Max. Negotiated Rate |
$73.44 |
Rate for Payer: Aetna Commercial |
$66.10
|
Rate for Payer: ASR ASR |
$71.24
|
Rate for Payer: BCBS Trust/PPO |
$56.94
|
Rate for Payer: BCN Commercial |
$56.94
|
Rate for Payer: Cash Price |
$58.75
|
Rate for Payer: Cofinity Commercial |
$69.03
|
Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
Rate for Payer: Healthscope Commercial |
$73.44
|
Rate for Payer: Healthscope Whirlpool |
$71.24
|
Rate for Payer: Mclaren Commercial |
$66.10
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
OP
|
$73.44
|
|
Service Code
|
CPT 97016
|
Hospital Charge Code |
43000017
|
Hospital Revenue Code
|
430
|
Min. Negotiated Rate |
$27.91 |
Max. Negotiated Rate |
$73.44 |
Rate for Payer: Aetna Commercial |
$66.10
|
Rate for Payer: ASR ASR |
$71.24
|
Rate for Payer: BCBS Complete |
$29.38
|
Rate for Payer: BCBS Trust/PPO |
$56.94
|
Rate for Payer: BCN Commercial |
$56.94
|
Rate for Payer: Cash Price |
$58.75
|
Rate for Payer: Cash Price |
$58.75
|
Rate for Payer: Cofinity Commercial |
$69.03
|
Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
Rate for Payer: Healthscope Commercial |
$73.44
|
Rate for Payer: Healthscope Whirlpool |
$71.24
|
Rate for Payer: Mclaren Commercial |
$66.10
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
Rate for Payer: Priority Health Narrow Network |
$27.91
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
HC VDRL SPINAL FLUID
|
Facility
|
OP
|
$34.68
|
|
Service Code
|
CPT 86592
|
Hospital Charge Code |
30200216
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.34 |
Max. Negotiated Rate |
$37.96 |
Rate for Payer: Aetna Commercial |
$31.21
|
Rate for Payer: Aetna Medicare |
$4.27
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
Rate for Payer: ASR ASR |
$33.64
|
Rate for Payer: BCBS Complete |
$2.45
|
Rate for Payer: BCBS MAPPO |
$4.27
|
Rate for Payer: BCBS Trust/PPO |
$26.89
|
Rate for Payer: BCN Commercial |
$26.89
|
Rate for Payer: BCN Medicare Advantage |
$4.27
|
Rate for Payer: Cash Price |
$27.74
|
Rate for Payer: Cash Price |
$27.74
|
Rate for Payer: Cofinity Commercial |
$32.60
|
Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
Rate for Payer: Healthscope Commercial |
$34.68
|
Rate for Payer: Healthscope Whirlpool |
$33.64
|
Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
Rate for Payer: Mclaren Commercial |
$31.21
|
Rate for Payer: Mclaren Medicaid |
$2.34
|
Rate for Payer: Mclaren Medicare |
$4.27
|
Rate for Payer: Meridian Medicaid |
$2.45
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
Rate for Payer: PACE Medicare |
$4.06
|
Rate for Payer: PACE SWMI |
$4.27
|
Rate for Payer: PHP Commercial |
$4.70
|
Rate for Payer: PHP Medicaid |
$2.34
|
Rate for Payer: PHP Medicare Advantage |
$4.27
|
Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.96
|
Rate for Payer: Priority Health Medicare |
$4.27
|
Rate for Payer: Priority Health Narrow Network |
$30.37
|
Rate for Payer: Railroad Medicare Medicare |
$4.27
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
Rate for Payer: UHC Medicare Advantage |
$4.40
|
Rate for Payer: VA VA |
$4.27
|
|
HC VDRL SPINAL FLUID
|
Facility
|
IP
|
$34.68
|
|
Service Code
|
CPT 86592
|
Hospital Charge Code |
30200216
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$24.28 |
Max. Negotiated Rate |
$34.68 |
Rate for Payer: Aetna Commercial |
$31.21
|
Rate for Payer: ASR ASR |
$33.64
|
Rate for Payer: BCBS Trust/PPO |
$26.89
|
Rate for Payer: BCN Commercial |
$26.89
|
Rate for Payer: Cash Price |
$27.74
|
Rate for Payer: Cofinity Commercial |
$32.60
|
Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
Rate for Payer: Healthscope Commercial |
$34.68
|
Rate for Payer: Healthscope Whirlpool |
$33.64
|
Rate for Payer: Mclaren Commercial |
$31.21
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
|
HC VDRL TITER CSF
|
Facility
|
IP
|
$74.00
|
|
Service Code
|
CPT 86593
|
Hospital Charge Code |
30200397
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$51.80 |
Max. Negotiated Rate |
$74.00 |
Rate for Payer: Aetna Commercial |
$66.60
|
Rate for Payer: ASR ASR |
$71.78
|
Rate for Payer: BCBS Trust/PPO |
$57.37
|
Rate for Payer: BCN Commercial |
$57.37
|
Rate for Payer: Cash Price |
$59.20
|
Rate for Payer: Cofinity Commercial |
$69.56
|
Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
Rate for Payer: Healthscope Commercial |
$74.00
|
Rate for Payer: Healthscope Whirlpool |
