|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,384.58 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: Aetna Medicare |
$893.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: ASR ASR |
$1,127.61
|
| Rate for Payer: ASR Commercial |
$1,127.61
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$951.95
|
| Rate for Payer: BCN Commercial |
$901.27
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$1,092.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$893.28
|
| Rate for Payer: Mclaren Commercial |
$1,046.23
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: Nomi Health Commercial |
$953.23
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$982.61
|
| Rate for Payer: PHP Medicaid |
$478.80
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.56
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$814.90
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$1,384.58
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP DNSP |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: VA VA |
$893.28
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
IP
|
$1,162.48
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.61 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: ASR ASR |
$1,127.61
|
| Rate for Payer: ASR Commercial |
$1,127.61
|
| Rate for Payer: BCBS Trust/PPO |
$947.30
|
| Rate for Payer: BCN Commercial |
$901.27
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$1,092.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.61
|
| Rate for Payer: Mclaren Commercial |
$1,046.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: Nomi Health Commercial |
$953.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.98
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
IP
|
$38.54
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$38.54 |
| Rate for Payer: Aetna Commercial |
$34.69
|
| Rate for Payer: ASR ASR |
$37.38
|
| Rate for Payer: ASR Commercial |
$37.38
|
| Rate for Payer: BCBS Trust/PPO |
$31.41
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.83
|
| Rate for Payer: Healthscope Commercial |
$38.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.38
|
| Rate for Payer: Mclaren Commercial |
$34.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.76
|
| Rate for Payer: Nomi Health Commercial |
$31.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.92
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
OP
|
$38.54
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$34.69
|
| 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 |
$37.38
|
| Rate for Payer: ASR Commercial |
$37.38
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$38.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$34.69
|
| 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 |
$32.76
|
| Rate for Payer: Nomi Health Commercial |
$31.60
|
| 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 |
$25.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.77
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$27.02
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.92
|
| 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 PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
OP
|
$38.54
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$34.69
|
| 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 |
$37.38
|
| Rate for Payer: ASR Commercial |
$37.38
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$38.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$34.69
|
| 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 |
$32.76
|
| Rate for Payer: Nomi Health Commercial |
$31.60
|
| 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 |
$25.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.77
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$27.02
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.92
|
| 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 PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
IP
|
$38.54
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$38.54 |
| Rate for Payer: Aetna Commercial |
$34.69
|
| Rate for Payer: ASR ASR |
$37.38
|
| Rate for Payer: ASR Commercial |
$37.38
|
| Rate for Payer: BCBS Trust/PPO |
$31.41
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.83
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.83
|
| Rate for Payer: Healthscope Commercial |
$38.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.38
|
| Rate for Payer: Mclaren Commercial |
$34.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.76
|
| Rate for Payer: Nomi Health Commercial |
$31.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.92
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
IP
|
$78.51
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$78.51 |
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: ASR ASR |
$76.15
|
| Rate for Payer: ASR Commercial |
$76.15
|
| Rate for Payer: BCBS Trust/PPO |
$63.98
|
| Rate for Payer: BCN Commercial |
$60.87
|
| Rate for Payer: Cash Price |
$62.81
|
| Rate for Payer: Cofinity Commercial |
$73.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.81
|
| Rate for Payer: Healthscope Commercial |
$78.51
|
| Rate for Payer: Healthscope Whirlpool |
$76.15
|
| Rate for Payer: Mclaren Commercial |
$70.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.73
|
| Rate for Payer: Nomi Health Commercial |
