|
HC RESPIRATORY VIRAL ID
|
Facility
|
OP
|
$73.24
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
30600182
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.77
|
| Rate for Payer: ASR ASR |
$71.04
|
| Rate for Payer: ASR Commercial |
$71.04
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS MAPPO |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.98
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: BCN Medicare Advantage |
$13.42
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$68.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.42
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$71.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.42
|
| Rate for Payer: Mclaren Commercial |
$65.92
|
| Rate for Payer: Mclaren Medicaid |
$7.19
|
| Rate for Payer: Mclaren Medicare |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.09
|
| Rate for Payer: Meridian Medicaid |
$7.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.25
|
| Rate for Payer: Nomi Health Commercial |
$60.06
|
| Rate for Payer: PACE Medicare |
$12.75
|
| Rate for Payer: PACE SWMI |
$13.42
|
| Rate for Payer: PHP Commercial |
$14.76
|
| Rate for Payer: PHP Medicaid |
$7.19
|
| Rate for Payer: PHP Medicare Advantage |
$13.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.17
|
| Rate for Payer: Priority Health Medicare |
$13.42
|
| Rate for Payer: Priority Health Narrow Network |
$51.34
|
| Rate for Payer: Railroad Medicare Medicare |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.42
|
| Rate for Payer: UHC Exchange |
$20.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: UHCCP DNSP |
$13.42
|
| Rate for Payer: UHCCP Medicaid |
$7.19
|
| Rate for Payer: VA VA |
$13.42
|
|
|
HC RESPIRATORY VIRAL ID
|
Facility
|
IP
|
$73.24
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
30600182
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.61 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: ASR ASR |
$71.04
|
| Rate for Payer: ASR Commercial |
$71.04
|
| Rate for Payer: BCBS Trust/PPO |
$59.68
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$68.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.59
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$71.04
|
| Rate for Payer: Mclaren Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.25
|
| Rate for Payer: Nomi Health Commercial |
$60.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.45
|
|
|
HC RESPIRATORY VIRAL PANEL
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 87300
|
| Hospital Charge Code |
30600134
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$63.34
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: ASR ASR |
$68.27
|
| Rate for Payer: ASR Commercial |
$68.27
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$57.63
|
| Rate for Payer: BCN Commercial |
$54.57
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$66.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Healthscope Whirlpool |
$68.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$63.34
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.67
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$49.34
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC RESPIRATORY VIRAL PANEL
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 87300
|
| Hospital Charge Code |
30600134
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$63.34
|
| Rate for Payer: ASR ASR |
$68.27
|
| Rate for Payer: ASR Commercial |
$68.27
|
| Rate for Payer: BCBS Trust/PPO |
$57.35
|
| Rate for Payer: BCN Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$66.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Healthscope Whirlpool |
$68.27
|
| Rate for Payer: Mclaren Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.93
|
|
|
HC RESP SYNCTIAL VIRUS IG PER 50 MG
|
Facility
|
OP
|
$5,030.37
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
63600156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$385.85 |
| Max. Negotiated Rate |
$5,030.37 |
| Rate for Payer: Aetna Commercial |
$4,527.33
|
| Rate for Payer: Aetna Medicare |
$719.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$899.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$899.84
|
| Rate for Payer: ASR ASR |
$4,879.46
|
| Rate for Payer: ASR Commercial |
$4,879.46
|
| Rate for Payer: BCBS Complete |
$405.14
|
| Rate for Payer: BCBS MAPPO |
$719.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,119.37
|
| Rate for Payer: BCN Commercial |
$3,900.05
|
| Rate for Payer: BCN Medicare Advantage |
$719.87
|
| Rate for Payer: Cash Price |
$4,024.30
|
| Rate for Payer: Cash Price |
$4,024.30
|
| Rate for Payer: Cofinity Commercial |
$4,728.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.87
|
| Rate for Payer: Healthscope Commercial |
$5,030.37
|
| Rate for Payer: Healthscope Whirlpool |
$4,879.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$719.87
|
| Rate for Payer: Mclaren Commercial |
$4,527.33
|
| Rate for Payer: Mclaren Medicaid |
$385.85
|
| Rate for Payer: Mclaren Medicare |
$719.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.86
|
| Rate for Payer: Meridian Medicaid |
$405.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$827.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.81
|
| Rate for Payer: Nomi Health Commercial |
$4,124.90
|
