|
HC RISK ASCVD TEST ONCE PER 12 MO
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS G0537
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: ASR ASR |
$92.15
|
| Rate for Payer: BCBS Trust/PPO |
$78.01
|
| Rate for Payer: BCN Commercial |
$78.01
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$89.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$92.15
|
| Rate for Payer: Healthscope Whirlpool |
$95.00
|
| Rate for Payer: Mclaren Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Nomi Health Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.60
|
|
|
HC RISK ASCVD TEST ONCE PER 12 MO
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS G0537
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare |
$37.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.66
|
| Rate for Payer: ASR ASR |
$92.15
|
| Rate for Payer: BCBS Complete |
$20.50
|
| Rate for Payer: BCBS MAPPO |
$37.33
|
| Rate for Payer: BCBS Trust/PPO |
$78.33
|
| Rate for Payer: BCN Commercial |
$78.33
|
| Rate for Payer: BCN Medicare Advantage |
$37.33
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$89.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$92.15
|
| Rate for Payer: Healthscope Whirlpool |
$95.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.33
|
| Rate for Payer: Mclaren Commercial |
$85.50
|
| Rate for Payer: Mclaren Medicaid |
$37.33
|
| Rate for Payer: Mclaren Medicare |
$37.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$20.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Nomi Health Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PACE Medicare |
$35.46
|
| Rate for Payer: PACE SWMI |
$37.33
|
| Rate for Payer: PHP Commercial |
$41.06
|
| Rate for Payer: PHP Medicaid |
$20.01
|
| Rate for Payer: PHP Medicare Advantage |
$37.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.84
|
| Rate for Payer: Priority Health Medicare |
$37.33
|
| Rate for Payer: Priority Health Narrow Network |
$26.28
|
| Rate for Payer: Railroad Medicare Medicare |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.33
|
| Rate for Payer: UHC Exchange |
$57.86
|
| Rate for Payer: UHC Medicaid |
$19.52
|
| Rate for Payer: UHCCP DNSP |
$37.33
|
| Rate for Payer: UHCCP Medicaid |
$19.52
|
| Rate for Payer: VA VA |
$37.33
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$115.48
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$115.48 |
| Rate for Payer: Aetna Commercial |
$103.93
|
| Rate for Payer: ASR ASR |
$112.02
|
| Rate for Payer: BCBS Trust/PPO |
$94.83
|
| Rate for Payer: BCN Commercial |
$94.83
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$108.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$112.02
|
| Rate for Payer: Healthscope Whirlpool |
$115.48
|
| Rate for Payer: Mclaren Commercial |
$103.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$94.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.62
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
OP
|
$115.48
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$115.48 |
| Rate for Payer: Aetna Commercial |
$103.93
|
| Rate for Payer: Aetna Medicare |
$42.73
|
| Rate for Payer: ASR ASR |
$112.02
|
| Rate for Payer: BCBS Complete |
$46.19
|
| Rate for Payer: BCBS Trust/PPO |
$95.21
|
| Rate for Payer: BCN Commercial |
$95.21
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$108.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$112.02
|
| Rate for Payer: Healthscope Whirlpool |
$115.48
|
| Rate for Payer: Mclaren Commercial |
$103.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$94.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.18
|
| Rate for Payer: Priority Health Narrow Network |
$80.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.62
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$70.46 |
| Rate for Payer: Aetna Commercial |
$63.41
|
| Rate for Payer: ASR ASR |
$68.35
|
| Rate for Payer: BCBS Trust/PPO |
$57.86
|
| Rate for Payer: BCN Commercial |
$57.86
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cofinity Commercial |
$66.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.37
|
| Rate for Payer: Healthscope Commercial |
$68.35
|
| Rate for Payer: Healthscope Whirlpool |
$70.46
|
| Rate for Payer: Mclaren Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.89
|
| Rate for Payer: Nomi Health Commercial |
$57.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.00
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$70.46 |
| Rate for Payer: Aetna Commercial |
$63.41
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$68.35
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$58.09
|
| Rate for Payer: BCN Commercial |
$58.09
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cofinity Commercial |
$66.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$68.35
|
| Rate for Payer: Healthscope Whirlpool |
$70.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$63.41
|
| Rate for Payer: Mclaren Medicaid |
$22.94
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.89
|
| Rate for Payer: Nomi Health Commercial |
$57.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.74
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$49.39
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicaid |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.00
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$97.07
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$97.07 |
| Rate for Payer: Aetna Commercial |
$87.36
|
| Rate for Payer: Aetna Medicare |
$35.92
|
| Rate for Payer: ASR ASR |
$94.16
|
| Rate for Payer: BCBS Complete |
$38.83
|
| Rate for Payer: BCBS Trust/PPO |
$80.03
|
| Rate for Payer: BCN Commercial |
$80.03
|
| Rate for Payer: Cash Price |
$77.66
|
| Rate for Payer: Cash Price |
$77.66
|
| Rate for Payer: Cofinity Commercial |
$91.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Healthscope Whirlpool |
$97.07
|
| Rate for Payer: Mclaren Commercial |
$87.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.51
|
| Rate for Payer: Nomi Health Commercial |
$79.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.40
|
| Rate for Payer: Priority Health Narrow Network |
$58.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.42
