|
HC PROTEIN ELECTROPHORESIS URINE
|
Facility
|
OP
|
$107.78
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
30100411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.29
|
| Rate for Payer: ASR ASR |
$104.55
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$17.83
|
| Rate for Payer: BCBS Trust/PPO |
$88.86
|
| Rate for Payer: BCN Commercial |
$88.86
|
| Rate for Payer: BCN Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$86.22
|
| 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: Health Alliance Plan Medicare Advantage |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$104.55
|
| Rate for Payer: Healthscope Whirlpool |
$107.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.83
|
| Rate for Payer: Mclaren Commercial |
$97.00
|
| Rate for Payer: Mclaren Medicaid |
$17.83
|
| Rate for Payer: Mclaren Medicare |
$17.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.72
|
| Rate for Payer: Meridian Medicaid |
$9.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.61
|
| 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: PACE Medicare |
$16.94
|
| Rate for Payer: PACE SWMI |
$17.83
|
| Rate for Payer: PHP Commercial |
$19.61
|
| Rate for Payer: PHP Medicaid |
$9.56
|
| Rate for Payer: PHP Medicare Advantage |
$17.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$17.83
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.83
|
| Rate for Payer: UHC Exchange |
$27.64
|
| Rate for Payer: UHC Medicaid |
$9.33
|
| Rate for Payer: UHCCP DNSP |
$17.83
|
| Rate for Payer: UHCCP Medicaid |
$9.33
|
| Rate for Payer: VA VA |
$17.83
|
|
|
HC PROTEIN S ACTIVITY
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$52.11
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC PROTEIN S ACTIVITY
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$52.32
|
| Rate for Payer: BCN Commercial |
$52.32
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$15.32
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.10
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$101.68
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.32
|
| Rate for Payer: UHC Exchange |
$23.75
|
| Rate for Payer: UHC Medicaid |
$8.01
|
| Rate for Payer: UHCCP DNSP |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.01
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC PROTEIN S ANTIGEN FREE
|
Facility
|
OP
|
$88.43
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500074
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$85.78
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$72.91
|
| Rate for Payer: BCN Commercial |
$72.91
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$83.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$15.32
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$72.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.32
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.10
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$101.68
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.32
|
| Rate for Payer: UHC Exchange |
$23.75
|
| Rate for Payer: UHC Medicaid |
$8.01
|
| Rate for Payer: UHCCP DNSP |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.01
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC PROTEIN S ANTIGEN FREE
|
Facility
|
IP
|
$88.43
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500074
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$88.43 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: ASR ASR |
$85.78
|
| Rate for Payer: BCBS Trust/PPO |
$72.62
|
| Rate for Payer: BCN Commercial |
$72.62
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$83.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.43
|
| Rate for Payer: Mclaren Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$72.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.82
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$41.01
|
| Rate for Payer: BCN Commercial |
$41.01
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$48.44
|
| Rate for Payer: Healthscope Whirlpool |
$49.94
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$41.18
|
| Rate for Payer: BCN Commercial |
$41.18
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$48.44
|
| Rate for Payer: Healthscope Whirlpool |
$49.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.29
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$4.29
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.45
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.72
|
| Rate for Payer: PHP Medicaid |
$2.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.45
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$22.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.29
|
| Rate for Payer: UHC Exchange |
$6.65
|
| Rate for Payer: UHC Medicaid |
$2.24
|
| Rate for Payer: UHCCP DNSP |
$4.29
|
| Rate for Payer: UHCCP Medicaid |
$2.24
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC PROTIME WITH INR
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.29
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$4.29
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.72
|
| Rate for Payer: PHP Medicaid |
$2.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.45
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$22.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.29
|
| Rate for Payer: UHC Exchange |
$6.65
|
| Rate for Payer: UHC Medicaid |
$2.24
|
| Rate for Payer: UHCCP DNSP |
$4.29
|
| Rate for Payer: UHCCP Medicaid |
$2.24
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC PROTIME WITH INR
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.40
|
| Rate for Payer: BCN Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$86.35 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$83.76
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$71.20
|
| Rate for Payer: BCN Commercial |
$71.20
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$81.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$83.76
|
| Rate for Payer: Healthscope Whirlpool |
