|
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 |
$52.02 |
| 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 |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$14.48
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| 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
|
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 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 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 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 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 |
$82.28 |
| 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 |
$176.53
|
| 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 |
$220.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$176.02
|
| 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 |
$237.93
|
| 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
|
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 |
$147.65
|
| 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 |
$147.65
|
| 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
|
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 |
$147.65
|
| 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 |
$147.65
|
| 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 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 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 |
$77.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.47
|
| 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 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
|
|
|
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 |
$57.12 |
| 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 |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$40.04
|
| 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 RABIES VACCINE IM
|
Facility
|
IP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$674.21 |
| Max. Negotiated Rate |
$1,037.24 |
| Rate for Payer: Aetna Commercial |
$933.52
|
| Rate for Payer: ASR ASR |
$1,006.12
|
| Rate for Payer: ASR Commercial |
$1,006.12
|
| Rate for Payer: BCBS Trust/PPO |
$845.25
|
| Rate for Payer: BCN Commercial |
$804.17
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$975.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Healthscope Commercial |
$1,037.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.12
|
| Rate for Payer: Mclaren Commercial |
$933.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: Nomi Health Commercial |
$850.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.77
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$1,037.24 |
| Rate for Payer: Aetna Commercial |
$933.52
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.10
|
| Rate for Payer: ASR ASR |
$1,006.12
|
| Rate for Payer: ASR Commercial |
$1,006.12
|
| Rate for Payer: BCBS Complete |
$176.54
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCBS Trust/PPO |
$849.40
|
| Rate for Payer: BCN Commercial |
$804.17
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$975.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Healthscope Commercial |
$1,037.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$313.68
|
| Rate for Payer: Mclaren Commercial |
$933.52
|
| Rate for Payer: Mclaren Medicaid |
$168.13
|
| Rate for Payer: Mclaren Medicare |
$313.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Meridian Medicaid |
$176.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: Nomi Health Commercial |
$850.54
|
| Rate for Payer: PACE Medicare |
$298.00
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PHP Commercial |
$345.05
|
| Rate for Payer: PHP Medicaid |
$168.13
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.83
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: Priority Health Narrow Network |
$727.11
|
| Rate for Payer: Railroad Medicare Medicare |
$313.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Exchange |
$486.20
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHCCP DNSP |
$313.68
|
| Rate for Payer: UHCCP Medicaid |
$168.13
|
| Rate for Payer: VA VA |
$313.68
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$188.62 |
| Rate for Payer: Aetna Commercial |
$169.76
|
| Rate for Payer: Aetna Medicare |
$94.31
|
| Rate for Payer: ASR ASR |
$182.96
|
| Rate for Payer: ASR Commercial |
$182.96
|
| Rate for Payer: BCBS Complete |
$75.45
|
| Rate for Payer: BCBS Trust/PPO |
$154.46
|
| Rate for Payer: BCN Commercial |
$146.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$188.62
|
| Rate for Payer: Healthscope Whirlpool |
$182.96
|
| Rate for Payer: Mclaren Commercial |
$169.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: Nomi Health Commercial |
$154.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.27
|
| Rate for Payer: Priority Health Narrow Network |
$132.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.99
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$188.62 |
| Rate for Payer: Aetna Commercial |
$169.76
|
| Rate for Payer: ASR ASR |
$182.96
|
| Rate for Payer: ASR Commercial |
$182.96
|
| Rate for Payer: BCBS Trust/PPO |
$153.71
|