| Rate for Payer: PACE Medicare |
$683.88
|
| Rate for Payer: PACE SWMI |
$719.87
|
| Rate for Payer: PHP Commercial |
$791.86
|
| Rate for Payer: PHP Medicaid |
$385.85
|
| Rate for Payer: PHP Medicare Advantage |
$719.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,407.61
|
| Rate for Payer: Priority Health Medicare |
$719.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,526.29
|
| Rate for Payer: Railroad Medicare Medicare |
$719.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,426.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.87
|
| Rate for Payer: UHC Exchange |
$1,115.80
|
| Rate for Payer: UHC Medicare Advantage |
$719.87
|
| Rate for Payer: UHCCP DNSP |
$719.87
|
| Rate for Payer: UHCCP Medicaid |
$385.85
|
| Rate for Payer: VA VA |
$719.87
|
|
|
HC RESP SYNCTIAL VIRUS IG PER 50 MG
|
Facility
|
IP
|
$5,030.37
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
63600156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,269.74 |
| Max. Negotiated Rate |
$5,030.37 |
| Rate for Payer: Aetna Commercial |
$4,527.33
|
| Rate for Payer: ASR ASR |
$4,879.46
|
| Rate for Payer: ASR Commercial |
$4,879.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,099.25
|
| Rate for Payer: BCN Commercial |
$3,900.05
|
| Rate for Payer: Cash Price |
$4,024.30
|
| Rate for Payer: Cofinity Commercial |
$4,728.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.30
|
| Rate for Payer: Healthscope Commercial |
$5,030.37
|
| Rate for Payer: Healthscope Whirlpool |
$4,879.46
|
| Rate for Payer: Mclaren Commercial |
$4,527.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.81
|
| Rate for Payer: Nomi Health Commercial |
$4,124.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,426.73
|
|
|
HC RESP SYNCYTIAL VIRUS W/OPTIC
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30000172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: ASR ASR |
$21.77
|
| Rate for Payer: ASR Commercial |
$21.77
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$21.77
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.07
|
| Rate for Payer: Nomi Health Commercial |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.75
|
|
|
HC RESP SYNCYTIAL VIRUS W/OPTIC
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30000172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.38
|
| Rate for Payer: ASR ASR |
$21.77
|
| Rate for Payer: ASR Commercial |
$21.77
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.10
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$21.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$7.02
|
| Rate for Payer: Mclaren Medicare |
$13.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$7.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.07
|
| Rate for Payer: Nomi Health Commercial |
$18.40
|
| Rate for Payer: PACE Medicare |
$12.45
|
| Rate for Payer: PACE SWMI |
$13.10
|
| Rate for Payer: PHP Commercial |
$14.41
|
| Rate for Payer: PHP Medicaid |
$7.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.66
|
| Rate for Payer: Priority Health Medicare |
$13.10
|
| Rate for Payer: Priority Health Narrow Network |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.10
|
| Rate for Payer: UHC Exchange |
$20.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.10
|
| Rate for Payer: UHCCP DNSP |
$13.10
|
| Rate for Payer: UHCCP Medicaid |
$7.02
|
| Rate for Payer: VA VA |
$13.10
|
|
|
HC RESP VIRAL PANEL BORDETELLA
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600189
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC RESP VIRAL PANEL BORDETELLA
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600189
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC RESP VIRAL PANEL CHLAMYDIA
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
30600186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC RESP VIRAL PANEL CHLAMYDIA
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
30600186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC RESP VIRAL PANEL MYCOPLASMA
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
30600185
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC RESP VIRAL PANEL MYCOPLASMA
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
30600185
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
IP
|
$624.24
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$405.76 |
| Max. Negotiated Rate |
$624.24 |
| Rate for Payer: Aetna Commercial |
$561.82
|
| Rate for Payer: ASR ASR |
$605.51
|
| Rate for Payer: ASR Commercial |
$605.51
|
| Rate for Payer: BCBS Trust/PPO |
$508.69
|
| Rate for Payer: BCN Commercial |
$483.97
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Commercial |
$586.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Healthscope Commercial |
$624.24
|
| Rate for Payer: Healthscope Whirlpool |
$605.51
|
| Rate for Payer: Mclaren Commercial |
$561.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Nomi Health Commercial |
$511.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$549.33
|
|
|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
OP
|
$624.24
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$646.01 |
| Rate for Payer: Aetna Commercial |
$561.82
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$605.51
|
| Rate for Payer: ASR Commercial |
$605.51