$86.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$77.72
|
| Rate for Payer: Mclaren Medicaid |
$2.17
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.66
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$60.53
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.36
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.76 |
| Max. Negotiated Rate |
$86.35 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: ASR ASR |
$83.76
|
| Rate for Payer: BCBS Trust/PPO |
$70.91
|
| Rate for Payer: BCN Commercial |
$70.91
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$81.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$83.76
|
| Rate for Payer: Healthscope Whirlpool |
$86.35
|
| Rate for Payer: Mclaren Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.99
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$88.08
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$79.27
|
| 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 |
$85.44
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$72.62
|
| Rate for Payer: BCN Commercial |
$72.62
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$82.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$85.44
|
| Rate for Payer: Healthscope Whirlpool |
$88.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$79.27
|
| 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 |
$74.87
|
| Rate for Payer: Nomi Health Commercial |
$72.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.06
|
| 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 |
$77.18
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$61.74
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.51
|
| 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 PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$88.08
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$79.27
|
| Rate for Payer: ASR ASR |
$85.44
|
| Rate for Payer: BCBS Trust/PPO |
$72.33
|
| Rate for Payer: BCN Commercial |
$72.33
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$82.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$85.44
|
| Rate for Payer: Healthscope Whirlpool |
$88.08
|
| Rate for Payer: Mclaren Commercial |
$79.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.87
|
| Rate for Payer: Nomi Health Commercial |
$72.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.51
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: Aetna Medicare |
$19.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.14
|
| Rate for Payer: ASR ASR |
$68.94
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS MAPPO |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$58.60
|
| Rate for Payer: BCN Commercial |
$58.60
|
| Rate for Payer: BCN Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$66.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$68.94
|
| Rate for Payer: Healthscope Whirlpool |
$71.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.31
|
| Rate for Payer: Mclaren Commercial |
$63.96
|
| Rate for Payer: Mclaren Medicaid |
$19.31
|
| Rate for Payer: Mclaren Medicare |
$19.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.28
|
| Rate for Payer: Meridian Medicaid |
$10.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Medicare |
$18.34
|
| Rate for Payer: PACE SWMI |
$19.31
|
| Rate for Payer: PHP Commercial |
$21.24
|
| Rate for Payer: PHP Medicaid |
$10.35
|
| Rate for Payer: PHP Medicare Advantage |
$19.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.56
|
| Rate for Payer: Priority Health Medicare |
$19.31
|
| Rate for Payer: Priority Health Narrow Network |
$87.65
|
| Rate for Payer: Railroad Medicare Medicare |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.31
|
| Rate for Payer: UHC Exchange |
$29.93
|
| Rate for Payer: UHC Medicaid |
$10.10
|
| Rate for Payer: UHCCP DNSP |
$19.31
|
| Rate for Payer: UHCCP Medicaid |
$10.10
|
| Rate for Payer: VA VA |
$19.31
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: ASR ASR |
$68.94
|
| Rate for Payer: BCBS Trust/PPO |
$58.36
|
| Rate for Payer: BCN Commercial |
$58.36
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$66.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$68.94
|
| Rate for Payer: Healthscope Whirlpool |
$71.07
|
| Rate for Payer: Mclaren Commercial |
$63.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.54
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: ASR ASR |
$68.94
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$58.60
|
| Rate for Payer: BCN Commercial |
$58.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$66.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$68.94
|
| Rate for Payer: Healthscope Whirlpool |
$71.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.39
|
| Rate for Payer: Mclaren Commercial |
$63.96
|
| Rate for Payer: Mclaren Medicaid |
$18.39
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$10.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.96
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$50.37
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.39
|
| Rate for Payer: UHC Exchange |
$28.50
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP DNSP |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: ASR ASR |
$68.94
|
| Rate for Payer: BCBS Trust/PPO |
$58.36
|
| Rate for Payer: BCN Commercial |
$58.36
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$66.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$68.94
|
| Rate for Payer: Healthscope Whirlpool |
$71.07
|
| Rate for Payer: Mclaren Commercial |
$63.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.54
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: ASR ASR |
$68.94
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$58.60
|
| Rate for Payer: BCN Commercial |
$58.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$66.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$68.94
|
| Rate for Payer: Healthscope Whirlpool |
$71.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.39
