|
HC PROGESTERONE LEVEL
|
Facility
|
OP
|
$80.08
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$80.08 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Medicare |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.07
|
| Rate for Payer: ASR ASR |
$77.68
|
| Rate for Payer: BCBS Complete |
$11.46
|
| Rate for Payer: BCBS MAPPO |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$66.03
|
| Rate for Payer: BCN Commercial |
$66.03
|
| Rate for Payer: BCN Medicare Advantage |
$20.86
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cofinity Commercial |
$75.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$77.68
|
| Rate for Payer: Healthscope Whirlpool |
$80.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.86
|
| Rate for Payer: Mclaren Commercial |
$72.07
|
| Rate for Payer: Mclaren Medicaid |
$20.86
|
| Rate for Payer: Mclaren Medicare |
$20.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.90
|
| Rate for Payer: Meridian Medicaid |
$11.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.07
|
| Rate for Payer: Nomi Health Commercial |
$65.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.06
|
| Rate for Payer: PACE Medicare |
$19.82
|
| Rate for Payer: PACE SWMI |
$20.86
|
| Rate for Payer: PHP Commercial |
$22.95
|
| Rate for Payer: PHP Medicaid |
$11.18
|
| Rate for Payer: PHP Medicare Advantage |
$20.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.42
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health Narrow Network |
$57.14
|
| Rate for Payer: Railroad Medicare Medicare |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.86
|
| Rate for Payer: UHC Exchange |
$32.33
|
| Rate for Payer: UHC Medicaid |
$10.91
|
| Rate for Payer: UHCCP DNSP |
$20.86
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: VA VA |
$20.86
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
IP
|
$80.08
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$80.08 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: ASR ASR |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$65.76
|
| Rate for Payer: BCN Commercial |
$65.76
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cofinity Commercial |
$75.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.06
|
| Rate for Payer: Healthscope Commercial |
$77.68
|
| Rate for Payer: Healthscope Whirlpool |
$80.08
|
| Rate for Payer: Mclaren Commercial |
$72.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.07
|
| Rate for Payer: Nomi Health Commercial |
$65.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.47
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$75.35
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$19.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.23
|
| Rate for Payer: ASR ASR |
$73.09
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$62.13
|
| Rate for Payer: BCN Commercial |
$62.13
|
| Rate for Payer: BCN Medicare Advantage |
$19.38
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$73.09
|
| Rate for Payer: Healthscope Whirlpool |
$75.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.38
|
| Rate for Payer: Mclaren Commercial |
$67.81
|
| Rate for Payer: Mclaren Medicaid |
$19.38
|
| Rate for Payer: Mclaren Medicare |
$19.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.35
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$61.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Medicare |
$18.41
|
| Rate for Payer: PACE SWMI |
$19.38
|
| Rate for Payer: PHP Commercial |
$21.32
|
| Rate for Payer: PHP Medicaid |
$10.39
|
| Rate for Payer: PHP Medicare Advantage |
$19.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.62
|
| Rate for Payer: Priority Health Medicare |
$19.38
|
| Rate for Payer: Priority Health Narrow Network |
$110.90
|
| Rate for Payer: Railroad Medicare Medicare |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.38
|
| Rate for Payer: UHC Exchange |
$30.04
|
| Rate for Payer: UHC Medicaid |
$10.14
|
| Rate for Payer: UHCCP DNSP |
$19.38
|
| Rate for Payer: UHCCP Medicaid |
$10.14
|
| Rate for Payer: VA VA |
$19.38
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$75.35
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$75.35 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: ASR ASR |
$73.09
|
| Rate for Payer: BCBS Trust/PPO |
$61.88
|
| Rate for Payer: BCN Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Healthscope Commercial |
$73.09
|
| Rate for Payer: Healthscope Whirlpool |
$75.35
|
| Rate for Payer: Mclaren Commercial |
$67.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$61.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.31
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
IP
|
$134.24
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.68 |
| Max. Negotiated Rate |
$134.24 |
| Rate for Payer: Aetna Commercial |
$120.82
|
| Rate for Payer: ASR ASR |
$130.21
|
| Rate for Payer: BCBS Trust/PPO |
$110.24
|
| Rate for Payer: BCN Commercial |
$110.24
|
| Rate for Payer: Cash Price |
$107.39
|
| Rate for Payer: Cofinity Commercial |
$126.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.39
|
| Rate for Payer: Healthscope Commercial |
$130.21
|
| Rate for Payer: Healthscope Whirlpool |
$134.24
|
| Rate for Payer: Mclaren Commercial |
$120.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.10
|
| Rate for Payer: Nomi Health Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.13
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
OP
|
$134.24
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.67 |
| Max. Negotiated Rate |
$134.24 |
| Rate for Payer: Aetna Commercial |
$120.82
|
| Rate for Payer: Aetna Medicare |
$49.67
|
| Rate for Payer: ASR ASR |
$130.21
|
| Rate for Payer: BCBS Complete |
$53.70
|
| Rate for Payer: BCBS Trust/PPO |
$110.68
|
| Rate for Payer: BCN Commercial |
