|
HC PV JAK2V617F
|
Facility
|
OP
|
$336.10
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$336.10 |
| Rate for Payer: Aetna Commercial |
$302.49
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$326.02
|
| Rate for Payer: BCBS Complete |
$50.34
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$277.11
|
| Rate for Payer: BCN Commercial |
$277.11
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cofinity Commercial |
$315.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$326.02
|
| Rate for Payer: Healthscope Whirlpool |
$336.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$302.49
|
| Rate for Payer: Mclaren Medicaid |
$91.66
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$50.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.69
|
| Rate for Payer: Nomi Health Commercial |
$275.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.07
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.92
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$52.74
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91.66
|
| Rate for Payer: UHC Exchange |
$142.07
|
| Rate for Payer: UHC Medicaid |
$47.94
|
| Rate for Payer: UHCCP DNSP |
$91.66
|
| Rate for Payer: UHCCP Medicaid |
$47.94
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$96.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: ASR ASR |
$93.86
|
| Rate for Payer: BCBS Trust/PPO |
$79.46
|
| Rate for Payer: BCN Commercial |
$79.46
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$90.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Healthscope Commercial |
$93.86
|
| Rate for Payer: Healthscope Whirlpool |
$96.76
|
| Rate for Payer: Mclaren Commercial |
$87.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$79.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.15
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$96.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$115.01 |
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: ASR ASR |
$93.86
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$79.78
|
| Rate for Payer: BCN Commercial |
$79.78
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$90.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$93.86
|
| Rate for Payer: Healthscope Whirlpool |
$96.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$87.08
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$79.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: PHP Medicaid |
$5.06
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.01
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow Network |
$92.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.44
|
| Rate for Payer: UHC Exchange |
$14.63
|
| Rate for Payer: UHC Medicaid |
$4.94
|
| Rate for Payer: UHCCP DNSP |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$4.94
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$136.79 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.10
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| 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 |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.48
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.93
|
| 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 |
$13.76
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Medicaid |
$7.76
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.79
|
| Rate for Payer: Priority Health Medicare |
$14.48
|
| Rate for Payer: Priority Health Narrow Network |
$109.44
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.48
|
| Rate for Payer: UHC Exchange |
$22.44
|
| Rate for Payer: UHC Medicaid |
$7.57
|
| Rate for Payer: UHCCP DNSP |
$14.48
|
| Rate for Payer: UHCCP Medicaid |
$7.57
|
| Rate for Payer: VA VA |
$14.48
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
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 Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
IP
|
$95.77
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.83 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: ASR ASR |
$92.90
|
| Rate for Payer: BCBS Trust/PPO |
$78.65
|
| Rate for Payer: BCN Commercial |
$78.65
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cofinity Commercial |
$90.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.62
|
| Rate for Payer: Healthscope Commercial |
$92.90
|
| Rate for Payer: Healthscope Whirlpool |
$95.77
|
| Rate for Payer: Mclaren Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.28
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
OP
|
$95.77
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Medicare |
$12.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
| Rate for Payer: ASR ASR |
$92.90
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS MAPPO |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$78.96
|
| Rate for Payer: BCN Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cofinity Commercial |
$90.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$92.90
|
| Rate for Payer: Healthscope Whirlpool |
$95.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.12
|
| Rate for Payer: Mclaren Commercial |
$86.19
|
| Rate for Payer: Mclaren Medicaid |
$12.12
|
| Rate for Payer: Mclaren Medicare |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.73
|
| Rate for Payer: Meridian Medicaid |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.83
|
| Rate for Payer: PACE Medicare |
$11.51
|
| Rate for Payer: PACE SWMI |
$12.12
|
| Rate for Payer: PHP Commercial |
$13.33
|
| Rate for Payer: PHP Medicaid |
$6.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.91
|
| Rate for Payer: Priority Health Medicare |
$12.12
|
| Rate for Payer: Priority Health Narrow Network |
$67.13
|
| Rate for Payer: Railroad Medicare Medicare |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.12
|
| Rate for Payer: UHC Exchange |