|
| Rate for Payer: Mclaren Commercial |
$63.96
|
| Rate for Payer: Mclaren Medicaid |
$18.39
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$10.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.56
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$87.65
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.39
|
| Rate for Payer: UHC Exchange |
$28.50
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP DNSP |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: ASR ASR |
$68.94
|
| Rate for Payer: BCBS Trust/PPO |
$58.36
|
| Rate for Payer: BCN Commercial |
$58.36
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$66.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$68.94
|
| Rate for Payer: Healthscope Whirlpool |
$71.07
|
| Rate for Payer: Mclaren Commercial |
$63.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.54
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,091.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.97 |
| Max. Negotiated Rate |
$1,091.96 |
| Rate for Payer: Aetna Commercial |
$982.76
|
| Rate for Payer: ASR ASR |
$1,059.20
|
| Rate for Payer: BCBS Trust/PPO |
$896.72
|
| Rate for Payer: BCN Commercial |
$896.72
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cofinity Commercial |
$1,026.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.57
|
| Rate for Payer: Healthscope Commercial |
$1,059.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.96
|
| Rate for Payer: Mclaren Commercial |
$982.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.17
|
| Rate for Payer: Nomi Health Commercial |
$895.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$960.92
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,091.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$1,091.96 |
| Rate for Payer: Aetna Commercial |
$982.76
|
| Rate for Payer: Aetna Medicare |
$625.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: ASR ASR |
$1,059.20
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$900.32
|
| Rate for Payer: BCN Commercial |
$900.32
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cofinity Commercial |
$1,026.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$1,059.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.05
|
| Rate for Payer: Mclaren Commercial |
$982.76
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$343.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.17
|
| Rate for Payer: Nomi Health Commercial |
$895.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.97
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$687.55
|
| Rate for Payer: PHP Medicaid |
$335.03
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$956.78
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Narrow Network |
$765.46
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$960.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Exchange |
$968.83
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP DNSP |
$625.05
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
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 PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| 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 |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.87
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Medicaid |
$4.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.66
|
| 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 |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.66
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.87
|
| Rate for Payer: UHC Exchange |
$12.20
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP DNSP |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,910.14
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$5,910.14 |
| Rate for Payer: Aetna Commercial |
$5,319.13
|
| Rate for Payer: Aetna Medicare |
$855.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: ASR ASR |
$5,732.84
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$4,872.91
|
| Rate for Payer: BCN Commercial |
$4,872.91
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cofinity Commercial |
$5,555.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,728.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$5,732.84
|
| Rate for Payer: Healthscope Whirlpool |
$5,910.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$855.65
|
| Rate for Payer: Mclaren Commercial |
$5,319.13
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$469.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,023.62
|
| Rate for Payer: Nomi Health Commercial |
$4,846.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,432.60
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$941.22
|
| Rate for Payer: PHP Medicaid |
$458.63
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,017.54
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Narrow Network |
$814.04
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,200.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,326.26
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP DNSP |
$855.65
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,910.14
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4,432.60 |
| Max. Negotiated Rate |
$5,910.14 |
| Rate for Payer: Aetna Commercial |
$5,319.13
|
| Rate for Payer: ASR ASR |
$5,732.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,853.41
|
| Rate for Payer: BCN Commercial |
$4,853.41
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cofinity Commercial |
$5,555.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,728.11
|
| Rate for Payer: Healthscope Commercial |
$5,732.84
|
| Rate for Payer: Healthscope Whirlpool |
$5,910.14
|
| Rate for Payer: Mclaren Commercial |
$5,319.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,023.62
|
| Rate for Payer: Nomi Health Commercial |
$4,846.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,432.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,200.92
|
|
