|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.23 |
| Max. Negotiated Rate |
$97.28 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: ASR ASR |
$94.36
|
| Rate for Payer: ASR Commercial |
$94.36
|
| Rate for Payer: BCBS Trust/PPO |
$79.27
|
| Rate for Payer: BCN Commercial |
$75.42
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$91.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Healthscope Commercial |
$97.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.36
|
| Rate for Payer: Mclaren Commercial |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: Nomi Health Commercial |
$79.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.61
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$97.28 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$94.36
|
| Rate for Payer: ASR Commercial |
$94.36
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$79.66
|
| Rate for Payer: BCN Commercial |
$75.42
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$91.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$97.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$87.55
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: Nomi Health Commercial |
$79.77
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.24
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$68.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP DNSP |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: ASR Commercial |
$89.82
|
| Rate for Payer: BCBS Trust/PPO |
$75.46
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$92.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.82
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: ASR Commercial |
$89.82
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.83
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$92.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.14
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$64.91
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP DNSP |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,262.58 |
| Max. Negotiated Rate |
$1,942.43 |
| Rate for Payer: Aetna Commercial |
$1,748.19
|
| Rate for Payer: ASR ASR |
$1,884.16
|
| Rate for Payer: ASR Commercial |
$1,884.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.89
|
| Rate for Payer: BCN Commercial |
$1,505.97
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,825.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Healthscope Commercial |
$1,942.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.16
|
| Rate for Payer: Mclaren Commercial |
$1,748.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: Nomi Health Commercial |
$1,592.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.34
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$2,077.91 |
| Rate for Payer: Aetna Commercial |
$1,748.19
|
| Rate for Payer: Aetna Medicare |
$1,340.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,675.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,675.74
|
| Rate for Payer: ASR ASR |
$1,884.16
|
| Rate for Payer: ASR Commercial |
$1,884.16
|
| Rate for Payer: BCBS Complete |
$754.48
|
| Rate for Payer: BCBS MAPPO |
$1,340.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,590.66
|
| Rate for Payer: BCN Commercial |
$1,505.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,340.59
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,825.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,340.59
|
| Rate for Payer: Healthscope Commercial |
$1,942.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,340.59
|
| Rate for Payer: Mclaren Commercial |
$1,748.19
|
| Rate for Payer: Mclaren Medicaid |
$718.56
|
| Rate for Payer: Mclaren Medicare |
$1,340.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,407.62
|
| Rate for Payer: Meridian Medicaid |
$754.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,541.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: Nomi Health Commercial |
$1,592.79
|
| Rate for Payer: PACE Medicare |
$1,273.56
|
| Rate for Payer: PACE SWMI |
$1,340.59
|
| Rate for Payer: PHP Commercial |
$1,474.65
|
| Rate for Payer: PHP Medicaid |
$718.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,340.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.96
|
| Rate for Payer: Priority Health Medicare |
$1,340.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,361.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,340.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,340.59
|
| Rate for Payer: UHC Exchange |
$2,077.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,340.59
|
| Rate for Payer: UHCCP DNSP |
$1,340.59
|
| Rate for Payer: UHCCP Medicaid |
$718.56
|
| Rate for Payer: VA VA |
$1,340.59
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$255.81 |
| Max. Negotiated Rate |
$2,204.30 |
| Rate for Payer: Aetna Commercial |
$1,983.87
|
| Rate for Payer: Aetna Medicare |
$477.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.56
|
| Rate for Payer: ASR ASR |
$2,138.17
|
| Rate for Payer: ASR Commercial |
$2,138.17
|
| Rate for Payer: BCBS Complete |
$268.60
|
| Rate for Payer: BCBS MAPPO |
$477.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.10
|
| Rate for Payer: BCN Commercial |
$1,708.99
|
| Rate for Payer: BCN Medicare Advantage |
$477.25
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$2,072.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.25
|
| Rate for Payer: Healthscope Commercial |
$2,204.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$477.25
|
| Rate for Payer: Mclaren Commercial |
$1,983.87
|
| Rate for Payer: Mclaren Medicaid |
$255.81
|
| Rate for Payer: Mclaren Medicare |
$477.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.11
|
| Rate for Payer: Meridian Medicaid |
$268.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.66
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: PACE Medicare |
$453.39
|
| Rate for Payer: PACE SWMI |
$477.25
|
| Rate for Payer: PHP Commercial |
$524.98
|
| Rate for Payer: PHP Medicaid |
$255.81
|
| Rate for Payer: PHP Medicare Advantage |
$477.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$872.92
|
| Rate for Payer: Priority Health Medicare |
