|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
OP
|
$54.10
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$52.48
|
| Rate for Payer: ASR Commercial |
$52.48
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$44.30
|
| Rate for Payer: BCN Commercial |
$41.94
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$50.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Healthscope Whirlpool |
$52.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.07
|
| Rate for Payer: Mclaren Commercial |
$48.69
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicaid |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.40
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$37.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.07
|
| Rate for Payer: UHCCP DNSP |
$16.07
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
IP
|
$54.10
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: ASR ASR |
$52.48
|
| Rate for Payer: ASR Commercial |
$52.48
|
| Rate for Payer: BCBS Trust/PPO |
$44.09
|
| Rate for Payer: BCN Commercial |
$41.94
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$50.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Healthscope Whirlpool |
$52.48
|
| Rate for Payer: Mclaren Commercial |
$48.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.61
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
OP
|
$282.13
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$282.13 |
| Rate for Payer: Aetna Commercial |
$253.92
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$273.67
|
| Rate for Payer: ASR Commercial |
$273.67
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$231.04
|
| Rate for Payer: BCN Commercial |
$218.74
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cofinity Commercial |
$265.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$282.13
|
| Rate for Payer: Healthscope Whirlpool |
$273.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$253.92
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.81
|
| Rate for Payer: Nomi Health Commercial |
$231.35
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.20
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$197.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
IP
|
$282.13
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$183.38 |
| Max. Negotiated Rate |
$282.13 |
| Rate for Payer: Aetna Commercial |
$253.92
|
| Rate for Payer: ASR ASR |
$273.67
|
| Rate for Payer: ASR Commercial |
$273.67
|
| Rate for Payer: BCBS Trust/PPO |
$229.91
|
| Rate for Payer: BCN Commercial |
$218.74
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cofinity Commercial |
$265.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.70
|
| Rate for Payer: Healthscope Commercial |
$282.13
|
| Rate for Payer: Healthscope Whirlpool |
$273.67
|
| Rate for Payer: Mclaren Commercial |
$253.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.81
|
| Rate for Payer: Nomi Health Commercial |
$231.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.27
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$210.12 |
| Rate for Payer: Aetna Commercial |
$189.11
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$203.82
|
| Rate for Payer: ASR Commercial |
$203.82
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$172.07
|
| Rate for Payer: BCN Commercial |
$162.91
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$197.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$210.12
|
| Rate for Payer: Healthscope Whirlpool |
$203.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$189.11
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.11
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$147.29
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$210.12 |
| Rate for Payer: Aetna Commercial |
$189.11
|
| Rate for Payer: ASR ASR |
$203.82
|
| Rate for Payer: ASR Commercial |
$203.82
|
| Rate for Payer: BCBS Trust/PPO |
$171.23
|
| Rate for Payer: BCN Commercial |
$162.91
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$197.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$210.12
|
| Rate for Payer: Healthscope Whirlpool |
$203.82
|
| Rate for Payer: Mclaren Commercial |
$189.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.91
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$210.12 |
| Rate for Payer: Aetna Commercial |
$189.11
|
| Rate for Payer: ASR ASR |
$203.82
|
| Rate for Payer: ASR Commercial |
$203.82
|
| Rate for Payer: BCBS Trust/PPO |
$171.23
|
| Rate for Payer: BCN Commercial |
$162.91
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$197.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$210.12
|
| Rate for Payer: Healthscope Whirlpool |
$203.82
|
| Rate for Payer: Mclaren Commercial |
$189.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.91
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$210.12 |
| Rate for Payer: Aetna Commercial |
$189.11
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$203.82
|
| Rate for Payer: ASR Commercial |
$203.82
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$172.07
|
| Rate for Payer: BCN Commercial |
$162.91
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$197.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$210.12
|
| Rate for Payer: Healthscope Whirlpool |
$203.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$189.11
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.11
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$147.29
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$4.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.92