| Rate for Payer: BCN Commercial |
$146.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$177.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$188.62
|
| Rate for Payer: Healthscope Whirlpool |
$182.96
|
| Rate for Payer: Mclaren Commercial |
$169.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: Nomi Health Commercial |
$154.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.99
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$429.69 |
| Rate for Payer: Aetna Commercial |
$386.72
|
| Rate for Payer: Aetna Medicare |
$129.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: ASR ASR |
$416.80
|
| Rate for Payer: ASR Commercial |
$416.80
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCBS Trust/PPO |
$351.87
|
| Rate for Payer: BCN Commercial |
$333.14
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$403.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$429.69
|
| Rate for Payer: Healthscope Whirlpool |
$416.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$129.49
|
| Rate for Payer: Mclaren Commercial |
$386.72
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: Nomi Health Commercial |
$352.35
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$142.44
|
| Rate for Payer: PHP Medicaid |
$69.41
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.49
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health Narrow Network |
$301.21
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$200.71
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP DNSP |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$69.41
|
| Rate for Payer: VA VA |
$129.49
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$429.69 |
| Rate for Payer: Aetna Commercial |
$386.72
|
| Rate for Payer: ASR ASR |
$416.80
|
| Rate for Payer: ASR Commercial |
$416.80
|
| Rate for Payer: BCBS Trust/PPO |
$350.15
|
| Rate for Payer: BCN Commercial |
$333.14
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$403.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Healthscope Commercial |
$429.69
|
| Rate for Payer: Healthscope Whirlpool |
$416.80
|
| Rate for Payer: Mclaren Commercial |
$386.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: Nomi Health Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.13
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$286.19 |
| Rate for Payer: Aetna Commercial |
$257.57
|
| Rate for Payer: Aetna Medicare |
$172.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.28
|
| Rate for Payer: ASR ASR |
$277.60
|
| Rate for Payer: ASR Commercial |
$277.60
|
| Rate for Payer: BCBS Complete |
$96.93
|
| Rate for Payer: BCBS MAPPO |
$172.22
|
| Rate for Payer: BCBS Trust/PPO |
$234.36
|
| Rate for Payer: BCN Commercial |
$221.88
|
| Rate for Payer: BCN Medicare Advantage |
$172.22
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$269.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.22
|
| Rate for Payer: Healthscope Commercial |
$286.19
|
| Rate for Payer: Healthscope Whirlpool |
$277.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$172.22
|
| Rate for Payer: Mclaren Commercial |
$257.57
|
| Rate for Payer: Mclaren Medicaid |
$92.31
|
| Rate for Payer: Mclaren Medicare |
$172.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.83
|
| Rate for Payer: Meridian Medicaid |
$96.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: Nomi Health Commercial |
$234.68
|
| Rate for Payer: PACE Medicare |
$163.61
|
| Rate for Payer: PACE SWMI |
$172.22
|
| Rate for Payer: PHP Commercial |
$189.44
|
| Rate for Payer: PHP Medicaid |
$92.31
|
| Rate for Payer: PHP Medicare Advantage |
$172.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.76
|
| Rate for Payer: Priority Health Medicare |
$172.22
|
| Rate for Payer: Priority Health Narrow Network |
$200.62
|
| Rate for Payer: Railroad Medicare Medicare |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.22
|
| Rate for Payer: UHC Exchange |
$266.94
|
| Rate for Payer: UHC Medicare Advantage |
$172.22
|
| Rate for Payer: UHCCP DNSP |
$172.22
|
| Rate for Payer: UHCCP Medicaid |
$92.31
|
| Rate for Payer: VA VA |
$172.22
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$286.19
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$286.19 |
| Rate for Payer: Aetna Commercial |
$257.57
|
| Rate for Payer: ASR ASR |
$277.60
|
| Rate for Payer: ASR Commercial |
$277.60
|
| Rate for Payer: BCBS Trust/PPO |
$233.22
|
| Rate for Payer: BCN Commercial |
$221.88
|
| Rate for Payer: Cash Price |
$228.95
|
| Rate for Payer: Cofinity Commercial |
$269.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.95
|
| Rate for Payer: Healthscope Commercial |
$286.19
|
| Rate for Payer: Healthscope Whirlpool |
$277.60
|
| Rate for Payer: Mclaren Commercial |
$257.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.26
|
| Rate for Payer: Nomi Health Commercial |
$234.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.85
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC RAD TX ANAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1073
|
| Hospital Charge Code |
33300063
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