$477.25
|
| Rate for Payer: Priority Health Narrow Network |
$698.34
|
| Rate for Payer: Railroad Medicare Medicare |
$477.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.25
|
| Rate for Payer: UHC Exchange |
$739.74
|
| Rate for Payer: UHC Medicare Advantage |
$477.25
|
| Rate for Payer: UHCCP DNSP |
$477.25
|
| Rate for Payer: UHCCP Medicaid |
$255.81
|
| Rate for Payer: VA VA |
$477.25
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,432.80 |
| Max. Negotiated Rate |
$2,204.30 |
| Rate for Payer: Aetna Commercial |
$1,983.87
|
| Rate for Payer: ASR ASR |
$2,138.17
|
| Rate for Payer: ASR Commercial |
$2,138.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.28
|
| Rate for Payer: BCN Commercial |
$1,708.99
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$2,072.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Healthscope Commercial |
$2,204.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.17
|
| Rate for Payer: Mclaren Commercial |
$1,983.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.66
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.78
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$354.83 |
| Max. Negotiated Rate |
$2,886.67 |
| Rate for Payer: Aetna Commercial |
$2,598.00
|
| Rate for Payer: Aetna Medicare |
$662.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$827.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$827.50
|
| Rate for Payer: ASR ASR |
$2,800.07
|
| Rate for Payer: ASR Commercial |
$2,800.07
|
| Rate for Payer: BCBS Complete |
$372.57
|
| Rate for Payer: BCBS MAPPO |
$662.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,363.89
|
| Rate for Payer: BCN Commercial |
$2,238.04
|
| Rate for Payer: BCN Medicare Advantage |
$662.00
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,713.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.00
|
| Rate for Payer: Healthscope Commercial |
$2,886.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,800.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$662.00
|
| Rate for Payer: Mclaren Commercial |
$2,598.00
|
| Rate for Payer: Mclaren Medicaid |
$354.83
|
| Rate for Payer: Mclaren Medicare |
$662.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.10
|
| Rate for Payer: Meridian Medicaid |
$372.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$761.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: PACE Medicare |
$628.90
|
| Rate for Payer: PACE SWMI |
$662.00
|
| Rate for Payer: PHP Commercial |
$728.20
|
| Rate for Payer: PHP Medicaid |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.49
|
| Rate for Payer: Priority Health Medicare |
$662.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,151.59
|
| Rate for Payer: Railroad Medicare Medicare |
$662.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,540.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.00
|
| Rate for Payer: UHC Exchange |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$662.00
|
| Rate for Payer: UHCCP DNSP |
$662.00
|
| Rate for Payer: UHCCP Medicaid |
$354.83
|
| Rate for Payer: VA VA |
$662.00
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,876.34 |
| Max. Negotiated Rate |
$2,886.67 |
| Rate for Payer: Aetna Commercial |
$2,598.00
|
| Rate for Payer: ASR ASR |
$2,800.07
|
| Rate for Payer: ASR Commercial |
$2,800.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,352.35
|
| Rate for Payer: BCN Commercial |
$2,238.04
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,713.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Healthscope Commercial |
$2,886.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,800.07
|
| Rate for Payer: Mclaren Commercial |
$2,598.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,540.27
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$874.41 |
| Max. Negotiated Rate |
$1,345.24 |
| Rate for Payer: Aetna Commercial |
$1,210.72
|
| Rate for Payer: ASR ASR |
$1,304.88
|
| Rate for Payer: ASR Commercial |
$1,304.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.24
|
| Rate for Payer: BCN Commercial |
$1,042.96
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,264.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Healthscope Commercial |
$1,345.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,304.88
|
| Rate for Payer: Mclaren Commercial |
$1,210.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: Nomi Health Commercial |
$1,103.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,183.81
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$354.83 |
| Max. Negotiated Rate |
$1,439.49 |
| Rate for Payer: Aetna Commercial |
$1,210.72
|
| Rate for Payer: Aetna Medicare |
$662.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$827.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$827.50
|
| Rate for Payer: ASR ASR |
$1,304.88
|
| Rate for Payer: ASR Commercial |
$1,304.88
|
| Rate for Payer: BCBS Complete |
$372.57
|
| Rate for Payer: BCBS MAPPO |
$662.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.62
|
| Rate for Payer: BCN Commercial |
$1,042.96
|
| Rate for Payer: BCN Medicare Advantage |
$662.00
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,264.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.00
|
| Rate for Payer: Healthscope Commercial |
$1,345.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,304.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$662.00
|
| Rate for Payer: Mclaren Commercial |
$1,210.72
|
| Rate for Payer: Mclaren Medicaid |
$354.83
|
| Rate for Payer: Mclaren Medicare |
$662.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.10
|
| Rate for Payer: Meridian Medicaid |
$372.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$761.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: Nomi Health Commercial |
$1,103.10
|
| Rate for Payer: PACE Medicare |
$628.90
|
| Rate for Payer: PACE SWMI |
$662.00
|
| Rate for Payer: PHP Commercial |
$728.20
|
| Rate for Payer: PHP Medicaid |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.49
|
| Rate for Payer: Priority Health Medicare |
$662.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,151.59
|
| Rate for Payer: Railroad Medicare Medicare |
