|
HC RADXF UNL ULTRASOUND 76999
|
Facility
|
OP
|
$217.26
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
40200051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$395.84 |
| Rate for Payer: Aetna Commercial |
$195.53
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$210.74
|
| Rate for Payer: ASR Commercial |
$210.74
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$177.91
|
| Rate for Payer: BCN Commercial |
$168.44
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$204.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$217.26
|
| Rate for Payer: Healthscope Whirlpool |
$210.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$195.53
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.67
|
| Rate for Payer: Nomi Health Commercial |
$178.15
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.84
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$316.67
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC RADXF UNL ULTRASOUND 76999
|
Facility
|
IP
|
$217.26
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
40200051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$217.26 |
| Rate for Payer: Aetna Commercial |
$195.53
|
| Rate for Payer: ASR ASR |
$210.74
|
| Rate for Payer: ASR Commercial |
$210.74
|
| Rate for Payer: BCBS Trust/PPO |
$177.05
|
| Rate for Payer: BCN Commercial |
$168.44
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$204.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.81
|
| Rate for Payer: Healthscope Commercial |
$217.26
|
| Rate for Payer: Healthscope Whirlpool |
$210.74
|
| Rate for Payer: Mclaren Commercial |
$195.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.67
|
| Rate for Payer: Nomi Health Commercial |
$178.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.19
|
|
|
HC RAGWEED SHORT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RAGWEED SHORT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC RAJI CELL ASSAY
|
Facility
|
OP
|
$150.96
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: Aetna Medicare |
$24.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.46
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: ASR Commercial |
$146.43
|
| Rate for Payer: BCBS Complete |
$13.72
|
| Rate for Payer: BCBS MAPPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: BCN Medicare Advantage |
$24.37
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.37
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Mclaren Medicaid |
$13.06
|
| Rate for Payer: Mclaren Medicare |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.59
|
| Rate for Payer: Meridian Medicaid |
$13.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: PACE Medicare |
$23.15
|
| Rate for Payer: PACE SWMI |
$24.37
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: PHP Medicaid |
$13.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.27
|
| Rate for Payer: Priority Health Medicare |
$24.37
|
| Rate for Payer: Priority Health Narrow Network |
$105.82
|
| Rate for Payer: Railroad Medicare Medicare |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.37
|
| Rate for Payer: UHC Exchange |
$37.77
|
| Rate for Payer: UHC Medicare Advantage |
$24.37
|
| Rate for Payer: UHCCP DNSP |
$24.37
|
| Rate for Payer: UHCCP Medicaid |
$13.06
|
| Rate for Payer: VA VA |
$24.37
|
|
|
HC RAJI CELL ASSAY
|
Facility
|
IP
|
$150.96
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.12 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: ASR Commercial |
$146.43
|
| Rate for Payer: BCBS Trust/PPO |
$123.02
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
|
|
HC RAPID DESENSITIZATION PROC EA HOUR
|
Facility
|
IP
|
$540.75
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.49 |
| Max. Negotiated Rate |
$540.75 |
| Rate for Payer: Aetna Commercial |
$486.68
|
| Rate for Payer: ASR ASR |
$524.53
|
| Rate for Payer: ASR Commercial |
$524.53
|
| Rate for Payer: BCBS Trust/PPO |
$440.66
|
| Rate for Payer: BCN Commercial |
$419.24
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cofinity Commercial |
$508.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.60
|
| Rate for Payer: Healthscope Commercial |
$540.75
|
| Rate for Payer: Healthscope Whirlpool |
$524.53
|
| Rate for Payer: Mclaren Commercial |
$486.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.64
|
| Rate for Payer: Nomi Health Commercial |
$443.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.86
|
|
|
HC RAPID DESENSITIZATION PROC EA HOUR
|
Facility
|
OP
|
$540.75
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna Commercial |
$486.68
|
| Rate for Payer: Aetna Medicare |
$390.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: ASR ASR |
$524.53
|
| Rate for Payer: ASR Commercial |
$524.53
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$442.82
