|
HC RIBOSOME P AB, IGG
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
OP
|
$3,767.24
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.61 |
| Max. Negotiated Rate |
$3,767.24 |
| Rate for Payer: Aetna Commercial |
$3,390.52
|
| Rate for Payer: Aetna Medicare |
$1,183.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,479.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,479.97
|
| Rate for Payer: ASR ASR |
$3,654.22
|
| Rate for Payer: ASR Commercial |
$3,654.22
|
| Rate for Payer: BCBS Complete |
$666.34
|
| Rate for Payer: BCBS MAPPO |
$1,183.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,084.99
|
| Rate for Payer: BCN Commercial |
$2,920.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,183.98
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cofinity Commercial |
$3,541.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,183.98
|
| Rate for Payer: Healthscope Commercial |
$3,767.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,654.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,183.98
|
| Rate for Payer: Mclaren Commercial |
$3,390.52
|
| Rate for Payer: Mclaren Medicaid |
$634.61
|
| Rate for Payer: Mclaren Medicare |
$1,183.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.18
|
| Rate for Payer: Meridian Medicaid |
$666.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,361.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.15
|
| Rate for Payer: Nomi Health Commercial |
$3,089.14
|
| Rate for Payer: PACE Medicare |
$1,124.78
|
| Rate for Payer: PACE SWMI |
$1,183.98
|
| Rate for Payer: PHP Commercial |
$1,302.38
|
| Rate for Payer: PHP Medicaid |
$634.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,183.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,300.86
|
| Rate for Payer: Priority Health Medicare |
$1,183.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,640.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,183.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,315.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,183.98
|
| Rate for Payer: UHC Exchange |
$1,835.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,183.98
|
| Rate for Payer: UHCCP DNSP |
$1,183.98
|
| Rate for Payer: UHCCP Medicaid |
$634.61
|
| Rate for Payer: VA VA |
$1,183.98
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
IP
|
$3,767.24
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,448.71 |
| Max. Negotiated Rate |
$3,767.24 |
| Rate for Payer: Aetna Commercial |
$3,390.52
|
| Rate for Payer: ASR ASR |
$3,654.22
|
| Rate for Payer: ASR Commercial |
$3,654.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,069.92
|
| Rate for Payer: BCN Commercial |
$2,920.74
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cofinity Commercial |
$3,541.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.79
|
| Rate for Payer: Healthscope Commercial |
$3,767.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,654.22
|
| Rate for Payer: Mclaren Commercial |
$3,390.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.15
|
| Rate for Payer: Nomi Health Commercial |
$3,089.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,315.17
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$113.22
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| Rate for Payer: ASR ASR |
$109.82
|
| Rate for Payer: ASR Commercial |
$109.82
|
| Rate for Payer: BCBS Trust/PPO |
$92.26
|
| Rate for Payer: BCN Commercial |
$87.78
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Commercial |
$106.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$113.22
|
| Rate for Payer: Healthscope Whirlpool |
$109.82
|
| Rate for Payer: Mclaren Commercial |
$101.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.24
|
| Rate for Payer: Nomi Health Commercial |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.63
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
OP
|
$113.22
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$101.90
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: ASR ASR |
$109.82
|
| Rate for Payer: ASR Commercial |
$109.82
|
| Rate for Payer: BCBS Complete |
$45.29
|
| Rate for Payer: BCBS Trust/PPO |
$92.72
|
| Rate for Payer: BCN Commercial |
$87.78
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Commercial |
$106.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$113.22
|
| Rate for Payer: Healthscope Whirlpool |
$109.82
|
| Rate for Payer: Mclaren Commercial |
$101.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.24
|
| Rate for Payer: Nomi Health Commercial |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.20
|
| Rate for Payer: Priority Health Narrow Network |
$79.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.63
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$69.08
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$62.17
|
| 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 |
$67.01
|
| Rate for Payer: ASR Commercial |
$67.01
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$56.57
|
| Rate for Payer: BCN Commercial |
$53.56
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$55.26
|
| Rate for Payer: Cash Price |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$64.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Healthscope Whirlpool |
$67.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$62.17
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| 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 |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.72
|
| Rate for Payer: Nomi Health Commercial |
$56.65
|
| 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 |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.53
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$48.43
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.30
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$69.08
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$62.17
|
| Rate for Payer: ASR ASR |
$67.01
|
| Rate for Payer: ASR Commercial |
$67.01
|
| Rate for Payer: BCBS Trust/PPO |
$56.29
|
| Rate for Payer: BCN Commercial |
$53.56
|
| Rate for Payer: Cash Price |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$64.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.26
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Healthscope Whirlpool |
$67.01
|
| Rate for Payer: Mclaren Commercial |
$62.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.72
|
| Rate for Payer: Nomi Health Commercial |
$56.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.79
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$95.17
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: ASR ASR |
$92.31
|
| Rate for Payer: ASR Commercial |
$92.31
|
| Rate for Payer: BCBS Trust/PPO |
$77.55
|
| Rate for Payer: BCN Commercial |
$73.79
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Commercial |
$89.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Healthscope Whirlpool |
$92.31
|
| Rate for Payer: Mclaren Commercial |
$85.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Nomi Health Commercial |
$78.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.75
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$95.17
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: ASR ASR |
$92.31
|
| Rate for Payer: ASR Commercial |
$92.31
|
| Rate for Payer: BCBS Complete |
$38.07
|
| Rate for Payer: BCBS Trust/PPO |
$77.93
|
| Rate for Payer: BCN Commercial |
$73.79
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Commercial |
$89.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Healthscope Whirlpool |
$92.31
|
| Rate for Payer: Mclaren Commercial |
$85.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Nomi Health Commercial |