$662.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,183.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.00
|
| Rate for Payer: UHC Exchange |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$662.00
|
| Rate for Payer: UHCCP DNSP |
$662.00
|
| Rate for Payer: UHCCP Medicaid |
$354.83
|
| Rate for Payer: VA VA |
$662.00
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.06 |
| Max. Negotiated Rate |
$295.47 |
| Rate for Payer: Aetna Commercial |
$265.92
|
| Rate for Payer: ASR ASR |
$286.61
|
| Rate for Payer: ASR Commercial |
$286.61
|
| Rate for Payer: BCBS Trust/PPO |
$240.78
|
| Rate for Payer: BCN Commercial |
$229.08
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$277.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Healthscope Commercial |
$295.47
|
| Rate for Payer: Healthscope Whirlpool |
$286.61
|
| Rate for Payer: Mclaren Commercial |
$265.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: Nomi Health Commercial |
$242.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.01
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.19 |
| Max. Negotiated Rate |
$295.47 |
| Rate for Payer: Aetna Commercial |
$265.92
|
| Rate for Payer: Aetna Medicare |
$147.74
|
| Rate for Payer: ASR ASR |
$286.61
|
| Rate for Payer: ASR Commercial |
$286.61
|
| Rate for Payer: BCBS Complete |
$118.19
|
| Rate for Payer: BCBS Trust/PPO |
$241.96
|
| Rate for Payer: BCN Commercial |
$229.08
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$277.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Healthscope Commercial |
$295.47
|
| Rate for Payer: Healthscope Whirlpool |
$286.61
|
| Rate for Payer: Mclaren Commercial |
$265.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: Nomi Health Commercial |
$242.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.99
|
| Rate for Payer: Priority Health Narrow Network |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.01
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$24.51 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$24.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$22.06
|
| Rate for Payer: Mclaren Medicaid |
$8.03
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.48
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$17.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.23
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: UHCCP DNSP |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$8.03
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$24.51 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$24.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Mclaren Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.57
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$24.51 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$24.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$22.06
|
| Rate for Payer: Mclaren Medicaid |
$8.03
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.48
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$17.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.23
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: UHCCP DNSP |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$8.03
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$24.51 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$24.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Mclaren Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.57
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$8.07
|
| Rate for Payer: ASR Commercial |
$8.07
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.81
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Healthscope Whirlpool |
$8.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$7.49
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.29
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$5.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: ASR ASR |
$8.07
|
| Rate for Payer: ASR Commercial |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$6.78
|
| Rate for Payer: BCN Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Healthscope Whirlpool |
$8.07
|
| Rate for Payer: Mclaren Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.32
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.38
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$14.70
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$148.78
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.71 |
| Max. Negotiated Rate |
$148.78 |
| Rate for Payer: Aetna Commercial |
$133.90
|
| Rate for Payer: ASR ASR |
$144.32
|
| Rate for Payer: ASR Commercial |
$144.32
|
| Rate for Payer: BCBS Trust/PPO |
$121.24
|
| Rate for Payer: BCN Commercial |
$115.35
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cofinity Commercial |
$139.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.02
|
| Rate for Payer: Healthscope Commercial |
$148.78
|
| Rate for Payer: Healthscope Whirlpool |
$144.32
|
| Rate for Payer: Mclaren Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.46
|
| Rate for Payer: Nomi Health Commercial |
$122.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.93
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$148.78
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$148.78 |
| Rate for Payer: Aetna Commercial |
$133.90
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: ASR ASR |
$144.32
|
| Rate for Payer: ASR Commercial |
$144.32
|
| Rate for Payer: BCBS Complete |
$59.51
|
| Rate for Payer: BCBS Trust/PPO |
$121.84
|
| Rate for Payer: BCN Commercial |
$115.35
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cofinity Commercial |
$139.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.02
|
| Rate for Payer: Healthscope Commercial |
$148.78
|
| Rate for Payer: Healthscope Whirlpool |
$144.32
|
| Rate for Payer: Mclaren Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.46
|
| Rate for Payer: Nomi Health Commercial |
$122.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.48
|
| Rate for Payer: Priority Health Narrow Network |
$106.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.93
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
