|
HC PROTEIN S ANTIGEN FREE
|
Facility
|
OP
|
$86.70
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500074
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$86.70 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$84.10
|
| Rate for Payer: ASR Commercial |
$84.10
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$71.00
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$81.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$86.70
|
| Rate for Payer: Healthscope Whirlpool |
$84.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$78.03
|
| Rate for Payer: Mclaren Medicaid |
$8.21
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.69
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.97
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$60.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.32
|
| Rate for Payer: UHC Exchange |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$15.32
|
| Rate for Payer: UHCCP DNSP |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.21
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: ASR Commercial |
$47.49
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$40.09
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.29
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$2.30
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.72
|
| Rate for Payer: PHP Medicaid |
$2.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$34.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Exchange |
$6.65
|
| Rate for Payer: UHC Medicare Advantage |
$4.29
|
| Rate for Payer: UHCCP DNSP |
$4.29
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: ASR Commercial |
$47.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.90
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
|
|
HC PROTIME WITH INR
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: ASR ASR |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.74
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
|
|
HC PROTIME WITH INR
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: ASR ASR |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$23.85
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.29
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$2.30
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$4.72
|
| Rate for Payer: PHP Medicaid |
$2.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$20.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Exchange |
$6.65
|
| Rate for Payer: UHC Medicare Advantage |
$4.29
|
| Rate for Payer: UHCCP DNSP |
$4.29
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: ASR ASR |
$82.12
|
| Rate for Payer: ASR Commercial |
$82.12
|
| Rate for Payer: BCBS Trust/PPO |
$68.99
|
| Rate for Payer: BCN Commercial |
$65.64
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$79.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$84.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Mclaren Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.50
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$82.12
|
| Rate for Payer: ASR Commercial |
$82.12
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$69.33
|
| Rate for Payer: BCN Commercial |
$65.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$79.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$84.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.18
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$59.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.36
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.16
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$86.35 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: ASR ASR |
$83.76
|
| Rate for Payer: ASR Commercial |
$83.76
|
| Rate for Payer: BCBS Trust/PPO |
$70.37
|
| Rate for Payer: BCN Commercial |
$66.95
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$81.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$86.35
|
| Rate for Payer: Healthscope Whirlpool |
$83.76
|
| Rate for Payer: Mclaren Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.99
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$86.35 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| 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 |
$83.76
|
| Rate for Payer: ASR Commercial |
$83.76
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$70.71
|
| Rate for Payer: BCN Commercial |
$66.95
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$81.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$86.35
|
| Rate for Payer: Healthscope Whirlpool |
$83.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$77.72
|
| 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 |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| 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 |
$56.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.66
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$60.53
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.99
|
| 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 PSA ANNUAL SCREEN
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Medicare |
$19.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.14
|
| Rate for Payer: ASR ASR |
$67.59
|
| Rate for Payer: ASR Commercial |
$67.59
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS MAPPO |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$57.06
|
| Rate for Payer: BCN Commercial |
$54.02
|
| Rate for Payer: BCN Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$65.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Healthscope Whirlpool |
$67.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.31
|
| Rate for Payer: Mclaren Commercial |
$62.71
|
| Rate for Payer: Mclaren Medicaid |
$10.35
|
| Rate for Payer: Mclaren Medicare |
$19.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.28
|
| Rate for Payer: Meridian Medicaid |
$10.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PACE Medicare |
$18.34
|
| Rate for Payer: PACE SWMI |
$19.31
|