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$511.19
|
| Rate for Payer: BCN Commercial |
$483.97
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Commercial |
$586.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$624.24
|
| Rate for Payer: Healthscope Whirlpool |
$605.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$561.82
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Nomi Health Commercial |
$511.88
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$223.39
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.96
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$437.59
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$549.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$646.01
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP DNSP |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$223.39
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
OP
|
$18.85
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna Medicare |
$9.43
|
| Rate for Payer: ASR ASR |
$18.28
|
| Rate for Payer: ASR Commercial |
$18.28
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$18.28
|
| Rate for Payer: Mclaren Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.52
|
| Rate for Payer: Priority Health Narrow Network |
$13.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
IP
|
$18.85
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: ASR ASR |
$18.28
|
| Rate for Payer: ASR Commercial |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.36
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$18.28
|
| Rate for Payer: Mclaren Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
IP
|
$275.71
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$275.71 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: ASR ASR |
$267.44
|
| Rate for Payer: ASR Commercial |
$267.44
|
| Rate for Payer: BCBS Trust/PPO |
$224.68
|
| Rate for Payer: BCN Commercial |
$213.76
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$275.71
|
| Rate for Payer: Healthscope Whirlpool |
$267.44
|
| Rate for Payer: Mclaren Commercial |
$248.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.62
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
OP
|
$275.71
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$267.44
|
| Rate for Payer: ASR Commercial |
$267.44
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$225.78
|
| Rate for Payer: BCN Commercial |
$213.76
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$275.71
|
| Rate for Payer: Healthscope Whirlpool |
$267.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$248.14
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.58
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$193.27
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
OP
|
$41.51
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$41.51 |
| Rate for Payer: Aetna Commercial |
$37.36
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: ASR ASR |
$40.26
|
| Rate for Payer: ASR Commercial |
$40.26
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$33.99
|
| Rate for Payer: BCN Commercial |
$32.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$41.51
|
| Rate for Payer: Healthscope Whirlpool |
$40.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$37.36
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.28
|
| Rate for Payer: Nomi Health Commercial |
$34.04
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$6.13
|
| Rate for Payer: PHP Medicaid |
$2.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.37
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$29.10
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$8.63
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP DNSP |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
IP
|
$41.51
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$41.51 |
| Rate for Payer: Aetna Commercial |
$37.36
|
| Rate for Payer: ASR ASR |
$40.26
|
| Rate for Payer: ASR Commercial |
$40.26
|
| Rate for Payer: BCBS Trust/PPO |
$33.83
|
| Rate for Payer: BCN Commercial |
$32.18
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.21
|
| Rate for Payer: Healthscope Commercial |
$41.51
|
| Rate for Payer: Healthscope Whirlpool |
$40.26
|
| Rate for Payer: Mclaren Commercial |
$37.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.28
|
| Rate for Payer: Nomi Health Commercial |
$34.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.53
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
OP
|
$19,352.18
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,740.87 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: Aetna Medicare |
$9,676.09
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Complete |
$7,740.87
|
| Rate for Payer: BCBS Trust/PPO |
$15,847.50
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,956.38
|
| Rate for Payer: Priority Health Narrow Network |
$13,565.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
IP
|
$19,352.18
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,578.92 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,770.09
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
IP
|
$19,352.18
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,578.92 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,770.09
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
