|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Trust/PPO |
$57.52
|
| Rate for Payer: BCN Commercial |
$57.52
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
|
|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$63.04
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.01
|
| Rate for Payer: ASR ASR |
$67.94
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS MAPPO |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$57.75
|
| Rate for Payer: BCN Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.41
|
| Rate for Payer: Healthscope Commercial |
$67.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$14.41
|
| Rate for Payer: Mclaren Medicare |
$14.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.13
|
| Rate for Payer: Meridian Medicaid |
$7.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$13.69
|
| Rate for Payer: PACE SWMI |
$14.41
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: PHP Medicaid |
$7.72
|
| Rate for Payer: PHP Medicare Advantage |
$14.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.73
|
| Rate for Payer: Priority Health Medicare |
$14.41
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: Railroad Medicare Medicare |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.41
|
| Rate for Payer: UHC Exchange |
$22.34
|
| Rate for Payer: UHC Medicaid |
$7.54
|
| Rate for Payer: UHCCP DNSP |
$14.41
|
| Rate for Payer: UHCCP Medicaid |
$7.54
|
| Rate for Payer: VA VA |
$14.41
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
IP
|
$2,379.77
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,784.83 |
| Max. Negotiated Rate |
$2,379.77 |
| Rate for Payer: Aetna Commercial |
$2,141.79
|
| Rate for Payer: ASR ASR |
$2,308.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,954.27
|
| Rate for Payer: BCN Commercial |
$1,954.27
|
| Rate for Payer: Cash Price |
$1,903.82
|
| Rate for Payer: Cofinity Commercial |
$2,236.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,903.82
|
| Rate for Payer: Healthscope Commercial |
$2,308.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,379.77
|
| Rate for Payer: Mclaren Commercial |
$2,141.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,022.80
|
| Rate for Payer: Nomi Health Commercial |
$1,951.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,784.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,094.20
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
OP
|
$2,379.77
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$2,430.79 |
| Rate for Payer: Aetna Commercial |
$2,141.79
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$2,308.38
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.12
|
| Rate for Payer: BCN Commercial |
$1,962.12
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,903.82
|
| Rate for Payer: Cash Price |
$1,903.82
|
| Rate for Payer: Cofinity Commercial |
$2,236.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,903.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$2,308.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,379.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$2,141.79
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,022.80
|
| Rate for Payer: Nomi Health Commercial |
$1,951.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,784.83
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,430.79
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,944.63
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,094.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.95
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.76
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$12.76
|
| Rate for Payer: Mclaren Medicare |
$12.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: Meridian Medicaid |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$12.12
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: PHP Medicaid |
$6.84
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.27
|
| Rate for Payer: Priority Health Medicare |
$12.76
|
| Rate for Payer: Priority Health Narrow Network |
$61.02
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.76
|
| Rate for Payer: UHC Exchange |
$19.78
|
| Rate for Payer: UHC Medicaid |
$6.67
|
| Rate for Payer: UHCCP DNSP |
$12.76
|
| Rate for Payer: UHCCP Medicaid |
$6.67
|
| Rate for Payer: VA VA |
$12.76
|
|
|
HC TOTAL PROTEIN
|
Facility
|
IP
|
$39.64
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: ASR ASR |
$38.45
|
| Rate for Payer: BCBS Trust/PPO |
$32.55
|
| Rate for Payer: BCN Commercial |
$32.55
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$39.64
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.88
|
|
|
HC TOTAL PROTEIN
|
Facility
|
OP
|
$39.64
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Aetna Medicare |
$3.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.59
|
| Rate for Payer: ASR ASR |
$38.45
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS MAPPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$32.68
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$39.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.67
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicare |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$2.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: PACE Medicare |
$3.49
|
| Rate for Payer: PACE SWMI |
$3.67
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicaid |
$1.97
|
| Rate for Payer: PHP Medicare Advantage |
$3.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.96
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow Network |
$50.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.67
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicaid |
$1.92
|
| Rate for Payer: UHCCP DNSP |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: VA VA |
$3.67
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
IP
|
$39.64
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: ASR ASR |
$38.45
|
| Rate for Payer: BCBS Trust/PPO |
$32.55
|
| Rate for Payer: BCN Commercial |
$32.55
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$39.64
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.88
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
OP
|
$39.64
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.00
|
| Rate for Payer: ASR ASR |
$38.45