| Rate for Payer: PHP Commercial |
$21.24
|
| Rate for Payer: PHP Medicaid |
$10.35
|
| Rate for Payer: PHP Medicare Advantage |
$19.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$19.31
|
| Rate for Payer: Priority Health Narrow Network |
$48.85
|
| Rate for Payer: Railroad Medicare Medicare |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.31
|
| Rate for Payer: UHC Exchange |
$29.93
|
| Rate for Payer: UHC Medicare Advantage |
$19.31
|
| Rate for Payer: UHCCP DNSP |
$19.31
|
| Rate for Payer: UHCCP Medicaid |
$10.35
|
| Rate for Payer: VA VA |
$19.31
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: ASR ASR |
$67.59
|
| Rate for Payer: ASR Commercial |
$67.59
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCN Commercial |
$54.02
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$65.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Healthscope Whirlpool |
$67.59
|
| Rate for Payer: Mclaren Commercial |
$62.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.32
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: ASR ASR |
$67.59
|
| Rate for Payer: ASR Commercial |
$67.59
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCN Commercial |
$54.02
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$65.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Healthscope Whirlpool |
$67.59
|
| Rate for Payer: Mclaren Commercial |
$62.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.32
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: ASR ASR |
$67.59
|
| Rate for Payer: ASR Commercial |
$67.59
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.06
|
| Rate for Payer: BCN Commercial |
$54.02
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$65.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Healthscope Whirlpool |
$67.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.39
|
| Rate for Payer: Mclaren Commercial |
$62.71
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$10.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$48.85
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Exchange |
$28.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: UHCCP DNSP |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: ASR ASR |
$67.59
|
| Rate for Payer: ASR Commercial |
$67.59
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.06
|
| Rate for Payer: BCN Commercial |
$54.02
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$65.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Healthscope Whirlpool |
$67.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.39
|
| Rate for Payer: Mclaren Commercial |
$62.71
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$10.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$48.85
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Exchange |
$28.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: UHCCP DNSP |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: ASR ASR |
$67.59
|
| Rate for Payer: ASR Commercial |
$67.59
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCN Commercial |
$54.02
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$65.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Healthscope Whirlpool |
$67.59
|
| Rate for Payer: Mclaren Commercial |
$62.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.32
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$1,039.96 |
| Rate for Payer: Aetna Commercial |
$935.96
|
| Rate for Payer: Aetna Medicare |
$602.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: ASR ASR |
$1,008.76
|
| Rate for Payer: ASR Commercial |
$1,008.76
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCBS Trust/PPO |
$851.62
|
| Rate for Payer: BCN Commercial |
$806.28
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$977.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$1,039.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$602.98
|
| Rate for Payer: Mclaren Commercial |
$935.96
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$852.77
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$663.28
|
| Rate for Payer: PHP Medicaid |
$323.20
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$911.21
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health Narrow Network |
$729.01
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$934.62
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP DNSP |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.97 |
| Max. Negotiated Rate |
$1,039.96 |
| Rate for Payer: Aetna Commercial |
$935.96
|
| Rate for Payer: ASR ASR |
$1,008.76
|
| Rate for Payer: ASR Commercial |
$1,008.76
|
| Rate for Payer: BCBS Trust/PPO |
$847.46
|
| Rate for Payer: BCN Commercial |
$806.28
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$977.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Healthscope Commercial |
$1,039.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.76
|
| Rate for Payer: Mclaren Commercial |
$935.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$852.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.16
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.87
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.66
|
| Rate for Payer: PHP Medicaid |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.87
|
| Rate for Payer: UHC Exchange |
$12.20
|
| Rate for Payer: UHC Medicare Advantage |
$7.87
|
| Rate for Payer: UHCCP DNSP |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,766.26 |
| Max. Negotiated Rate |
$5,794.25 |
| Rate for Payer: Aetna Commercial |
$5,214.82
|
| Rate for Payer: ASR ASR |
$5,620.42
|
| Rate for Payer: ASR Commercial |
$5,620.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,721.73
|
| Rate for Payer: BCN Commercial |
$4,492.28
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$5,446.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Healthscope Commercial |
$5,794.25
|
| Rate for Payer: Healthscope Whirlpool |
$5,620.42
|
| Rate for Payer: Mclaren Commercial |