$64.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.09
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
OP
|
$78.51
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$78.51 |
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: Aetna Medicare |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.08
|
| Rate for Payer: ASR ASR |
$76.15
|
| Rate for Payer: ASR Commercial |
$76.15
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: BCBS MAPPO |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$64.29
|
| Rate for Payer: BCN Commercial |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.86
|
| Rate for Payer: Cash Price |
$62.81
|
| Rate for Payer: Cash Price |
$62.81
|
| Rate for Payer: Cofinity Commercial |
$73.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$78.51
|
| Rate for Payer: Healthscope Whirlpool |
$76.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.86
|
| Rate for Payer: Mclaren Commercial |
$70.66
|
| Rate for Payer: Mclaren Medicaid |
$11.18
|
| Rate for Payer: Mclaren Medicare |
$20.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.90
|
| Rate for Payer: Meridian Medicaid |
$11.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.73
|
| Rate for Payer: Nomi Health Commercial |
$64.38
|
| Rate for Payer: PACE Medicare |
$19.82
|
| Rate for Payer: PACE SWMI |
$20.86
|
| Rate for Payer: PHP Commercial |
$22.95
|
| Rate for Payer: PHP Medicaid |
$11.18
|
| Rate for Payer: PHP Medicare Advantage |
$20.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.78
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health Narrow Network |
$51.82
|
| Rate for Payer: Railroad Medicare Medicare |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.86
|
| Rate for Payer: UHC Exchange |
$32.33
|
| Rate for Payer: UHC Medicare Advantage |
$20.86
|
| Rate for Payer: UHCCP DNSP |
$20.86
|
| Rate for Payer: UHCCP Medicaid |
$11.18
|
| Rate for Payer: VA VA |
$20.86
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: Aetna Medicare |
$19.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.22
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: ASR Commercial |
$71.65
|
| Rate for Payer: BCBS Complete |
$10.91
|
| Rate for Payer: BCBS MAPPO |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.49
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Medicare Advantage |
$19.38
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.38
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Mclaren Medicaid |
$10.39
|
| Rate for Payer: Mclaren Medicare |
$19.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.35
|
| Rate for Payer: Meridian Medicaid |
$10.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PACE Medicare |
$18.41
|
| Rate for Payer: PACE SWMI |
$19.38
|
| Rate for Payer: PHP Commercial |
$21.32
|
| Rate for Payer: PHP Medicaid |
$10.39
|
| Rate for Payer: PHP Medicare Advantage |
$19.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.73
|
| Rate for Payer: Priority Health Medicare |
$19.38
|
| Rate for Payer: Priority Health Narrow Network |
$100.58
|
| Rate for Payer: Railroad Medicare Medicare |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.38
|
| Rate for Payer: UHC Exchange |
$30.04
|
| Rate for Payer: UHC Medicare Advantage |
$19.38
|
| Rate for Payer: UHCCP DNSP |
$19.38
|
| Rate for Payer: UHCCP Medicaid |
$10.39
|
| Rate for Payer: VA VA |
$19.38
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: ASR Commercial |
$71.65
|
| Rate for Payer: BCBS Trust/PPO |
$60.20
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.65
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
IP
|
$131.61
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.55 |
| Max. Negotiated Rate |
$131.61 |
| Rate for Payer: Aetna Commercial |
$118.45
|
| Rate for Payer: ASR ASR |
$127.66
|
| Rate for Payer: ASR Commercial |
$127.66
|
| Rate for Payer: BCBS Trust/PPO |
$107.25
|
| Rate for Payer: BCN Commercial |
$102.04
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$123.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$131.61
|
| Rate for Payer: Healthscope Whirlpool |
$127.66
|
| Rate for Payer: Mclaren Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.87
|
| Rate for Payer: Nomi Health Commercial |
$107.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.82
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
OP
|
$131.61
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$131.61 |
| Rate for Payer: Aetna Commercial |
$118.45
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: ASR ASR |
$127.66
|
| Rate for Payer: ASR Commercial |
$127.66
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: BCBS Trust/PPO |
$107.78
|
| Rate for Payer: BCN Commercial |
$102.04
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$123.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$131.61
|
| Rate for Payer: Healthscope Whirlpool |
$127.66
|
| Rate for Payer: Mclaren Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.87
|
| Rate for Payer: Nomi Health Commercial |
$107.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.32
|
| Rate for Payer: Priority Health Narrow Network |
$92.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.82
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
OP
|
$29.92
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Aetna Commercial |