|
| Rate for Payer: BCN Commercial |
$419.24
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cofinity Commercial |
$508.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$540.75
|
| Rate for Payer: Healthscope Whirlpool |
$524.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$390.97
|
| Rate for Payer: Mclaren Commercial |
$486.68
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.64
|
| Rate for Payer: Nomi Health Commercial |
$443.42
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$430.07
|
| Rate for Payer: PHP Medicaid |
$209.56
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$473.81
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$379.07
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$606.00
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP DNSP |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC RAPID HIV ANTIBODY
|
Facility
|
OP
|
$153.71
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$153.71 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: ASR ASR |
$149.10
|
| Rate for Payer: ASR Commercial |
$149.10
|
| Rate for Payer: BCBS Complete |
$5.00
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$125.87
|
| Rate for Payer: BCN Commercial |
$119.17
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$144.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$153.71
|
| Rate for Payer: Healthscope Whirlpool |
$149.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.89
|
| Rate for Payer: Mclaren Commercial |
$138.34
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: Meridian Medicaid |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$126.04
|
| Rate for Payer: PACE Medicare |
$8.45
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: PHP Medicaid |
$4.77
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.68
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$107.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.89
|
| Rate for Payer: UHC Exchange |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$8.89
|
| Rate for Payer: UHCCP DNSP |
$8.89
|
| Rate for Payer: UHCCP Medicaid |
$4.77
|
| Rate for Payer: VA VA |
$8.89
|
|
|
HC RAPID HIV ANTIBODY
|
Facility
|
IP
|
$153.71
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$153.71 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: ASR ASR |
$149.10
|
| Rate for Payer: ASR Commercial |
$149.10
|
| Rate for Payer: BCBS Trust/PPO |
$125.26
|
| Rate for Payer: BCN Commercial |
$119.17
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$144.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Healthscope Commercial |
$153.71
|
| Rate for Payer: Healthscope Whirlpool |
$149.10
|
| Rate for Payer: Mclaren Commercial |
$138.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$126.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.26
|
|
|
HC RAPID INFLUENZA A & B SCREEN
|
Facility
|
OP
|
$77.93
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
30600174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$70.14
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.69
|
| Rate for Payer: ASR ASR |
$75.59
|
| Rate for Payer: ASR Commercial |
$75.59
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS MAPPO |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$63.82
|
| Rate for Payer: BCN Commercial |
$60.42
|
| Rate for Payer: BCN Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$62.34
|
| Rate for Payer: Cash Price |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$73.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$77.93
|
| Rate for Payer: Healthscope Whirlpool |
$75.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.55
|
| Rate for Payer: Mclaren Commercial |
$70.14
|
| Rate for Payer: Mclaren Medicaid |
$8.87
|
| Rate for Payer: Mclaren Medicare |
$16.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.38
|
| Rate for Payer: Meridian Medicaid |
$9.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$63.90
|
| Rate for Payer: PACE Medicare |
$15.72
|
| Rate for Payer: PACE SWMI |
$16.55
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Medicaid |
$8.87
|
| Rate for Payer: PHP Medicare Advantage |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.12
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow Network |
$104.10
|
| Rate for Payer: Railroad Medicare Medicare |
$16.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.55
|
| Rate for Payer: UHC Exchange |
$25.65
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: UHCCP DNSP |
$16.55
|
| Rate for Payer: UHCCP Medicaid |
$8.87
|
| Rate for Payer: VA VA |
$16.55
|
|
|
HC RAPID INFLUENZA A & B SCREEN
|
Facility
|
IP
|
$77.93
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
30600174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.65 |