$110.68
|
| Rate for Payer: Cash Price |
$107.39
|
| Rate for Payer: Cofinity Commercial |
$126.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.39
|
| Rate for Payer: Healthscope Commercial |
$130.21
|
| Rate for Payer: Healthscope Whirlpool |
$134.24
|
| Rate for Payer: Mclaren Commercial |
$120.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.10
|
| Rate for Payer: Nomi Health Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$94.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.13
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
IP
|
$30.52
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$27.47
|
| Rate for Payer: ASR ASR |
$29.60
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$25.06
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cofinity Commercial |
$28.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.42
|
| Rate for Payer: Healthscope Commercial |
$29.60
|
| Rate for Payer: Healthscope Whirlpool |
$30.52
|
| Rate for Payer: Mclaren Commercial |
$27.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.94
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.86
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
OP
|
$30.52
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$27.47
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: ASR ASR |
$29.60
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$24.42
|
| Rate for Payer: Cofinity Commercial |
$28.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.42
|
| Rate for Payer: Healthscope Commercial |
$29.60
|
| Rate for Payer: Healthscope Whirlpool |
$30.52
|
| Rate for Payer: Mclaren Commercial |
$27.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.94
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.74
|
| Rate for Payer: Priority Health Narrow Network |
$21.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.86
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$27.02
|
| Rate for Payer: BCN Commercial |
$27.02
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$27.13
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$27.02
|
| Rate for Payer: BCN Commercial |
$27.02
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$27.13
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
IP
|
$304.84
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$228.63 |
| Max. Negotiated Rate |
$304.84 |
| Rate for Payer: Aetna Commercial |
$274.36
|
| Rate for Payer: ASR ASR |
$295.69
|
| Rate for Payer: BCBS Trust/PPO |
$250.33
|
| Rate for Payer: BCN Commercial |
$250.33
|
| Rate for Payer: Cash Price |
$243.87
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.87
|
| Rate for Payer: Healthscope Commercial |
$295.69
|
| Rate for Payer: Healthscope Whirlpool |
$304.84
|
| Rate for Payer: Mclaren Commercial |
$274.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.11
|
| Rate for Payer: Nomi Health Commercial |
$249.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.26
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
OP
|
$304.84
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$304.84 |
| Rate for Payer: Aetna Commercial |
$274.36
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$295.69
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$251.34
|
| Rate for Payer: BCN Commercial |
$251.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$243.87
|
| Rate for Payer: Cash Price |
$243.87
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$295.69
|
| Rate for Payer: Healthscope Whirlpool |
$304.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$274.36
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.11
|
| Rate for Payer: Nomi Health Commercial |
$249.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.63
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.10
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$213.69
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
IP
|
$120.69
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$108.62
|
| Rate for Payer: ASR ASR |
$117.07
|
| Rate for Payer: BCBS Trust/PPO |
$99.11
|
| Rate for Payer: BCN Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cofinity Commercial |
$113.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$117.07
|
| Rate for Payer: Healthscope Whirlpool |
$120.69
|
| Rate for Payer: Mclaren Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.21
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
OP
|
$120.69
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.66 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$108.62
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: ASR ASR |
$117.07
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: BCBS Trust/PPO |
$99.51
|
| Rate for Payer: BCN Commercial |
$99.51
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cash Price |
$96.55
|
| Rate for Payer: Cofinity Commercial |
$113.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$117.07
|
| Rate for Payer: Healthscope Whirlpool |
$120.69
|
| Rate for Payer: Mclaren Commercial |
$108.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.59
|
| Rate for Payer: Nomi Health Commercial |
$98.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.85
|
| Rate for Payer: Priority Health Narrow Network |
$59.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.21
|
|
|
HC PROTEINASE 3 AB (HC ANCA VASCULITIS PANEL CMPT)
|
Facility
|
IP
|
$30.77
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: ASR ASR |
$29.85
|
| Rate for Payer: BCBS Trust/PPO |
$25.27
|
| Rate for Payer: BCN Commercial |
$25.27
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$28.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$30.77
|
| Rate for Payer: Mclaren Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.08
|
|
|
HC PROTEINASE 3 AB (HC ANCA VASCULITIS PANEL CMPT)