$26.93
|
| Rate for Payer: Aetna Medicare |
$14.96
|
| Rate for Payer: ASR ASR |
$29.02
|
| Rate for Payer: ASR Commercial |
$29.02
|
| Rate for Payer: BCBS Complete |
$11.97
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Whirlpool |
$29.02
|
| Rate for Payer: Mclaren Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.43
|
| Rate for Payer: Nomi Health Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.22
|
| Rate for Payer: Priority Health Narrow Network |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.33
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
IP
|
$29.92
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Aetna Commercial |
$26.93
|
| Rate for Payer: ASR ASR |
$29.02
|
| Rate for Payer: ASR Commercial |
$29.02
|
| Rate for Payer: BCBS Trust/PPO |
$24.38
|
| Rate for Payer: BCN Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Whirlpool |
$29.02
|
| Rate for Payer: Mclaren Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.43
|
| Rate for Payer: Nomi Health Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.33
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$26.41
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.44
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$26.41
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.44
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
OP
|
$298.86
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$298.86 |
| Rate for Payer: Aetna Commercial |
$268.97
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$289.89
|
| Rate for Payer: ASR Commercial |
$289.89
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$244.74
|
| Rate for Payer: BCN Commercial |
$231.71
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cofinity Commercial |
$280.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Healthscope Whirlpool |
$289.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$268.97
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.03
|
| Rate for Payer: Nomi Health Commercial |
$245.07
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.86
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$209.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
IP
|
$298.86
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$298.86 |
| Rate for Payer: Aetna Commercial |
$268.97
|
| Rate for Payer: ASR ASR |
$289.89
|
| Rate for Payer: ASR Commercial |
$289.89
|
| Rate for Payer: BCBS Trust/PPO |
$243.54
|
| Rate for Payer: BCN Commercial |
$231.71
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cofinity Commercial |
$280.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.09
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Healthscope Whirlpool |
$289.89
|
| Rate for Payer: Mclaren Commercial |
$268.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.03
|
| Rate for Payer: Nomi Health Commercial |
$245.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.00
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
IP
|
$120.03
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$120.03 |
| Rate for Payer: Aetna Commercial |
$108.03
|
| Rate for Payer: ASR ASR |
$116.43
|
| Rate for Payer: ASR Commercial |
$116.43
|
| Rate for Payer: BCBS Trust/PPO |
$97.81
|
| Rate for Payer: BCN Commercial |
$93.06
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$112.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Healthscope Commercial |
$120.03
|
| Rate for Payer: Healthscope Whirlpool |
$116.43
|
| Rate for Payer: Mclaren Commercial |
$108.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.03
|
| Rate for Payer: Nomi Health Commercial |
$98.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.63
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
OP
|
$120.03
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$120.03 |
| Rate for Payer: Aetna Commercial |
$108.03
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: ASR ASR |
$116.43
|
| Rate for Payer: ASR Commercial |
$116.43
|
| Rate for Payer: BCBS Complete |
$48.01
|
| Rate for Payer: BCBS Trust/PPO |
$98.29
|
| Rate for Payer: BCN Commercial |
$93.06
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$112.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Healthscope Commercial |
$120.03
|
| Rate for Payer: Healthscope Whirlpool |
$116.43
|
| Rate for Payer: Mclaren Commercial |
$108.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.03
|
| Rate for Payer: Nomi Health Commercial |
$98.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.98
|
| Rate for Payer: Priority Health Narrow Network |
$53.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.63
|
|
|
HC PROTEINASE 3 AB (HC ANCA VASCULITIS PANEL CMPT)
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$29.26
|
| Rate for Payer: ASR Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$24.71
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$29.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC PROTEINASE 3 AB (HC ANCA VASCULITIS PANEL CMPT)
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: ASR ASR |
$29.26
|
| Rate for Payer: ASR Commercial |
$29.26
|
| Rate for Payer: BCBS Trust/PPO |
$24.59
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$29.26
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
30500038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