$18.79
|
| Rate for Payer: UHC Medicaid |
$6.34
|
| Rate for Payer: UHCCP DNSP |
$12.12
|
| Rate for Payer: UHCCP Medicaid |
$6.34
|
| Rate for Payer: VA VA |
$12.12
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$347.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$347.93 |
| Rate for Payer: Aetna Commercial |
$313.14
|
| Rate for Payer: ASR ASR |
$337.49
|
| Rate for Payer: BCBS Trust/PPO |
$285.72
|
| Rate for Payer: BCN Commercial |
$285.72
|
| Rate for Payer: Cash Price |
$278.34
|
| Rate for Payer: Cofinity Commercial |
$327.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.34
|
| Rate for Payer: Healthscope Commercial |
$337.49
|
| Rate for Payer: Healthscope Whirlpool |
$347.93
|
| Rate for Payer: Mclaren Commercial |
$313.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.74
|
| Rate for Payer: Nomi Health Commercial |
$285.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.18
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$347.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.73 |
| Max. Negotiated Rate |
$347.93 |
| Rate for Payer: Aetna Commercial |
$313.14
|
| Rate for Payer: Aetna Medicare |
$128.73
|
| Rate for Payer: ASR ASR |
$337.49
|
| Rate for Payer: BCBS Complete |
$139.17
|
| Rate for Payer: BCBS Trust/PPO |
$286.87
|
| Rate for Payer: BCN Commercial |
$286.87
|
| Rate for Payer: Cash Price |
$278.34
|
| Rate for Payer: Cofinity Commercial |
$327.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.34
|
| Rate for Payer: Healthscope Commercial |
$337.49
|
| Rate for Payer: Healthscope Whirlpool |
$347.93
|
| Rate for Payer: Mclaren Commercial |
$313.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.74
|
| Rate for Payer: Nomi Health Commercial |
$285.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.86
|
| Rate for Payer: Priority Health Narrow Network |
$243.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.18
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$354.27
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.70 |
| Max. Negotiated Rate |
$354.27 |
| Rate for Payer: Aetna Commercial |
$318.84
|
| Rate for Payer: ASR ASR |
$343.64
|
| Rate for Payer: BCBS Trust/PPO |
$290.93
|
| Rate for Payer: BCN Commercial |
$290.93
|
| Rate for Payer: Cash Price |
$283.42
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.42
|
| Rate for Payer: Healthscope Commercial |
$343.64
|
| Rate for Payer: Healthscope Whirlpool |
$354.27
|
| Rate for Payer: Mclaren Commercial |
$318.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.13
|
| Rate for Payer: Nomi Health Commercial |
$290.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.76
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$354.27
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.08 |
| Max. Negotiated Rate |
$354.27 |
| Rate for Payer: Aetna Commercial |
$318.84
|
| Rate for Payer: Aetna Medicare |
$131.08
|
| Rate for Payer: ASR ASR |
$343.64
|
| Rate for Payer: BCBS Complete |
$141.71
|
| Rate for Payer: BCBS Trust/PPO |
$292.10
|
| Rate for Payer: BCN Commercial |
$292.10
|
| Rate for Payer: Cash Price |
$283.42
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.42
|
| Rate for Payer: Healthscope Commercial |
$343.64
|
| Rate for Payer: Healthscope Whirlpool |
$354.27
|
| Rate for Payer: Mclaren Commercial |
$318.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.13
|
| Rate for Payer: Nomi Health Commercial |
$290.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$310.41
|
| Rate for Payer: Priority Health Narrow Network |
$248.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.76
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$206.09 |
| Max. Negotiated Rate |
$274.79 |
| Rate for Payer: Aetna Commercial |
$247.31
|
| Rate for Payer: ASR ASR |
$266.55
|
| Rate for Payer: BCBS Trust/PPO |
$225.66
|
| Rate for Payer: BCN Commercial |
$225.66
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Commercial |
$258.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Healthscope Commercial |
$266.55
|
| Rate for Payer: Healthscope Whirlpool |
$274.79
|
| Rate for Payer: Mclaren Commercial |
$247.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$225.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.82
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$274.79 |
| Rate for Payer: Aetna Commercial |
$247.31
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$266.55
|
| Rate for Payer: BCBS Complete |
$84.30
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$226.56
|
| Rate for Payer: BCN Commercial |
$226.56
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Commercial |
$258.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$266.55
|
| Rate for Payer: Healthscope Whirlpool |
$274.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$247.31
|
| Rate for Payer: Mclaren Medicaid |
$153.50
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$84.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$225.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$153.50
|
| Rate for Payer: UHC Exchange |
$237.93
|
| Rate for Payer: UHC Medicaid |
$80.28
|
| Rate for Payer: UHCCP DNSP |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$80.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$167.33
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.50 |
| Max. Negotiated Rate |
$167.33 |
| Rate for Payer: Aetna Commercial |
$150.60
|
| Rate for Payer: ASR ASR |
$162.31
|
| Rate for Payer: BCBS Trust/PPO |
$137.41
|
| Rate for Payer: BCN Commercial |
$137.41
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cofinity Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Healthscope Commercial |
$162.31
|
| Rate for Payer: Healthscope Whirlpool |
$167.33
|
| Rate for Payer: Mclaren Commercial |