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$32.68
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: BCN Medicare Advantage |
$4.00
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$39.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.00
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$4.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.20
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: PACE Medicare |
$3.80
|
| Rate for Payer: PACE SWMI |
$4.00
|
| Rate for Payer: PHP Commercial |
$4.40
|
| Rate for Payer: PHP Medicaid |
$2.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.45
|
| Rate for Payer: Priority Health Medicare |
$4.00
|
| Rate for Payer: Priority Health Narrow Network |
$22.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.00
|
| Rate for Payer: UHC Exchange |
$6.20
|
| Rate for Payer: UHC Medicaid |
$2.09
|
| Rate for Payer: UHCCP DNSP |
$4.00
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: VA VA |
$4.00
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
IP
|
$39.64
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.73 |
| Max. Negotiated Rate |
$39.64 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: ASR ASR |
$38.45
|
| Rate for Payer: BCBS Trust/PPO |
$32.55
|
| Rate for Payer: BCN Commercial |
$32.55
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$39.64
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.88
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
OP
|
$39.64
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Aetna Medicare |
$3.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.59
|
| Rate for Payer: ASR ASR |
$38.45
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS MAPPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$32.68
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$38.45
|
| Rate for Payer: Healthscope Whirlpool |
$39.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.67
|
| Rate for Payer: Mclaren Commercial |
$35.68
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicare |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$2.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: PACE Medicare |
$3.49
|
| Rate for Payer: PACE SWMI |
$3.67
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: PHP Medicaid |
$1.97
|
| Rate for Payer: PHP Medicare Advantage |
$3.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.06
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow Network |
$41.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.67
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicaid |
$1.92
|
| Rate for Payer: UHCCP DNSP |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: VA VA |
$3.67
|
|
|
HC TOTAL T3
|
Facility
|
IP
|
$48.72
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: BCBS Trust/PPO |
$40.01
|
| Rate for Payer: BCN Commercial |
$40.01
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Whirlpool |
$48.72
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
|
|
HC TOTAL T3
|
Facility
|
OP
|
$48.72
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: Aetna Medicare |
$14.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.73
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: BCBS Complete |
$7.79
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$40.17
|
| Rate for Payer: BCN Commercial |
$40.17
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Whirlpool |
$48.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: Mclaren Medicaid |
$14.18
|
| Rate for Payer: Mclaren Medicare |
$14.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.89
|
| Rate for Payer: Meridian Medicaid |
$7.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.54
|
| Rate for Payer: PACE Medicare |
$13.47
|
| Rate for Payer: PACE SWMI |
$14.18
|
| Rate for Payer: PHP Commercial |
$15.60
|
| Rate for Payer: PHP Medicaid |
$7.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$14.18
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.18
|
| Rate for Payer: UHC Exchange |
$21.98
|
| Rate for Payer: UHC Medicaid |
$7.42
|
| Rate for Payer: UHCCP DNSP |
$14.18
|
| Rate for Payer: UHCCP Medicaid |
$7.42
|
| Rate for Payer: VA VA |
$14.18
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
IP
|
$169.79
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.34 |
| Max. Negotiated Rate |
$169.79 |
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: ASR ASR |
$164.70
|
| Rate for Payer: BCBS Trust/PPO |
$139.43
|
| Rate for Payer: BCN Commercial |
$139.43
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Healthscope Commercial |
$164.70
|
| Rate for Payer: Healthscope Whirlpool |
$169.79
|
| Rate for Payer: Mclaren Commercial |
$152.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Nomi Health Commercial |
$139.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.42
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
OP
|
$169.79
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$169.79 |
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$164.70
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$139.99
|
| Rate for Payer: BCN Commercial |
$139.99
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$164.70
|
| Rate for Payer: Healthscope Whirlpool |
$169.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$152.81
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Nomi Health Commercial |
$139.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$148.77
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$119.02
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Trust/PPO |
$96.55
|
| Rate for Payer: BCN Commercial |
$96.55
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$96.94
|
| Rate for Payer: BCN Commercial |
$96.94
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$14.39
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.21
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$37.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$61.73 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.01
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS MAPPO |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.41
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$14.41
|
| Rate for Payer: Mclaren Medicare |
$14.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.13
|
| Rate for Payer: Meridian Medicaid |