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.74
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicare |
$4.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.98
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$4.50
|
| Rate for Payer: PACE SWMI |
$4.74
|
| Rate for Payer: PHP Commercial |
$5.21
|
| Rate for Payer: PHP Medicaid |
$2.54
|
| Rate for Payer: PHP Medicare Advantage |
$4.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$4.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.74
|
| Rate for Payer: UHC Exchange |
$7.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.74
|
| Rate for Payer: UHCCP DNSP |
$4.74
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: VA VA |
$4.74
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$52.94 |
| Rate for Payer: Aetna Commercial |
$47.65
|
| Rate for Payer: ASR ASR |
$51.35
|
| Rate for Payer: ASR Commercial |
$51.35
|
| Rate for Payer: BCBS Trust/PPO |
$43.14
|
| Rate for Payer: BCN Commercial |
$41.04
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Healthscope Commercial |
$52.94
|
| Rate for Payer: Healthscope Whirlpool |
$51.35
|
| Rate for Payer: Mclaren Commercial |
$47.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: Nomi Health Commercial |
$43.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.59
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$52.94 |
| Rate for Payer: Aetna Commercial |
$47.65
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.22
|
| Rate for Payer: ASR ASR |
$51.35
|
| Rate for Payer: ASR Commercial |
$51.35
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$43.35
|
| Rate for Payer: BCN Commercial |
$41.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$52.94
|
| Rate for Payer: Healthscope Whirlpool |
$51.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.78
|
| Rate for Payer: Mclaren Commercial |
$47.65
|
| Rate for Payer: Mclaren Medicaid |
$3.10
|
| Rate for Payer: Mclaren Medicare |
$5.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: Nomi Health Commercial |
$43.41
|
| Rate for Payer: PACE Medicare |
$5.49
|
| Rate for Payer: PACE SWMI |
$5.78
|
| Rate for Payer: PHP Commercial |
$6.36
|
| Rate for Payer: PHP Medicaid |
$3.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.39
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health Narrow Network |
$37.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.78
|
| Rate for Payer: UHC Exchange |
$8.96
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
| Rate for Payer: UHCCP DNSP |
$5.78
|
| Rate for Payer: UHCCP Medicaid |
$3.10
|
| Rate for Payer: VA VA |
$5.78
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: ASR Commercial |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.31
|
| Rate for Payer: BCN Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: ASR Commercial |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$76.68
|
| Rate for Payer: BCN Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC PICC INTRODUCER
|
Facility
|
OP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$88.49
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: ASR ASR |
$95.37
|
| Rate for Payer: ASR Commercial |
$95.37
|
| Rate for Payer: BCBS Complete |
$39.33
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$76.23
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$92.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Healthscope Whirlpool |
$95.37
|
| Rate for Payer: Mclaren Commercial |
$88.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.15
|
| Rate for Payer: Priority Health Narrow Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.52
|
|
|
HC PICC INTRODUCER
|
Facility
|
IP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.91 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$88.49
|
| Rate for Payer: ASR ASR |
$95.37
|
| Rate for Payer: ASR Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$80.12
|
| Rate for Payer: BCN Commercial |
$76.23
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$92.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Healthscope Whirlpool |
$95.37
|
| Rate for Payer: Mclaren Commercial |
$88.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.52
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
IP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$112.59 |
| Rate for Payer: Aetna Commercial |
$101.33
|
| Rate for Payer: ASR ASR |
$109.21
|
| Rate for Payer: ASR Commercial |
$109.21
|
| Rate for Payer: BCBS Trust/PPO |
$91.75
|
| Rate for Payer: BCN Commercial |
$87.29
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$105.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Healthscope Commercial |
$112.59
|
| Rate for Payer: Healthscope Whirlpool |
$109.21
|
| Rate for Payer: Mclaren Commercial |
$101.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.08
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
OP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$112.59 |
| Rate for Payer: Aetna Commercial |
$101.33
|
| Rate for Payer: Aetna Medicare |
$56.30
|
| Rate for Payer: ASR ASR |
$109.21
|
| Rate for Payer: ASR Commercial |
$109.21
|
| Rate for Payer: BCBS Complete |
$45.04
|
| Rate for Payer: BCBS Trust/PPO |
$92.20
|
| Rate for Payer: BCN Commercial |
$87.29
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$105.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Healthscope Commercial |
$112.59
|
| Rate for Payer: Healthscope Whirlpool |
$109.21
|
| Rate for Payer: Mclaren Commercial |
$101.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.65