$150.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.23
|
| Rate for Payer: Nomi Health Commercial |
$137.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.25
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$167.33
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$167.33 |
| Rate for Payer: Aetna Commercial |
$150.60
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: ASR ASR |
$162.31
|
| Rate for Payer: BCBS Complete |
$54.92
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$137.96
|
| Rate for Payer: BCN Commercial |
$137.96
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cofinity Commercial |
$157.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$162.31
|
| Rate for Payer: Healthscope Whirlpool |
$167.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$100.00
|
| Rate for Payer: Mclaren Commercial |
$150.60
|
| Rate for Payer: Mclaren Medicaid |
$100.00
|
| Rate for Payer: Mclaren Medicare |
$100.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: Meridian Medicaid |
$54.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.23
|
| Rate for Payer: Nomi Health Commercial |
$137.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.50
|
| Rate for Payer: PACE Medicare |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$110.00
|
| Rate for Payer: PHP Medicaid |
$53.60
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.61
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health Narrow Network |
$117.30
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.00
|
| Rate for Payer: UHC Exchange |
$155.00
|
| Rate for Payer: UHC Medicaid |
$52.30
|
| Rate for Payer: UHCCP DNSP |
$100.00
|
| Rate for Payer: UHCCP Medicaid |
$52.30
|
| Rate for Payer: VA VA |
$100.00
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$119.71
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$119.71 |
| Rate for Payer: Aetna Commercial |
$107.74
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.47
|
| Rate for Payer: ASR ASR |
$116.12
|
| Rate for Payer: BCBS Complete |
$34.04
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$98.70
|
| Rate for Payer: BCN Commercial |
$98.70
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Healthscope Whirlpool |
$119.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$61.98
|
| Rate for Payer: Mclaren Commercial |
$107.74
|
| Rate for Payer: Mclaren Medicaid |
$61.98
|
| Rate for Payer: Mclaren Medicare |
$61.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: Meridian Medicaid |
$34.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Nomi Health Commercial |
$98.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PACE Medicare |
$58.88
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Commercial |
$68.18
|
| Rate for Payer: PHP Medicaid |
$33.22
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$104.89
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health Narrow Network |
$83.92
|
| Rate for Payer: Railroad Medicare Medicare |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.98
|
| Rate for Payer: UHC Exchange |
$96.07
|
| Rate for Payer: UHC Medicaid |
$32.42
|
| Rate for Payer: UHCCP DNSP |
$61.98
|
| Rate for Payer: UHCCP Medicaid |
$32.42
|
| Rate for Payer: VA VA |
$61.98
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$119.71
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$119.71 |
| Rate for Payer: Aetna Commercial |
$107.74
|
| Rate for Payer: ASR ASR |
$116.12
|
| Rate for Payer: BCBS Trust/PPO |
$98.31
|
| Rate for Payer: BCN Commercial |
$98.31
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.77
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Healthscope Whirlpool |
$119.71
|
| Rate for Payer: Mclaren Commercial |
$107.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Nomi Health Commercial |
$98.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.34
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$64.17 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: Aetna Medicare |
$14.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$48.04
|
| Rate for Payer: BCN Commercial |
$48.04
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.60
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$14.60
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: Meridian Medicaid |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Medicaid |
$7.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$64.17
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$51.33
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.60
|
| Rate for Payer: UHC Exchange |
$22.63
|
| Rate for Payer: UHC Medicaid |
$7.64
|
| Rate for Payer: UHCCP DNSP |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$7.64
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Trust/PPO |
$47.84
|
| Rate for Payer: BCN Commercial |
$47.84
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,057.98
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$793.49 |
| Max. Negotiated Rate |
$1,057.98 |
| Rate for Payer: Aetna Commercial |
$952.18
|
| Rate for Payer: ASR ASR |
$1,026.24
|
| Rate for Payer: BCBS Trust/PPO |
$868.81
|
| Rate for Payer: BCN Commercial |
$868.81
|
| Rate for Payer: Cash Price |
$846.38
|
| Rate for Payer: Cofinity Commercial |
$994.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.38
|
| Rate for Payer: Healthscope Commercial |
$1,026.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,057.98
|
| Rate for Payer: Mclaren Commercial |
$952.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.28
|
| Rate for Payer: Nomi Health Commercial |
$867.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$931.02
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,057.98
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$1,057.98 |
| Rate for Payer: Aetna Commercial |
$952.18
|