| Max. Negotiated Rate |
$77.93 |
| Rate for Payer: Aetna Commercial |
$70.14
|
| Rate for Payer: ASR ASR |
$75.59
|
| Rate for Payer: ASR Commercial |
$75.59
|
| Rate for Payer: BCBS Trust/PPO |
$63.51
|
| Rate for Payer: BCN Commercial |
$60.42
|
| Rate for Payer: Cash Price |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$73.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.34
|
| Rate for Payer: Healthscope Commercial |
$77.93
|
| Rate for Payer: Healthscope Whirlpool |
$75.59
|
| Rate for Payer: Mclaren Commercial |
$70.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.58
|
|
|
HC RAPID INFUSER
|
Facility
|
OP
|
$1,432.45
|
|
| Hospital Charge Code |
27000294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$572.98 |
| Max. Negotiated Rate |
$1,432.45 |
| Rate for Payer: Aetna Commercial |
$1,289.20
|
| Rate for Payer: Aetna Medicare |
$716.22
|
| Rate for Payer: ASR ASR |
$1,389.48
|
| Rate for Payer: ASR Commercial |
$1,389.48
|
| Rate for Payer: BCBS Complete |
$572.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.03
|
| Rate for Payer: BCN Commercial |
$1,110.58
|
| Rate for Payer: Cash Price |
$1,145.96
|
| Rate for Payer: Cofinity Commercial |
$1,346.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,145.96
|
| Rate for Payer: Healthscope Commercial |
$1,432.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,389.48
|
| Rate for Payer: Mclaren Commercial |
$1,289.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,217.58
|
| Rate for Payer: Nomi Health Commercial |
$1,174.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$931.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,255.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,004.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,260.56
|
|
|
HC RAPID INFUSER
|
Facility
|
IP
|
$1,432.45
|
|
| Hospital Charge Code |
27000294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$931.09 |
| Max. Negotiated Rate |
$1,432.45 |
| Rate for Payer: Aetna Commercial |
$1,289.20
|
| Rate for Payer: ASR ASR |
$1,389.48
|
| Rate for Payer: ASR Commercial |
$1,389.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.30
|
| Rate for Payer: BCN Commercial |
$1,110.58
|
| Rate for Payer: Cash Price |
$1,145.96
|
| Rate for Payer: Cofinity Commercial |
$1,346.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,145.96
|
| Rate for Payer: Healthscope Commercial |
$1,432.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,389.48
|
| Rate for Payer: Mclaren Commercial |
$1,289.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,217.58
|
| Rate for Payer: Nomi Health Commercial |
$1,174.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$931.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,260.56
|
|
|
HC RAPID MALARIA ASSAY
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.07
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicaid |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.07
|
| Rate for Payer: UHCCP DNSP |
$16.07
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC RAPID MALARIA ASSAY
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600298
|
|
Hospital Revenue Code
|
306
|
| 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 RAPID STREP SCREEN.
|
Facility
|
IP
|
$61.70
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
30600176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.10 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: ASR ASR |
$59.85
|
| Rate for Payer: ASR Commercial |
$59.85
|
| Rate for Payer: BCBS Trust/PPO |
$50.28
|
| Rate for Payer: BCN Commercial |
$47.84
|
| Rate for Payer: Cash Price |
$49.36
|
| Rate for Payer: Cofinity Commercial |
$58.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.36
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Healthscope Whirlpool |
$59.85
|
| Rate for Payer: Mclaren Commercial |
$55.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.30
|
|
|
HC RAPID STREP SCREEN.
|
Facility
|
OP
|
$61.70
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
30600176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: Aetna Medicare |
$16.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.66
|
| Rate for Payer: ASR ASR |
$59.85
|
| Rate for Payer: ASR Commercial |
$59.85
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$50.53
|
| Rate for Payer: BCN Commercial |
$47.84
|
| Rate for Payer: BCN Medicare Advantage |
$16.53
|
| Rate for Payer: Cash Price |
$49.36
|
| Rate for Payer: Cash Price |
$49.36
|
| Rate for Payer: Cofinity Commercial |
$58.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.53
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Healthscope Whirlpool |
$59.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.53
|
| Rate for Payer: Mclaren Commercial |
$55.53
