|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$204.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$204.07 |
| Rate for Payer: Aetna Commercial |
$183.66
|
| Rate for Payer: Aetna Medicare |
$102.04
|
| Rate for Payer: ASR ASR |
$197.95
|
| Rate for Payer: ASR Commercial |
$197.95
|
| Rate for Payer: BCBS Complete |
$81.63
|
| Rate for Payer: BCBS Trust/PPO |
$167.11
|
| Rate for Payer: BCN Commercial |
$158.22
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$191.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.26
|
| Rate for Payer: Healthscope Commercial |
$204.07
|
| Rate for Payer: Healthscope Whirlpool |
$197.95
|
| Rate for Payer: Mclaren Commercial |
$183.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.46
|
| Rate for Payer: Nomi Health Commercial |
$167.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.58
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: ASR ASR |
$131.92
|
| Rate for Payer: ASR Commercial |
$131.92
|
| Rate for Payer: BCBS Trust/PPO |
$110.83
|
| Rate for Payer: BCN Commercial |
$105.44
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$127.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.80
|
| Rate for Payer: Healthscope Commercial |
$136.00
|
| Rate for Payer: Healthscope Whirlpool |
$131.92
|
| Rate for Payer: Mclaren Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.60
|
| Rate for Payer: Nomi Health Commercial |
$111.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.68
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: ASR ASR |
$131.92
|
| Rate for Payer: ASR Commercial |
$131.92
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS Trust/PPO |
$111.37
|
| Rate for Payer: BCN Commercial |
$105.44
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$127.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.80
|
| Rate for Payer: Healthscope Commercial |
$136.00
|
| Rate for Payer: Healthscope Whirlpool |
$131.92
|
| Rate for Payer: Mclaren Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.60
|
| Rate for Payer: Nomi Health Commercial |
$111.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.31
|
| Rate for Payer: Priority Health Narrow Network |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.68
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$166.17
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$149.55
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$161.18
|
| Rate for Payer: ASR Commercial |
$161.18
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$136.08
|
| Rate for Payer: BCN Commercial |
$128.83
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$156.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$166.17
|
| Rate for Payer: Healthscope Whirlpool |
$161.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$149.55
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.24
|
| Rate for Payer: Nomi Health Commercial |
$136.26
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$116.49
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$166.17
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$166.17 |
| Rate for Payer: Aetna Commercial |
$149.55
|
| Rate for Payer: ASR ASR |
$161.18
|
| Rate for Payer: ASR Commercial |
$161.18
|
| Rate for Payer: BCBS Trust/PPO |
$135.41
|
| Rate for Payer: BCN Commercial |
$128.83
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$156.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Healthscope Commercial |
$166.17
|
| Rate for Payer: Healthscope Whirlpool |
$161.18
|
| Rate for Payer: Mclaren Commercial |
$149.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.24
|
| Rate for Payer: Nomi Health Commercial |
$136.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.23
|
|
|
HC PV JAK2V617F
|
Facility
|
OP
|
$329.51
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$329.51 |
| Rate for Payer: Aetna Commercial |
$296.56
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$319.62
|
| Rate for Payer: ASR Commercial |
$319.62
|
| Rate for Payer: BCBS Complete |
$51.59
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$269.84
|
| Rate for Payer: BCN Commercial |
$255.47
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$309.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$329.51
|
| Rate for Payer: Healthscope Whirlpool |
$319.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$296.56
|
| Rate for Payer: Mclaren Medicaid |
$49.13
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$51.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.08
|
| Rate for Payer: Nomi Health Commercial |
$270.20
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.79
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$47.83
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.66
|
| Rate for Payer: UHC Exchange |
$142.07
|
| Rate for Payer: UHC Medicare Advantage |
$91.66
|
| Rate for Payer: UHCCP DNSP |
$91.66
|
| Rate for Payer: UHCCP Medicaid |
$49.13
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$329.51
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$214.18 |
| Max. Negotiated Rate |
$329.51 |
| Rate for Payer: Aetna Commercial |
$296.56
|
| Rate for Payer: ASR ASR |
$319.62
|
| Rate for Payer: ASR Commercial |
$319.62
|
| Rate for Payer: BCBS Trust/PPO |
$268.52
|
| Rate for Payer: BCN Commercial |
$255.47
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$309.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.61
|