$7.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.69
|
| Rate for Payer: PACE SWMI |
$14.41
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: PHP Medicaid |
$7.72
|
| Rate for Payer: PHP Medicare Advantage |
$14.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.73
|
| Rate for Payer: Priority Health Medicare |
$14.41
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: Railroad Medicare Medicare |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.41
|
| Rate for Payer: UHC Exchange |
$22.34
|
| Rate for Payer: UHC Medicaid |
$7.54
|
| Rate for Payer: UHCCP DNSP |
$14.41
|
| Rate for Payer: UHCCP Medicaid |
$7.54
|
| Rate for Payer: VA VA |
$14.41
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
IP
|
$540.06
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$405.05 |
| Max. Negotiated Rate |
$540.06 |
| Rate for Payer: Aetna Commercial |
$486.05
|
| Rate for Payer: ASR ASR |
$523.86
|
| Rate for Payer: BCBS Trust/PPO |
$443.50
|
| Rate for Payer: BCN Commercial |
$443.50
|
| Rate for Payer: Cash Price |
$432.05
|
| Rate for Payer: Cofinity Commercial |
$507.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.05
|
| Rate for Payer: Healthscope Commercial |
$523.86
|
| Rate for Payer: Healthscope Whirlpool |
$540.06
|
| Rate for Payer: Mclaren Commercial |
$486.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.05
|
| Rate for Payer: Nomi Health Commercial |
$442.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.25
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
OP
|
$540.06
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$243.81 |
| Max. Negotiated Rate |
$722.56 |
| Rate for Payer: Aetna Commercial |
$486.05
|
| Rate for Payer: Aetna Medicare |
$466.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$582.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$582.71
|
| Rate for Payer: ASR ASR |
$523.86
|
| Rate for Payer: BCBS Complete |
$256.02
|
| Rate for Payer: BCBS MAPPO |
$466.17
|
| Rate for Payer: BCBS Trust/PPO |
$445.28
|
| Rate for Payer: BCN Commercial |
$445.28
|
| Rate for Payer: BCN Medicare Advantage |
$466.17
|
| Rate for Payer: Cash Price |
$432.05
|
| Rate for Payer: Cash Price |
$432.05
|
| Rate for Payer: Cofinity Commercial |
$507.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.17
|
| Rate for Payer: Healthscope Commercial |
$523.86
|
| Rate for Payer: Healthscope Whirlpool |
$540.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$466.17
|
| Rate for Payer: Mclaren Commercial |
$486.05
|
| Rate for Payer: Mclaren Medicaid |
$466.17
|
| Rate for Payer: Mclaren Medicare |
$466.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.48
|
| Rate for Payer: Meridian Medicaid |
$256.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$536.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$512.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.05
|
| Rate for Payer: Nomi Health Commercial |
$442.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$405.05
|
| Rate for Payer: PACE Medicare |
$442.86
|
| Rate for Payer: PACE SWMI |
$466.17
|
| Rate for Payer: PHP Commercial |
$512.79
|
| Rate for Payer: PHP Medicaid |
$249.87
|
| Rate for Payer: PHP Medicare Advantage |
$466.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$588.43
|
| Rate for Payer: Priority Health Medicare |
$466.17
|
| Rate for Payer: Priority Health Narrow Network |
$470.74
|
| Rate for Payer: Railroad Medicare Medicare |
$466.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$466.17
|
| Rate for Payer: UHC Exchange |
$722.56
|
| Rate for Payer: UHC Medicaid |
$243.81
|
| Rate for Payer: UHCCP DNSP |
$466.17
|
| Rate for Payer: UHCCP Medicaid |
$243.81
|
| Rate for Payer: VA VA |
$466.17
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
IP
|
$305.31
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$228.98 |
| Max. Negotiated Rate |
$305.31 |
| Rate for Payer: Aetna Commercial |
$274.78
|
| Rate for Payer: ASR ASR |
$296.15
|
| Rate for Payer: BCBS Trust/PPO |
$250.72
|
| Rate for Payer: BCN Commercial |
$250.72
|
| Rate for Payer: Cash Price |
$244.25
|
| Rate for Payer: Cofinity Commercial |
$286.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.25
|
| Rate for Payer: Healthscope Commercial |
$296.15
|
| Rate for Payer: Healthscope Whirlpool |
$305.31
|
| Rate for Payer: Mclaren Commercial |
$274.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.51
|
| Rate for Payer: Nomi Health Commercial |
$250.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.67
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
OP
|
$305.31
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$305.31 |
| Rate for Payer: Aetna Commercial |
$274.78
|
| Rate for Payer: Aetna Medicare |
$112.96
|
| Rate for Payer: ASR ASR |
$296.15
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: BCBS Trust/PPO |
$251.73
|
| Rate for Payer: BCN Commercial |
$251.73
|
| Rate for Payer: Cash Price |
$244.25
|
| Rate for Payer: Cofinity Commercial |
$286.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.25
|
| Rate for Payer: Healthscope Commercial |
$296.15
|
| Rate for Payer: Healthscope Whirlpool |
$305.31
|
| Rate for Payer: Mclaren Commercial |
$274.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.51
|
| Rate for Payer: Nomi Health Commercial |
$250.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.51
|
| Rate for Payer: Priority Health Narrow Network |
$214.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.67
|
|
|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
IP
|
$1,352.52
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,014.39 |
| Max. Negotiated Rate |
$1,352.52 |
| Rate for Payer: Aetna Commercial |
$1,217.27
|
| Rate for Payer: ASR ASR |
$1,311.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.69
|
| Rate for Payer: BCN Commercial |
$1,110.69
|
| Rate for Payer: Cash Price |
$1,082.02
|
| Rate for Payer: Cofinity Commercial |
$1,271.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.02
|
| Rate for Payer: Healthscope Commercial |
$1,311.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,352.52
|
| Rate for Payer: Mclaren Commercial |
$1,217.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,149.64
|
| Rate for Payer: Nomi Health Commercial |
$1,109.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.22
|
|