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Mclaren Medicare |
$16.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.36
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: PACE Medicare |
$15.70
|
| Rate for Payer: PACE SWMI |
$16.53
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: PHP Medicaid |
$8.86
|
| Rate for Payer: PHP Medicare Advantage |
$16.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.06
|
| Rate for Payer: Priority Health Medicare |
$16.53
|
| Rate for Payer: Priority Health Narrow Network |
$43.25
|
| Rate for Payer: Railroad Medicare Medicare |
$16.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.53
|
| Rate for Payer: UHC Exchange |
$25.62
|
| Rate for Payer: UHC Medicare Advantage |
$16.53
|
| Rate for Payer: UHCCP DNSP |
$16.53
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.53
|
|
|
HC RAVAS CTO/DES
|
Facility
|
OP
|
$29,673.35
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,110.45 |
| Max. Negotiated Rate |
$29,673.35 |
| Rate for Payer: Aetna Commercial |
$26,706.02
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: ASR ASR |
$28,783.15
|
| Rate for Payer: ASR Commercial |
$28,783.15
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$24,299.51
|
| Rate for Payer: BCN Commercial |
$23,005.75
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$27,892.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$29,673.35
|
| Rate for Payer: Healthscope Whirlpool |
$28,783.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$26,706.02
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: Nomi Health Commercial |
$24,332.15
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,888.06
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$7,110.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,112.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
HC RAVAS CTO/DES
|
Facility
|
IP
|
$29,673.35
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,287.68 |
| Max. Negotiated Rate |
$29,673.35 |
| Rate for Payer: Aetna Commercial |
$26,706.02
|
| Rate for Payer: ASR ASR |
$28,783.15
|
| Rate for Payer: ASR Commercial |
$28,783.15
|
| Rate for Payer: BCBS Trust/PPO |
$24,180.81
|
| Rate for Payer: BCN Commercial |
$23,005.75
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$27,892.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Healthscope Commercial |
$29,673.35
|
| Rate for Payer: Healthscope Whirlpool |
$28,783.15
|
| Rate for Payer: Mclaren Commercial |
$26,706.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: Nomi Health Commercial |
$24,332.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,112.55
|
|
|
HC RAVAS CTO/STENT
|
Facility
|
IP
|
$29,673.35
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,287.68 |
| Max. Negotiated Rate |
$29,673.35 |
| Rate for Payer: Aetna Commercial |
$26,706.02
|
| Rate for Payer: ASR ASR |
$28,783.15
|
| Rate for Payer: ASR Commercial |
$28,783.15
|
| Rate for Payer: BCBS Trust/PPO |
$24,180.81
|
| Rate for Payer: BCN Commercial |
$23,005.75
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$27,892.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Healthscope Commercial |
$29,673.35
|
| Rate for Payer: Healthscope Whirlpool |
$28,783.15
|
| Rate for Payer: Mclaren Commercial |
$26,706.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: Nomi Health Commercial |
$24,332.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,112.55
|
|
|
HC RAVAS CTO/STENT
|
Facility
|
OP
|
$29,673.35
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,596.67 |
| Max. Negotiated Rate |
$29,673.35 |
| Rate for Payer: Aetna Commercial |
$26,706.02
|
| Rate for Payer: Aetna Medicare |
$11,111.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: ASR ASR |
$28,783.15
|
| Rate for Payer: ASR Commercial |
$28,783.15
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$24,299.51
|
| Rate for Payer: BCN Commercial |
$23,005.75
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$27,892.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$29,673.35
|
| Rate for Payer: Healthscope Whirlpool |
$28,783.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,111.26
|
| Rate for Payer: Mclaren Commercial |
$26,706.02
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: Nomi Health Commercial |
$24,332.15
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$12,222.39
|
| Rate for Payer: PHP Medicaid |
$5,955.64
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,995.84
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,112.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$17,222.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP DNSP |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
OP
|
$725.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$95.58 |
| Max. Negotiated Rate |