| Rate for Payer: Healthscope Commercial |
$329.51
|
| Rate for Payer: Healthscope Whirlpool |
$319.62
|
| Rate for Payer: Mclaren Commercial |
$296.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.08
|
| Rate for Payer: Nomi Health Commercial |
$270.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.97
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$94.86
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: ASR ASR |
$92.01
|
| Rate for Payer: ASR Commercial |
$92.01
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$77.68
|
| Rate for Payer: BCN Commercial |
$73.54
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Healthscope Whirlpool |
$92.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$85.37
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.63
|
| Rate for Payer: Nomi Health Commercial |
$77.79
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: PHP Medicaid |
$5.06
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.31
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow Network |
$83.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Exchange |
$14.63
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: UHCCP DNSP |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$5.06
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$94.86
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: ASR ASR |
$92.01
|
| Rate for Payer: ASR Commercial |
$92.01
|
| Rate for Payer: BCBS Trust/PPO |
$77.30
|
| Rate for Payer: BCN Commercial |
$73.54
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$89.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Healthscope Whirlpool |
$92.01
|
| Rate for Payer: Mclaren Commercial |
$85.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.63
|
| Rate for Payer: Nomi Health Commercial |
$77.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.48
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
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 PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$124.08 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.10
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$8.15
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| 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 |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.48
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$7.76
|
| Rate for Payer: Mclaren Medicare |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$8.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$13.76
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Medicaid |
$7.76
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.08
|
| Rate for Payer: Priority Health Medicare |
$14.48
|
| Rate for Payer: Priority Health Narrow Network |
$99.26
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.48
|
| Rate for Payer: UHC Exchange |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$14.48
|
| Rate for Payer: UHCCP DNSP |
$14.48
|
| Rate for Payer: UHCCP Medicaid |
$7.76
|
| Rate for Payer: VA VA |
$14.48
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
IP
|
$93.89
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Aetna Commercial |
$84.50
|
| Rate for Payer: ASR ASR |
$91.07
|
| Rate for Payer: ASR Commercial |
$91.07
|
| Rate for Payer: BCBS Trust/PPO |
$76.51
|
| Rate for Payer: BCN Commercial |
$72.79
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cofinity Commercial |
$88.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.11
|
| Rate for Payer: Healthscope Commercial |
$93.89
|
| Rate for Payer: Healthscope Whirlpool |
$91.07
|
| Rate for Payer: Mclaren Commercial |
$84.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: Nomi Health Commercial |
$76.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.62
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
OP
|
$93.89
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Aetna Commercial |
$84.50
|
| Rate for Payer: Aetna Medicare |
$12.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
| Rate for Payer: ASR ASR |
$91.07
|
| Rate for Payer: ASR Commercial |
$91.07
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$76.89
|
| Rate for Payer: BCN Commercial |
$72.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cofinity Commercial |
$88.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$93.89
|
| Rate for Payer: Healthscope Whirlpool |
$91.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.12
|
| Rate for Payer: Mclaren Commercial |
$84.50
|
| Rate for Payer: Mclaren Medicaid |
$6.50
|
| Rate for Payer: Mclaren Medicare |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.73
|
| Rate for Payer: Meridian Medicaid |
$6.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: Nomi Health Commercial |
$76.99
|
| Rate for Payer: PACE Medicare |
$11.51
|
| Rate for Payer: PACE SWMI |
$12.12
|
| Rate for Payer: PHP Commercial |
$13.33
|
| Rate for Payer: PHP Medicaid |
$6.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.27
|
| Rate for Payer: Priority Health Medicare |
$12.12
|
| Rate for Payer: Priority Health Narrow Network |
$65.82
|
| Rate for Payer: Railroad Medicare Medicare |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.12
|
| Rate for Payer: UHC Exchange |
$18.79
|
| Rate for Payer: UHC Medicare Advantage |
$12.12
|
| Rate for Payer: UHCCP DNSP |
$12.12
|
| Rate for Payer: UHCCP Medicaid |
$6.50
|
| Rate for Payer: VA VA |
$12.12