$71.78
|
Rate for Payer: Mclaren Commercial |
$66.60
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.12
|
|
HC VDRL TITER CSF
|
Facility
|
OP
|
$74.00
|
|
Service Code
|
CPT 86593
|
Hospital Charge Code |
30200397
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.41 |
Max. Negotiated Rate |
$74.00 |
Rate for Payer: Aetna Commercial |
$66.60
|
Rate for Payer: Aetna Medicare |
$4.40
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
Rate for Payer: ASR ASR |
$71.78
|
Rate for Payer: BCBS Complete |
$2.53
|
Rate for Payer: BCBS MAPPO |
$4.40
|
Rate for Payer: BCBS Trust/PPO |
$57.37
|
Rate for Payer: BCN Commercial |
$57.37
|
Rate for Payer: BCN Medicare Advantage |
$4.40
|
Rate for Payer: Cash Price |
$59.20
|
Rate for Payer: Cash Price |
$59.20
|
Rate for Payer: Cofinity Commercial |
$69.56
|
Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
Rate for Payer: Healthscope Commercial |
$74.00
|
Rate for Payer: Healthscope Whirlpool |
$71.78
|
Rate for Payer: Humana Choice PPO Medicare |
$4.40
|
Rate for Payer: Mclaren Commercial |
$66.60
|
Rate for Payer: Mclaren Medicaid |
$2.41
|
Rate for Payer: Mclaren Medicare |
$4.40
|
Rate for Payer: Meridian Medicaid |
$2.53
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.62
|
Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
Rate for Payer: PACE Medicare |
$4.18
|
Rate for Payer: PACE SWMI |
$4.40
|
Rate for Payer: PHP Commercial |
$4.84
|
Rate for Payer: PHP Medicaid |
$2.41
|
Rate for Payer: PHP Medicare Advantage |
$4.40
|
Rate for Payer: Priority Health Choice Medicaid |
$2.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.34
|
Rate for Payer: Priority Health Medicare |
$4.40
|
Rate for Payer: Priority Health Narrow Network |
$52.54
|
Rate for Payer: Railroad Medicare Medicare |
$4.40
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.12
|
Rate for Payer: UHC Medicare Advantage |
$4.53
|
Rate for Payer: VA VA |
$4.40
|
|
HC VEDOLIZUMAB
|
Facility
|
IP
|
$163.00
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
30100671
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$114.10 |
Max. Negotiated Rate |
$163.00 |
Rate for Payer: Aetna Commercial |
$146.70
|
Rate for Payer: ASR ASR |
$158.11
|
Rate for Payer: BCBS Trust/PPO |
$126.37
|
Rate for Payer: BCN Commercial |
$126.37
|
Rate for Payer: Cash Price |
$130.40
|
Rate for Payer: Cofinity Commercial |
$153.22
|
Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
Rate for Payer: Healthscope Commercial |
$163.00
|
Rate for Payer: Healthscope Whirlpool |
$158.11
|
Rate for Payer: Mclaren Commercial |
$146.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.44
|
|
HC VEDOLIZUMAB
|
Facility
|
OP
|
$163.00
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
30100671
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$9.45 |
Max. Negotiated Rate |
$292.46 |
Rate for Payer: Aetna Commercial |
$146.70
|
Rate for Payer: Aetna Medicare |
$17.27
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
Rate for Payer: ASR ASR |
$158.11
|
Rate for Payer: BCBS Complete |
$9.92
|
Rate for Payer: BCBS MAPPO |
$17.27
|
Rate for Payer: BCBS Trust/PPO |
$126.37
|
Rate for Payer: BCN Commercial |
$126.37
|
Rate for Payer: BCN Medicare Advantage |
$17.27
|
Rate for Payer: Cash Price |
$130.40
|
Rate for Payer: Cash Price |
$130.40
|
Rate for Payer: Cofinity Commercial |
$153.22
|
Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
Rate for Payer: Healthscope Commercial |
$163.00
|
Rate for Payer: Healthscope Whirlpool |
$158.11
|
Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
Rate for Payer: Mclaren Commercial |
$146.70
|
Rate for Payer: Mclaren Medicaid |
$9.45
|
Rate for Payer: Mclaren Medicare |
$17.27
|
Rate for Payer: Meridian Medicaid |
$9.92
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
Rate for Payer: PACE Medicare |
$16.41
|
Rate for Payer: PACE SWMI |
$17.27
|
Rate for Payer: PHP Commercial |
$19.00
|
Rate for Payer: PHP Medicaid |
$9.45
|
Rate for Payer: PHP Medicare Advantage |
$17.27
|
Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.46
|
Rate for Payer: Priority Health Medicare |
$17.27
|
Rate for Payer: Priority Health Narrow Network |
$233.97
|
Rate for Payer: Railroad Medicare Medicare |
$17.27
|
Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.44
|
Rate for Payer: UHC Medicare Advantage |
$17.79
|
Rate for Payer: VA VA |
$17.27
|
|