|
| Rate for Payer: Priority Health Narrow Network |
$78.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.08
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: ASR ASR |
$194.91
|
| Rate for Payer: ASR Commercial |
$194.91
|
| Rate for Payer: BCBS Trust/PPO |
$163.75
|
| Rate for Payer: BCN Commercial |
$155.79
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$188.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$200.94
|
| Rate for Payer: Healthscope Whirlpool |
$194.91
|
| Rate for Payer: Mclaren Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.83
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$80.38 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: Aetna Medicare |
$100.47
|
| Rate for Payer: ASR ASR |
$194.91
|
| Rate for Payer: ASR Commercial |
$194.91
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS Trust/PPO |
$164.55
|
| Rate for Payer: BCN Commercial |
$155.79
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$188.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$200.94
|
| Rate for Payer: Healthscope Whirlpool |
$194.91
|
| Rate for Payer: Mclaren Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.06
|
| Rate for Payer: Priority Health Narrow Network |
$140.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.83
|
|
|
HC PICU OR PED CRITICAL CARE R&B
|
Facility
|
IP
|
$7,801.90
|
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,071.23 |
| Max. Negotiated Rate |
$7,801.90 |
| Rate for Payer: Aetna Commercial |
$7,021.71
|
| Rate for Payer: ASR ASR |
$7,567.84
|
| Rate for Payer: ASR Commercial |
$7,567.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,357.77
|
| Rate for Payer: BCN Commercial |
$6,048.81
|
| Rate for Payer: Cash Price |
$6,241.52
|
| Rate for Payer: Cofinity Commercial |
$7,333.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,241.52
|
| Rate for Payer: Healthscope Commercial |
$7,801.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,567.84
|
| Rate for Payer: Mclaren Commercial |
$7,021.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,631.61
|
| Rate for Payer: Nomi Health Commercial |
$6,397.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,071.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,865.67
|
|
|
HC PICU OR PED INTERMEDIATE CARE R&B
|
Facility
|
IP
|
$6,510.25
|
|
| Hospital Charge Code |
20600002
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,231.66 |
| Max. Negotiated Rate |
$6,510.25 |
| Rate for Payer: Aetna Commercial |
$5,859.23
|
| Rate for Payer: ASR ASR |
$6,314.94
|
| Rate for Payer: ASR Commercial |
$6,314.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,305.20
|
| Rate for Payer: BCN Commercial |
$5,047.40
|
| Rate for Payer: Cash Price |
$5,208.20
|
| Rate for Payer: Cofinity Commercial |
$6,119.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,208.20
|
| Rate for Payer: Healthscope Commercial |
$6,510.25
|
| Rate for Payer: Healthscope Whirlpool |
$6,314.94
|
| Rate for Payer: Mclaren Commercial |
$5,859.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,533.71
|
| Rate for Payer: Nomi Health Commercial |
$5,338.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,729.02
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
IP
|
$315.06
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$315.06 |
| Rate for Payer: Aetna Commercial |
$283.55
|
| Rate for Payer: ASR ASR |
$305.61
|
| Rate for Payer: ASR Commercial |
$305.61
|
| Rate for Payer: BCBS Trust/PPO |
$256.74
|
| Rate for Payer: BCN Commercial |
$244.27
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$296.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$315.06
|
| Rate for Payer: Healthscope Whirlpool |
$305.61
|
| Rate for Payer: Mclaren Commercial |
$283.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.25
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
OP
|
$315.06
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$126.02 |
| Max. Negotiated Rate |
$315.06 |
| Rate for Payer: Aetna Commercial |
$283.55
|
| Rate for Payer: Aetna Medicare |
$157.53
|
| Rate for Payer: ASR ASR |
$305.61
|
| Rate for Payer: ASR Commercial |
$305.61
|
| Rate for Payer: BCBS Complete |
$126.02
|
| Rate for Payer: BCBS Trust/PPO |
$258.00
|
| Rate for Payer: BCN Commercial |
$244.27
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$296.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$315.06
|
| Rate for Payer: Healthscope Whirlpool |
$305.61
|
| Rate for Payer: Mclaren Commercial |
$283.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.06
|
| Rate for Payer: Priority Health Narrow Network |
$220.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.25
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
IP
|
$1,560.60
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,014.39 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna Commercial |
$1,404.54
|
| Rate for Payer: ASR ASR |
$1,513.78
|
| Rate for Payer: ASR Commercial |
$1,513.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.73
|
| Rate for Payer: BCN Commercial |
$1,209.93
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cofinity Commercial |
$1,466.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.48
|
| Rate for Payer: Healthscope Commercial |
$1,560.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,513.78
|
| Rate for Payer: Mclaren Commercial |
$1,404.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.51
|
| Rate for Payer: Nomi Health Commercial |
$1,279.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.33
|
|