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$341.11
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$341.11 |
| Rate for Payer: Aetna Commercial |
$307.00
|
| Rate for Payer: ASR ASR |
$330.88
|
| Rate for Payer: ASR Commercial |
$330.88
|
| Rate for Payer: BCBS Trust/PPO |
$277.97
|
| Rate for Payer: BCN Commercial |
$264.46
|
| Rate for Payer: Cash Price |
$272.89
|
| Rate for Payer: Cofinity Commercial |
$320.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.89
|
| Rate for Payer: Healthscope Commercial |
$341.11
|
| Rate for Payer: Healthscope Whirlpool |
$330.88
|
| Rate for Payer: Mclaren Commercial |
$307.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.94
|
| Rate for Payer: Nomi Health Commercial |
$279.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.18
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$341.11
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.44 |
| Max. Negotiated Rate |
$341.11 |
| Rate for Payer: Aetna Commercial |
$307.00
|
| Rate for Payer: Aetna Medicare |
$170.56
|
| Rate for Payer: ASR ASR |
$330.88
|
| Rate for Payer: ASR Commercial |
$330.88
|
| Rate for Payer: BCBS Complete |
$136.44
|
| Rate for Payer: BCBS Trust/PPO |
$279.33
|
| Rate for Payer: BCN Commercial |
$264.46
|
| Rate for Payer: Cash Price |
$272.89
|
| Rate for Payer: Cofinity Commercial |
$320.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.89
|
| Rate for Payer: Healthscope Commercial |
$341.11
|
| Rate for Payer: Healthscope Whirlpool |
$330.88
|
| Rate for Payer: Mclaren Commercial |
$307.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.94
|
| Rate for Payer: Nomi Health Commercial |
$279.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.88
|
| Rate for Payer: Priority Health Narrow Network |
$239.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.18
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$347.32
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.93 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$312.59
|
| Rate for Payer: Aetna Medicare |
$173.66
|
| Rate for Payer: ASR ASR |
$336.90
|
| Rate for Payer: ASR Commercial |
$336.90
|
| Rate for Payer: BCBS Complete |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$284.42
|
| Rate for Payer: BCN Commercial |
$269.28
|
| Rate for Payer: Cash Price |
$277.86
|
| Rate for Payer: Cofinity Commercial |
$326.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.86
|
| Rate for Payer: Healthscope Commercial |
$347.32
|
| Rate for Payer: Healthscope Whirlpool |
$336.90
|
| Rate for Payer: Mclaren Commercial |
$312.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.22
|
| Rate for Payer: Nomi Health Commercial |
$284.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.32
|
| Rate for Payer: Priority Health Narrow Network |
$243.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.64
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$347.32
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.76 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$312.59
|
| Rate for Payer: ASR ASR |
$336.90
|
| Rate for Payer: ASR Commercial |
$336.90
|
| Rate for Payer: BCBS Trust/PPO |
$283.03
|
| Rate for Payer: BCN Commercial |
$269.28
|
| Rate for Payer: Cash Price |
$277.86
|
| Rate for Payer: Cofinity Commercial |
$326.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.86
|
| Rate for Payer: Healthscope Commercial |
$347.32
|
| Rate for Payer: Healthscope Whirlpool |
$336.90
|
| Rate for Payer: Mclaren Commercial |
$312.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.22
|
| Rate for Payer: Nomi Health Commercial |
$284.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.64
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$163.22 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna Commercial |
$225.99
|
| Rate for Payer: ASR ASR |
$243.57
|
| Rate for Payer: ASR Commercial |
$243.57
|
| Rate for Payer: BCBS Trust/PPO |
$204.62
|
| Rate for Payer: BCN Commercial |
$194.68
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$236.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$251.10
|
| Rate for Payer: Healthscope Whirlpool |
$243.57
|
| Rate for Payer: Mclaren Commercial |
$225.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: Nomi Health Commercial |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.97
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$251.10 |
| Rate for Payer: Aetna Commercial |
$225.99
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$243.57
|
| Rate for Payer: ASR Commercial |
$243.57
|
| Rate for Payer: BCBS Complete |
$86.39
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$205.63
|
| Rate for Payer: BCN Commercial |
$194.68
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$236.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$251.10
|
| Rate for Payer: Healthscope Whirlpool |
$243.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$225.99
|
| Rate for Payer: Mclaren Medicaid |
$82.28
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$86.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: Nomi Health Commercial |
$205.90
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$237.92
|
| Rate for Payer: UHC Medicare Advantage |
$153.50
|
| Rate for Payer: UHCCP DNSP |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$82.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$164.05
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Aetna Commercial |