| Rate for Payer: Aetna Medicare |
$315.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.02
|
| Rate for Payer: ASR ASR |
$1,026.24
|
| Rate for Payer: BCBS Complete |
$173.12
|
| Rate for Payer: BCBS MAPPO |
$315.22
|
| Rate for Payer: BCBS Trust/PPO |
$872.30
|
| Rate for Payer: BCN Commercial |
$872.30
|
| Rate for Payer: BCN Medicare Advantage |
$315.22
|
| Rate for Payer: Cash Price |
$846.38
|
| Rate for Payer: Cash Price |
$846.38
|
| Rate for Payer: Cofinity Commercial |
$994.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.22
|
| Rate for Payer: Healthscope Commercial |
$1,026.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,057.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$315.22
|
| Rate for Payer: Mclaren Commercial |
$952.18
|
| Rate for Payer: Mclaren Medicaid |
$315.22
|
| Rate for Payer: Mclaren Medicare |
$315.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.98
|
| Rate for Payer: Meridian Medicaid |
$173.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$346.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.28
|
| Rate for Payer: Nomi Health Commercial |
$867.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.49
|
| Rate for Payer: PACE Medicare |
$299.46
|
| Rate for Payer: PACE SWMI |
$315.22
|
| Rate for Payer: PHP Commercial |
$346.74
|
| Rate for Payer: PHP Medicaid |
$168.96
|
| Rate for Payer: PHP Medicare Advantage |
$315.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$495.45
|
| Rate for Payer: Priority Health Medicare |
$315.22
|
| Rate for Payer: Priority Health Narrow Network |
$396.36
|
| Rate for Payer: Railroad Medicare Medicare |
$315.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$931.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$315.22
|
| Rate for Payer: UHC Exchange |
$488.59
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP DNSP |
$315.22
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
| Rate for Payer: VA VA |
$315.22
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$192.39
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$192.39 |
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Aetna Medicare |
$71.18
|
| Rate for Payer: ASR ASR |
$186.62
|
| Rate for Payer: BCBS Complete |
$76.96
|
| Rate for Payer: BCBS Trust/PPO |
$158.63
|
| Rate for Payer: BCN Commercial |
$158.63
|
| Rate for Payer: Cash Price |
$153.91
|
| Rate for Payer: Cofinity Commercial |
$180.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.91
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Healthscope Whirlpool |
$192.39
|
| Rate for Payer: Mclaren Commercial |
$173.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.53
|
| Rate for Payer: Nomi Health Commercial |
$157.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.57
|
| Rate for Payer: Priority Health Narrow Network |
$134.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.30
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$192.39
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.29 |
| Max. Negotiated Rate |
$192.39 |
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: ASR ASR |
$186.62
|
| Rate for Payer: BCBS Trust/PPO |
$157.99
|
| Rate for Payer: BCN Commercial |
$157.99
|
| Rate for Payer: Cash Price |
$153.91
|
| Rate for Payer: Cofinity Commercial |
$180.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.91
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Healthscope Whirlpool |
$192.39
|
| Rate for Payer: Mclaren Commercial |
$173.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.53
|
| Rate for Payer: Nomi Health Commercial |
$157.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.30
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$438.28
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$438.28 |
| Rate for Payer: Aetna Commercial |
$394.45
|
| Rate for Payer: Aetna Medicare |
$133.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: ASR ASR |
$425.13
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$361.36
|
| Rate for Payer: BCN Commercial |
$361.36
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$350.62
|
| Rate for Payer: Cash Price |
$350.62
|
| Rate for Payer: Cofinity Commercial |
$411.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$425.13
|
| Rate for Payer: Healthscope Whirlpool |
$438.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$133.93
|
| Rate for Payer: Mclaren Commercial |
$394.45
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$73.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.54
|
| Rate for Payer: Nomi Health Commercial |
$359.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.71
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$147.32
|
| Rate for Payer: PHP Medicaid |
$71.79
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$384.02
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health Narrow Network |
$307.23
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$207.59
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP DNSP |
$133.93
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$438.28
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$328.71 |
| Max. Negotiated Rate |
$438.28 |
| Rate for Payer: Aetna Commercial |
$394.45
|
| Rate for Payer: ASR ASR |
$425.13
|
| Rate for Payer: BCBS Trust/PPO |
$359.92
|
| Rate for Payer: BCN Commercial |
$359.92
|
| Rate for Payer: Cash Price |
$350.62
|
| Rate for Payer: Cofinity Commercial |
$411.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.62
|
| Rate for Payer: Healthscope Commercial |
$425.13
|
| Rate for Payer: Healthscope Whirlpool |
$438.28
|
| Rate for Payer: Mclaren Commercial |
$394.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.54
|
| Rate for Payer: Nomi Health Commercial |
$359.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.69
|
|