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$97.07
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$97.07 |
| Rate for Payer: Aetna Commercial |
$87.36
|
| Rate for Payer: ASR ASR |
$94.16
|
| Rate for Payer: BCBS Trust/PPO |
$79.71
|
| Rate for Payer: BCN Commercial |
$79.71
|
| Rate for Payer: Cash Price |
$77.66
|
| Rate for Payer: Cofinity Commercial |
$91.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Healthscope Whirlpool |
$97.07
|
| Rate for Payer: Mclaren Commercial |
$87.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.51
|
| Rate for Payer: Nomi Health Commercial |
$79.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.42
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$11,423.48
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,567.61 |
| Max. Negotiated Rate |
$11,423.48 |
| Rate for Payer: Aetna Commercial |
$10,281.13
|
| Rate for Payer: ASR ASR |
$11,080.78
|
| Rate for Payer: BCBS Trust/PPO |
$9,380.96
|
| Rate for Payer: BCN Commercial |
$9,380.96
|
| Rate for Payer: Cash Price |
$9,138.78
|
| Rate for Payer: Cofinity Commercial |
$10,738.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,138.78
|
| Rate for Payer: Healthscope Commercial |
$11,080.78
|
| Rate for Payer: Healthscope Whirlpool |
$11,423.48
|
| Rate for Payer: Mclaren Commercial |
$10,281.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,709.96
|
| Rate for Payer: Nomi Health Commercial |
$9,367.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,567.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,052.66
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$11,423.48
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.43 |
| Max. Negotiated Rate |
$11,423.48 |
| Rate for Payer: Aetna Commercial |
$10,281.13
|
| Rate for Payer: Aetna Medicare |
$3,230.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,037.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,037.84
|
| Rate for Payer: ASR ASR |
$11,080.78
|
| Rate for Payer: BCBS Complete |
$1,774.06
|
| Rate for Payer: BCBS MAPPO |
$3,230.27
|
| Rate for Payer: BCBS Trust/PPO |
$9,418.66
|
| Rate for Payer: BCN Commercial |
$9,418.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,230.27
|
| Rate for Payer: Cash Price |
$9,138.78
|
| Rate for Payer: Cash Price |
$9,138.78
|
| Rate for Payer: Cofinity Commercial |
$10,738.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,138.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,230.27
|
| Rate for Payer: Healthscope Commercial |
$11,080.78
|
| Rate for Payer: Healthscope Whirlpool |
$11,423.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,230.27
|
| Rate for Payer: Mclaren Commercial |
$10,281.13
|
| Rate for Payer: Mclaren Medicaid |
$3,230.27
|
| Rate for Payer: Mclaren Medicare |
$3,230.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,391.78
|
| Rate for Payer: Meridian Medicaid |
$1,774.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,714.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,553.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,709.96
|
| Rate for Payer: Nomi Health Commercial |
$9,367.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,567.61
|
| Rate for Payer: PACE Medicare |
$3,068.76
|
| Rate for Payer: PACE SWMI |
$3,230.27
|
| Rate for Payer: PHP Commercial |
$3,553.30
|
| Rate for Payer: PHP Medicaid |
$1,731.42
|
| Rate for Payer: PHP Medicare Advantage |
$3,230.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,009.25
|
| Rate for Payer: Priority Health Medicare |
$3,230.27
|
| Rate for Payer: Priority Health Narrow Network |
$8,007.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,230.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,052.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,230.27
|
| Rate for Payer: UHC Exchange |
$5,006.92
|
| Rate for Payer: UHC Medicaid |
$1,689.43
|
| Rate for Payer: UHCCP DNSP |
$3,230.27
|
| Rate for Payer: UHCCP Medicaid |
$1,689.43
|
| Rate for Payer: VA VA |
$3,230.27
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,444.94
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,833.70 |
| Max. Negotiated Rate |
$2,444.94 |
| Rate for Payer: Aetna Commercial |
$2,200.45
|
| Rate for Payer: ASR ASR |
$2,371.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,007.78
|
| Rate for Payer: BCN Commercial |
$2,007.78
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cofinity Commercial |
$2,298.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Commercial |
$2,371.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,444.94
|
| Rate for Payer: Mclaren Commercial |
$2,200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.20
|
| Rate for Payer: Nomi Health Commercial |
$2,004.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,151.55
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,444.94
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$2,444.94 |
| Rate for Payer: Aetna Commercial |
$2,200.45
|
| Rate for Payer: Aetna Medicare |
$903.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: ASR ASR |
$2,371.59
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,015.85
|
| Rate for Payer: BCN Commercial |
$2,015.85
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cofinity Commercial |
$2,298.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$2,371.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,444.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$903.72
|
| Rate for Payer: Mclaren Commercial |
$2,200.45
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.20
|
| Rate for Payer: Nomi Health Commercial |
$2,004.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.70
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$994.09
|
| Rate for Payer: PHP Medicaid |
$484.39
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$111.37
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Narrow Network |
$89.10
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,151.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Exchange |
$1,400.77
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP DNSP |
$903.72
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
IP
|
$366.18
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.63 |
| Max. Negotiated Rate |