$147.64
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: ASR ASR |
$159.13
|
| Rate for Payer: ASR Commercial |
$159.13
|
| Rate for Payer: BCBS Complete |
$56.28
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$134.34
|
| Rate for Payer: BCN Commercial |
$127.19
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$154.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$164.05
|
| Rate for Payer: Healthscope Whirlpool |
$159.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$100.00
|
| Rate for Payer: Mclaren Commercial |
$147.64
|
| Rate for Payer: Mclaren Medicaid |
$53.60
|
| Rate for Payer: Mclaren Medicare |
$100.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: Meridian Medicaid |
$56.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.44
|
| Rate for Payer: Nomi Health Commercial |
$134.52
|
| Rate for Payer: PACE Medicare |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$110.00
|
| Rate for Payer: PHP Medicaid |
$53.60
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.74
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health Narrow Network |
$115.00
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.00
|
| Rate for Payer: UHC Exchange |
$155.00
|
| Rate for Payer: UHC Medicare Advantage |
$100.00
|
| Rate for Payer: UHCCP DNSP |
$100.00
|
| Rate for Payer: UHCCP Medicaid |
$53.60
|
| Rate for Payer: VA VA |
$100.00
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$164.05
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Aetna Commercial |
$147.64
|
| Rate for Payer: ASR ASR |
$159.13
|
| Rate for Payer: ASR Commercial |
$159.13
|
| Rate for Payer: BCBS Trust/PPO |
$133.68
|
| Rate for Payer: BCN Commercial |
$127.19
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$154.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.24
|
| Rate for Payer: Healthscope Commercial |
$164.05
|
| Rate for Payer: Healthscope Whirlpool |
$159.13
|
| Rate for Payer: Mclaren Commercial |
$147.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.44
|
| Rate for Payer: Nomi Health Commercial |
$134.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.36
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$117.36
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$117.36 |
| Rate for Payer: Aetna Commercial |
$105.62
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.48
|
| Rate for Payer: ASR ASR |
$113.84
|
| Rate for Payer: ASR Commercial |
$113.84
|
| Rate for Payer: BCBS Complete |
$34.88
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$96.11
|
| Rate for Payer: BCN Commercial |
$90.99
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cofinity Commercial |
$110.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$117.36
|
| Rate for Payer: Healthscope Whirlpool |
$113.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$61.98
|
| Rate for Payer: Mclaren Commercial |
$105.62
|
| Rate for Payer: Mclaren Medicaid |
$33.22
|
| Rate for Payer: Mclaren Medicare |
$61.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: Meridian Medicaid |
$34.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.76
|
| Rate for Payer: Nomi Health Commercial |
$96.24
|
| Rate for Payer: PACE Medicare |
$58.88
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Commercial |
$68.18
|
| Rate for Payer: PHP Medicaid |
$33.22
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.83
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health Narrow Network |
$82.27
|
| Rate for Payer: Railroad Medicare Medicare |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.98
|
| Rate for Payer: UHC Exchange |
$96.07
|
| Rate for Payer: UHC Medicare Advantage |
$61.98
|
| Rate for Payer: UHCCP DNSP |
$61.98
|
| Rate for Payer: UHCCP Medicaid |
$33.22
|
| Rate for Payer: VA VA |
$61.98
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$117.36
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$117.36 |
| Rate for Payer: Aetna Commercial |
$105.62
|
| Rate for Payer: ASR ASR |
$113.84
|
| Rate for Payer: ASR Commercial |
$113.84
|
| Rate for Payer: BCBS Trust/PPO |
$95.64
|
| Rate for Payer: BCN Commercial |
$90.99
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cofinity Commercial |
$110.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.89
|
| Rate for Payer: Healthscope Commercial |
$117.36
|
| Rate for Payer: Healthscope Whirlpool |
$113.84
|
| Rate for Payer: Mclaren Commercial |
$105.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.76
|
| Rate for Payer: Nomi Health Commercial |
$96.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.28
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: Aetna Medicare |
$14.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$46.78
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.60
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: Meridian Medicaid |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: PHP Medicaid |
$7.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.20
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$46.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.60
|
| Rate for Payer: UHC Exchange |
$22.63
|
| Rate for Payer: UHC Medicare Advantage |
$14.60
|
| Rate for Payer: UHCCP DNSP |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$7.83
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Trust/PPO |
$46.55
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
|