$78.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.39
|
| Rate for Payer: Priority Health Narrow Network |
$66.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.75
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$11,199.49
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$11,199.49 |
| Rate for Payer: Aetna Commercial |
$10,079.54
|
| Rate for Payer: Aetna Medicare |
$3,136.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: ASR ASR |
$10,863.51
|
| Rate for Payer: ASR Commercial |
$10,863.51
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCBS Trust/PPO |
$9,171.26
|
| Rate for Payer: BCN Commercial |
$8,682.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$8,959.59
|
| Rate for Payer: Cash Price |
$8,959.59
|
| Rate for Payer: Cofinity Commercial |
$10,527.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$11,199.49
|
| Rate for Payer: Healthscope Whirlpool |
$10,863.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,136.90
|
| Rate for Payer: Mclaren Commercial |
$10,079.54
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.57
|
| Rate for Payer: Nomi Health Commercial |
$9,183.58
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$3,450.59
|
| Rate for Payer: PHP Medicaid |
$1,681.38
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,812.99
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health Narrow Network |
$7,850.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,855.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Exchange |
$4,862.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP DNSP |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,681.38
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$11,199.49
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,279.67 |
| Max. Negotiated Rate |
$11,199.49 |
| Rate for Payer: Aetna Commercial |
$10,079.54
|
| Rate for Payer: ASR ASR |
$10,863.51
|
| Rate for Payer: ASR Commercial |
$10,863.51
|
| Rate for Payer: BCBS Trust/PPO |
$9,126.46
|
| Rate for Payer: BCN Commercial |
$8,682.96
|
| Rate for Payer: Cash Price |
$8,959.59
|
| Rate for Payer: Cofinity Commercial |
$10,527.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.59
|
| Rate for Payer: Healthscope Commercial |
$11,199.49
|
| Rate for Payer: Healthscope Whirlpool |
$10,863.51
|
| Rate for Payer: Mclaren Commercial |
$10,079.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.57
|
| Rate for Payer: Nomi Health Commercial |
$9,183.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,855.55
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: ASR Commercial |
$2,325.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.32
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$2,325.09
|
| Rate for Payer: ASR Commercial |
$2,325.09
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.90
|
| Rate for Payer: BCN Commercial |
$1,858.39
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$2,253.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$2,397.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$2,157.30
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.45
|
| Rate for Payer: Nomi Health Commercial |
$1,965.54
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,100.25
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,680.30
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.35 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: ASR ASR |
$348.23
|
| Rate for Payer: ASR Commercial |
$348.23
|
| Rate for Payer: BCBS Trust/PPO |
$292.55
|
| Rate for Payer: BCN Commercial |
$278.33
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$337.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.20
|
| Rate for Payer: Healthscope Commercial |
$359.00
|
| Rate for Payer: Healthscope Whirlpool |
$348.23
|
| Rate for Payer: Mclaren Commercial |
$323.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.15
|
| Rate for Payer: Nomi Health Commercial |
$294.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.92
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$348.23
|
| Rate for Payer: ASR Commercial |
$348.23
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$293.99
|
| Rate for Payer: BCN Commercial |
$278.33
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$337.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$359.00
|
| Rate for Payer: Healthscope Whirlpool |
$348.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$323.10
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.15
|
| Rate for Payer: Nomi Health Commercial |
$294.38
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.56
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$251.66
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| 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 |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| 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 |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| 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 |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.56
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$50.05
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| 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 |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| 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 |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| 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 |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| 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 |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| 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 |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| 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 |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.65
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$223.79
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.52 |
| Max. Negotiated Rate |
$223.79 |
| Rate for Payer: Aetna Commercial |
$201.41
|
| Rate for Payer: Aetna Medicare |
$111.89
|
| Rate for Payer: ASR ASR |
$217.08
|
| Rate for Payer: ASR Commercial |
$217.08
|
| Rate for Payer: BCBS Complete |
$89.52
|
| Rate for Payer: BCBS Trust/PPO |
$183.26
|
| Rate for Payer: BCN Commercial |
$173.50
|
| Rate for Payer: Cash Price |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$210.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.03
|
| Rate for Payer: Healthscope Commercial |
$223.79
|
| Rate for Payer: Healthscope Whirlpool |
$217.08
|
| Rate for Payer: Mclaren Commercial |
$201.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.22
|
| Rate for Payer: Nomi Health Commercial |
$183.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.08
|
| Rate for Payer: Priority Health Narrow Network |
$156.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.94
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$223.79
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$145.46 |
| Max. Negotiated Rate |
$223.79 |
| Rate for Payer: Aetna Commercial |
$201.41
|
| Rate for Payer: ASR ASR |
$217.08
|
| Rate for Payer: ASR Commercial |
$217.08
|
| Rate for Payer: BCBS Trust/PPO |
$182.37
|
| Rate for Payer: BCN Commercial |
$173.50
|
| Rate for Payer: Cash Price |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$210.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.03
|
| Rate for Payer: Healthscope Commercial |
$223.79
|
| Rate for Payer: Healthscope Whirlpool |
$217.08
|
| Rate for Payer: Mclaren Commercial |
$201.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.22
|
| Rate for Payer: Nomi Health Commercial |
$183.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.94
|
|