$366.18 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: ASR ASR |
$355.19
|
| Rate for Payer: BCBS Trust/PPO |
$300.71
|
| Rate for Payer: BCN Commercial |
$300.71
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cofinity Commercial |
$344.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.94
|
| Rate for Payer: Healthscope Commercial |
$355.19
|
| Rate for Payer: Healthscope Whirlpool |
$366.18
|
| Rate for Payer: Mclaren Commercial |
$329.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.25
|
| Rate for Payer: Nomi Health Commercial |
$300.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.24
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
OP
|
$366.18
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$366.18 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$355.19
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$301.92
|
| Rate for Payer: BCN Commercial |
$301.92
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cofinity Commercial |
$344.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$355.19
|
| Rate for Payer: Healthscope Whirlpool |
$366.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$329.56
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.25
|
| Rate for Payer: Nomi Health Commercial |
$300.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.63
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$207.30
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$165.84
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
IP
|
$10,002.80
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
48100138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,502.10 |
| Max. Negotiated Rate |
$10,002.80 |
| Rate for Payer: Aetna Commercial |
$9,002.52
|
| Rate for Payer: ASR ASR |
$9,702.72
|
| Rate for Payer: BCBS Trust/PPO |
$8,214.30
|
| Rate for Payer: BCN Commercial |
$8,214.30
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cofinity Commercial |
$9,402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,002.24
|
| Rate for Payer: Healthscope Commercial |
$9,702.72
|
| Rate for Payer: Healthscope Whirlpool |
$10,002.80
|
| Rate for Payer: Mclaren Commercial |
$9,002.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,502.38
|
| Rate for Payer: Nomi Health Commercial |
$8,202.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,502.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,802.46
|
|
|
HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$10,002.80
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
48100138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,947.40 |
| Max. Negotiated Rate |
$10,002.80 |
| Rate for Payer: Aetna Commercial |
$9,002.52
|
| Rate for Payer: Aetna Medicare |
$3,723.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,654.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,654.40
|
| Rate for Payer: ASR ASR |
$9,702.72
|
| Rate for Payer: BCBS Complete |
$2,044.96
|
| Rate for Payer: BCBS MAPPO |
$3,723.52
|
| Rate for Payer: BCBS Trust/PPO |
$8,247.31
|
| Rate for Payer: BCN Commercial |
$8,247.31
|
| Rate for Payer: BCN Medicare Advantage |
$3,723.52
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cofinity Commercial |
$9,402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,002.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,723.52
|
| Rate for Payer: Healthscope Commercial |
$9,702.72
|
| Rate for Payer: Healthscope Whirlpool |
$10,002.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,723.52
|
| Rate for Payer: Mclaren Commercial |
$9,002.52
|
| Rate for Payer: Mclaren Medicaid |
$3,723.52
|
| Rate for Payer: Mclaren Medicare |
$3,723.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,909.70
|
| Rate for Payer: Meridian Medicaid |
$2,044.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,282.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,095.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,502.38
|
| Rate for Payer: Nomi Health Commercial |
$8,202.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,502.10
|
| Rate for Payer: PACE Medicare |
$3,537.34
|
| Rate for Payer: PACE SWMI |
$3,723.52
|
| Rate for Payer: PHP Commercial |
$4,095.87
|
| Rate for Payer: PHP Medicaid |
$1,995.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,723.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,947.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,764.45
|
| Rate for Payer: Priority Health Medicare |
$3,723.52
|
| Rate for Payer: Priority Health Narrow Network |
$7,011.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3,723.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,802.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,723.52
|
| Rate for Payer: UHC Exchange |
$5,771.46
|
| Rate for Payer: UHC Medicaid |
$1,947.40
|
| Rate for Payer: UHCCP DNSP |
$3,723.52
|
| Rate for Payer: UHCCP Medicaid |
$1,947.40
|
| Rate for Payer: VA VA |
$3,723.52
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$60.05
|
| Rate for Payer: BCN Commercial |
$60.05
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.81
|
| Rate for Payer: BCN Commercial |
$59.81
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$17.93
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$9.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$17.93
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$9.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$17.93
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$9.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$228.27
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$228.27 |
| Rate for Payer: Aetna Commercial |
$205.44
|
| Rate for Payer: ASR ASR |
$221.42
|
| Rate for Payer: BCBS Trust/PPO |
$187.46
|
| Rate for Payer: BCN Commercial |
$187.46
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cofinity Commercial |
$214.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.62
|
| Rate for Payer: Healthscope Commercial |
$221.42
|
| Rate for Payer: Healthscope Whirlpool |
$228.27
|
| Rate for Payer: Mclaren Commercial |
$205.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.03
|
| Rate for Payer: Nomi Health Commercial |
$187.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.88
|
|