$5,214.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$4,751.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,098.94
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$5,794.25 |
| Rate for Payer: Aetna Commercial |
$5,214.82
|
| Rate for Payer: Aetna Medicare |
$992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: ASR ASR |
$5,620.42
|
| Rate for Payer: ASR Commercial |
$5,620.42
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,744.91
|
| Rate for Payer: BCN Commercial |
$4,492.28
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$5,446.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$5,794.25
|
| Rate for Payer: Healthscope Whirlpool |
$5,620.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$992.24
|
| Rate for Payer: Mclaren Commercial |
$5,214.82
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$4,751.28
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$1,091.46
|
| Rate for Payer: PHP Medicaid |
$531.84
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,076.92
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,061.77
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,098.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$1,537.97
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP DNSP |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$531.84
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$5,983.02 |
| Rate for Payer: Aetna Commercial |
$5,384.72
|
| Rate for Payer: Aetna Medicare |
$992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: ASR ASR |
$5,803.53
|
| Rate for Payer: ASR Commercial |
$5,803.53
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,899.50
|
| Rate for Payer: BCN Commercial |
$4,638.64
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,624.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$5,983.02
|
| Rate for Payer: Healthscope Whirlpool |
$5,803.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$992.24
|
| Rate for Payer: Mclaren Commercial |
$5,384.72
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: Nomi Health Commercial |
$4,906.08
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$1,091.46
|
| Rate for Payer: PHP Medicaid |
$531.84
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,242.32
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,194.10
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,265.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$1,537.97
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP DNSP |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$531.84
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,888.96 |
| Max. Negotiated Rate |
$5,983.02 |
| Rate for Payer: Aetna Commercial |
$5,384.72
|
| Rate for Payer: ASR ASR |
$5,803.53
|
| Rate for Payer: ASR Commercial |
$5,803.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,875.56
|
| Rate for Payer: BCN Commercial |
$4,638.64
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,624.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Healthscope Commercial |
$5,983.02
|
| Rate for Payer: Healthscope Whirlpool |
$5,803.53
|
| Rate for Payer: Mclaren Commercial |
$5,384.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: Nomi Health Commercial |
$4,906.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,265.06
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,401.99 |
| Max. Negotiated Rate |
$2,156.91 |
| Rate for Payer: Aetna Commercial |
$1,941.22
|
| Rate for Payer: ASR ASR |
$2,092.20
|
| Rate for Payer: ASR Commercial |
$2,092.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.67
|
| Rate for Payer: BCN Commercial |
$1,672.25
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$2,027.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Healthscope Commercial |
$2,156.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,092.20
|
| Rate for Payer: Mclaren Commercial |
$1,941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: Nomi Health Commercial |
$1,768.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,898.08
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$2,156.91 |
| Rate for Payer: Aetna Commercial |
$1,941.22
|
| Rate for Payer: Aetna Medicare |
$572.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.95
|
| Rate for Payer: ASR ASR |
$2,092.20
|
| Rate for Payer: ASR Commercial |
$2,092.20
|
| Rate for Payer: BCBS Complete |
$322.35
|
| Rate for Payer: BCBS MAPPO |
$572.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,766.29
|
| Rate for Payer: BCN Commercial |
$1,672.25
|
| Rate for Payer: BCN Medicare Advantage |
$572.76
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$2,027.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.76
|
| Rate for Payer: Healthscope Commercial |
$2,156.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,092.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$572.76
|
| Rate for Payer: Mclaren Commercial |
$1,941.22
|
| Rate for Payer: Mclaren Medicaid |
$307.00
|
| Rate for Payer: Mclaren Medicare |
$572.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.40
|
| Rate for Payer: Meridian Medicaid |
$322.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$658.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: Nomi Health Commercial |
$1,768.67
|
| Rate for Payer: PACE Medicare |
$544.12
|
| Rate for Payer: PACE SWMI |
$572.76
|
| Rate for Payer: PHP Commercial |
$630.04
|
| Rate for Payer: PHP Medicaid |
$307.00
|
| Rate for Payer: PHP Medicare Advantage |
$572.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,889.88
|
| Rate for Payer: Priority Health Medicare |
$572.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,511.99
|
| Rate for Payer: Railroad Medicare Medicare |
$572.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,898.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.76
|
| Rate for Payer: UHC Exchange |
$887.78
|
| Rate for Payer: UHC Medicare Advantage |
$572.76
|
| Rate for Payer: UHCCP DNSP |
$572.76
|
| Rate for Payer: UHCCP Medicaid |
$307.00
|
| Rate for Payer: VA VA |
$572.76
|
|