|
Facility
|
OP
|
$30.77
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$29.85
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.37
|
| Rate for Payer: BCN Commercial |
$25.37
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$28.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$30.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$27.69
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
30500038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$64.73 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Trust/PPO |
$53.16
|
| Rate for Payer: BCN Commercial |
$53.16
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
30500038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$163.42 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: Aetna Medicare |
$13.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.30
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$13.84
|
| Rate for Payer: BCBS Trust/PPO |
$53.37
|
| Rate for Payer: BCN Commercial |
$53.37
|
| Rate for Payer: BCN Medicare Advantage |
$13.84
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.84
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.84
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Mclaren Medicaid |
$13.84
|
| Rate for Payer: Mclaren Medicare |
$13.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.53
|
| Rate for Payer: Meridian Medicaid |
$7.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Medicare |
$13.15
|
| Rate for Payer: PACE SWMI |
$13.84
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: PHP Medicaid |
$7.42
|
| Rate for Payer: PHP Medicare Advantage |
$13.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$163.42
|
| Rate for Payer: Priority Health Medicare |
$13.84
|
| Rate for Payer: Priority Health Narrow Network |
$130.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.84
|
| Rate for Payer: UHC Exchange |
$21.45
|
| Rate for Payer: UHC Medicaid |
$7.24
|
| Rate for Payer: UHCCP DNSP |
$13.84
|
| Rate for Payer: UHCCP Medicaid |
$7.24
|
| Rate for Payer: VA VA |
$13.84
|
|
|
HC PROTEIN C ANTIGEN
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
30500037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$57.22 |
| Rate for Payer: Aetna Commercial |
$51.50
|
| Rate for Payer: ASR ASR |
$55.50
|
| Rate for Payer: BCBS Trust/PPO |
$46.99
|
| Rate for Payer: BCN Commercial |
$46.99
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$53.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$55.50
|
| Rate for Payer: Healthscope Whirlpool |
$57.22
|
| Rate for Payer: Mclaren Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.35
|
|
|
HC PROTEIN C ANTIGEN
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
30500037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$265.10 |
| Rate for Payer: Aetna Commercial |
$51.50
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.01
|
| Rate for Payer: ASR ASR |
$55.50
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS MAPPO |
$12.01
|
| Rate for Payer: BCBS Trust/PPO |
$47.18
|
| Rate for Payer: BCN Commercial |
$47.18
|
| Rate for Payer: BCN Medicare Advantage |
$12.01
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$53.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.01
|
| Rate for Payer: Healthscope Commercial |
$55.50
|
| Rate for Payer: Healthscope Whirlpool |
$57.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.01
|
| Rate for Payer: Mclaren Commercial |
$51.50
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Mclaren Medicare |
$12.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.61
|
| Rate for Payer: Meridian Medicaid |
$6.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: PACE Medicare |
$11.41
|
| Rate for Payer: PACE SWMI |
$12.01
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Medicaid |
$6.44
|
| Rate for Payer: PHP Medicare Advantage |
$12.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$265.10
|
| Rate for Payer: Priority Health Medicare |
$12.01
|
| Rate for Payer: Priority Health Narrow Network |
$212.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.01
|
| Rate for Payer: UHC Exchange |
$18.62
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP DNSP |
$12.01
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.01
|
|
|
HC PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
30100410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
30100410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$72.63 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.43
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$5.90
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$10.74
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: Meridian Medicaid |
$5.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$11.81
|
| Rate for Payer: PHP Medicaid |
$5.76
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.63
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health Narrow Network |
$58.10
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.74
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicaid |
$5.62
|
| Rate for Payer: UHCCP DNSP |
$10.74
|
| Rate for Payer: UHCCP Medicaid |
$5.62
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC PROTEIN ELECTROPHORESIS URINE
|
Facility
|
IP
|
$107.78
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
30100411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$107.78 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: ASR ASR |
$104.55
|
| Rate for Payer: BCBS Trust/PPO |
$88.51
|
| Rate for Payer: BCN Commercial |
$88.51
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$104.55
|
| Rate for Payer: Healthscope Whirlpool |
$107.78
|
| Rate for Payer: Mclaren Commercial |
$97.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.85
|
|