$725.60 |
| Rate for Payer: Aetna Commercial |
$653.04
|
| Rate for Payer: Aetna Medicare |
$178.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.90
|
| Rate for Payer: ASR ASR |
$703.83
|
| Rate for Payer: ASR Commercial |
$703.83
|
| Rate for Payer: BCBS Complete |
$100.36
|
| Rate for Payer: BCBS MAPPO |
$178.32
|
| Rate for Payer: BCBS Trust/PPO |
$594.19
|
| Rate for Payer: BCN Commercial |
$562.56
|
| Rate for Payer: BCN Medicare Advantage |
$178.32
|
| Rate for Payer: Cash Price |
$580.48
|
| Rate for Payer: Cash Price |
$580.48
|
| Rate for Payer: Cofinity Commercial |
$682.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$580.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.32
|
| Rate for Payer: Healthscope Commercial |
$725.60
|
| Rate for Payer: Healthscope Whirlpool |
$703.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$178.32
|
| Rate for Payer: Mclaren Commercial |
$653.04
|
| Rate for Payer: Mclaren Medicaid |
$95.58
|
| Rate for Payer: Mclaren Medicare |
$178.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.24
|
| Rate for Payer: Meridian Medicaid |
$100.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.76
|
| Rate for Payer: Nomi Health Commercial |
$594.99
|
| Rate for Payer: PACE Medicare |
$169.40
|
| Rate for Payer: PACE SWMI |
$178.32
|
| Rate for Payer: PHP Commercial |
$196.15
|
| Rate for Payer: PHP Medicaid |
$95.58
|
| Rate for Payer: PHP Medicare Advantage |
$178.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.14
|
| Rate for Payer: Priority Health Medicare |
$178.32
|
| Rate for Payer: Priority Health Narrow Network |
$252.11
|
| Rate for Payer: Railroad Medicare Medicare |
$178.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$638.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.32
|
| Rate for Payer: UHC Exchange |
$276.40
|
| Rate for Payer: UHC Medicare Advantage |
$178.32
|
| Rate for Payer: UHCCP DNSP |
$178.32
|
| Rate for Payer: UHCCP Medicaid |
$95.58
|
| Rate for Payer: VA VA |
$178.32
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
IP
|
$725.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$471.64 |
| Max. Negotiated Rate |
$725.60 |
| Rate for Payer: Aetna Commercial |
$653.04
|
| Rate for Payer: ASR ASR |
$703.83
|
| Rate for Payer: ASR Commercial |
$703.83
|
| Rate for Payer: BCBS Trust/PPO |
$591.29
|
| Rate for Payer: BCN Commercial |
$562.56
|
| Rate for Payer: Cash Price |
$580.48
|
| Rate for Payer: Cofinity Commercial |
$682.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$580.48
|
| Rate for Payer: Healthscope Commercial |
$725.60
|
| Rate for Payer: Healthscope Whirlpool |
$703.83
|
| Rate for Payer: Mclaren Commercial |
$653.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.76
|
| Rate for Payer: Nomi Health Commercial |
$594.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$638.53
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.34 |
| Max. Negotiated Rate |
$1,257.09 |
| Rate for Payer: Aetna Commercial |
$1,131.38
|
| Rate for Payer: Aetna Medicare |
$250.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$313.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$313.29
|
| Rate for Payer: ASR ASR |
$1,219.38
|
| Rate for Payer: ASR Commercial |
$1,219.38
|
| Rate for Payer: BCBS Complete |
$141.05
|
| Rate for Payer: BCBS MAPPO |
$250.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.43
|
| Rate for Payer: BCN Commercial |
$974.62
|
| Rate for Payer: BCN Medicare Advantage |
$250.63
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.63
|
| Rate for Payer: Healthscope Commercial |
$1,257.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,219.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$250.63
|
| Rate for Payer: Mclaren Commercial |
$1,131.38
|
| Rate for Payer: Mclaren Medicaid |
$134.34
|
| Rate for Payer: Mclaren Medicare |
$250.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.16
|
| Rate for Payer: Meridian Medicaid |
$141.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: Nomi Health Commercial |
$1,030.81
|
| Rate for Payer: PACE Medicare |
$238.10
|
| Rate for Payer: PACE SWMI |
$250.63
|
| Rate for Payer: PHP Commercial |
$275.69
|
| Rate for Payer: PHP Medicaid |
$134.34
|
| Rate for Payer: PHP Medicare Advantage |
$250.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.62
|
| Rate for Payer: Priority Health Medicare |
$250.63
|
| Rate for Payer: Priority Health Narrow Network |
$435.70
|
| Rate for Payer: Railroad Medicare Medicare |
$250.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.63
|
| Rate for Payer: UHC Exchange |
$388.48
|
| Rate for Payer: UHC Medicare Advantage |
$250.63
|
| Rate for Payer: UHCCP DNSP |
$250.63
|
| Rate for Payer: UHCCP Medicaid |
$134.34
|
| Rate for Payer: VA VA |
$250.63
|
|
