|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.93
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP DNSP |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.37
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$11.87
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| 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 |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.93
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| 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 |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| 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 |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$10.21
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: ASR ASR |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| 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 |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| 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 |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| 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 |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.17
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$48.14
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| 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 |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: BCN Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.41
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$7.72
|
| 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 |
$8.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| 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 |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.17
|
| Rate for Payer: Priority Health Medicare |
$14.41
|
| Rate for Payer: Priority Health Narrow Network |
$48.14
|
| Rate for Payer: Railroad Medicare Medicare |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.41
|
| Rate for Payer: UHC Exchange |
$22.34
|
| Rate for Payer: UHC Medicare Advantage |
$14.41
|
| Rate for Payer: UHCCP DNSP |
$14.41
|
| Rate for Payer: UHCCP Medicaid |
$7.72
|
| Rate for Payer: VA VA |
$14.41
|
|
|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna Commercial |
$61.80
|
| Rate for Payer: ASR ASR |
$66.61
|
| Rate for Payer: ASR Commercial |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$53.24
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Healthscope Whirlpool |
$66.61
|
| Rate for Payer: Mclaren Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.43
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
IP
|
$2,333.11
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,516.52 |
| Max. Negotiated Rate |
$2,333.11 |
| Rate for Payer: Aetna Commercial |
$2,099.80
|
| Rate for Payer: ASR ASR |
$2,263.12
|
| Rate for Payer: ASR Commercial |
$2,263.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.25
|
| Rate for Payer: BCN Commercial |
$1,808.86
|
| Rate for Payer: Cash Price |
$1,866.49
|
| Rate for Payer: Cofinity Commercial |
$2,193.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.49
|
| Rate for Payer: Healthscope Commercial |
$2,333.11
|
| Rate for Payer: Healthscope Whirlpool |
$2,263.12
|
| Rate for Payer: Mclaren Commercial |
$2,099.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.14
|
| Rate for Payer: Nomi Health Commercial |
$1,913.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,053.14
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
OP
|
$2,333.11
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$2,333.11 |
| Rate for Payer: Aetna Commercial |
$2,099.80
|
| Rate for Payer: Aetna Medicare |
$1,273.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: ASR ASR |
$2,263.12
|
| Rate for Payer: ASR Commercial |
$2,263.12
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,910.58
|
| Rate for Payer: BCN Commercial |
$1,808.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$1,866.49
|
| Rate for Payer: Cash Price |
$1,866.49
|
| Rate for Payer: Cofinity Commercial |
$2,193.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$2,333.11
|
| Rate for Payer: Healthscope Whirlpool |
$2,263.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,273.21
|
| Rate for Payer: Mclaren Commercial |
$2,099.80
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.14
|
| Rate for Payer: Nomi Health Commercial |
$1,913.15
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,400.53
|
| Rate for Payer: PHP Medicaid |
$682.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,044.27
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,635.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,053.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,973.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP DNSP |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$682.44
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.76
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$6.84
|
| 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 |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$12.76
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.76
|
| Rate for Payer: UHC Exchange |
$19.78
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: UHCCP DNSP |
$12.76
|
| Rate for Payer: UHCCP Medicaid |
$6.84
|
| Rate for Payer: VA VA |
$12.76
|
|
|
HC TOTAL PROTEIN
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| 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 |
$37.69
|
| Rate for Payer: ASR Commercial |
$37.69
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: BCBS MAPPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$31.82
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Healthscope Whirlpool |
$37.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.67
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Mclaren Medicaid |
$1.97
|
| 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 |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| 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 |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.05
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow Network |
$27.24
|
| Rate for Payer: Railroad Medicare Medicare |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.67
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$3.67
|
| Rate for Payer: UHCCP DNSP |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$1.97
|
| Rate for Payer: VA VA |
$3.67
|
|
|
HC TOTAL PROTEIN
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| Rate for Payer: ASR ASR |
$37.69
|
| Rate for Payer: ASR Commercial |
$37.69
|
| Rate for Payer: BCBS Trust/PPO |
$31.67
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Healthscope Whirlpool |
$37.69
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.20
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| Rate for Payer: ASR ASR |
$37.69
|
| Rate for Payer: ASR Commercial |
$37.69
|
| Rate for Payer: BCBS Trust/PPO |
$31.67
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Healthscope Whirlpool |
$37.69
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.20
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| 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 |
$37.69
|
| Rate for Payer: ASR Commercial |
$37.69
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$31.82
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.00
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Healthscope Whirlpool |
$37.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.00
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Mclaren Medicaid |
$2.14
|
| 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 |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| 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 |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.05
|
| Rate for Payer: Priority Health Medicare |
$4.00
|
| Rate for Payer: Priority Health Narrow Network |
$27.24
|
| Rate for Payer: Railroad Medicare Medicare |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.00
|
| Rate for Payer: UHC Exchange |
$6.20
|
| Rate for Payer: UHC Medicare Advantage |
$4.00
|
| Rate for Payer: UHCCP DNSP |
$4.00
|
| Rate for Payer: UHCCP Medicaid |
$2.14
|
| Rate for Payer: VA VA |
$4.00
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| Rate for Payer: ASR ASR |
$37.69
|
| Rate for Payer: ASR Commercial |
$37.69
|
| Rate for Payer: BCBS Trust/PPO |
$31.67
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Healthscope Whirlpool |
$37.69
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.20
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| 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 |
$37.69
|
| Rate for Payer: ASR Commercial |
$37.69
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: BCBS MAPPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$31.82
|
| Rate for Payer: BCN Commercial |
$30.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$38.86
|
| Rate for Payer: Healthscope Whirlpool |
$37.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.67
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Mclaren Medicaid |
$1.97
|
| 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 |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| 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 |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.05
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health Narrow Network |
$27.24
|
| Rate for Payer: Railroad Medicare Medicare |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.67
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$3.67
|
| Rate for Payer: UHCCP DNSP |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$1.97
|
| Rate for Payer: VA VA |
$3.67
|
|
|
HC TOTAL T3
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| 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 |
$46.33
|
| Rate for Payer: ASR Commercial |
$46.33
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$39.11
|
| Rate for Payer: BCN Commercial |
$37.03
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$47.76
|
| Rate for Payer: Healthscope Whirlpool |
$46.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$7.60
|
| 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 |
$7.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| 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 |
$7.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.85
|
| Rate for Payer: Priority Health Medicare |
$14.18
|
| Rate for Payer: Priority Health Narrow Network |
$33.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.18
|
| Rate for Payer: UHC Exchange |
$21.98
|
| Rate for Payer: UHC Medicare Advantage |
$14.18
|
| Rate for Payer: UHCCP DNSP |
$14.18
|
| Rate for Payer: UHCCP Medicaid |
$7.60
|
| Rate for Payer: VA VA |
$14.18
|
|
|
HC TOTAL T3
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: ASR Commercial |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$38.92
|
| Rate for Payer: BCN Commercial |
$37.03
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$47.76
|
| Rate for Payer: Healthscope Whirlpool |
$46.33
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$166.46 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| 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 |
$161.47
|
| Rate for Payer: ASR Commercial |
$161.47
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$136.31
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$156.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$166.46
|
| Rate for Payer: Healthscope Whirlpool |
$161.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$149.81
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| 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 |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.85
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$116.69
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$166.46 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: ASR ASR |
$161.47
|
| Rate for Payer: ASR Commercial |
$161.47
|
| Rate for Payer: BCBS Trust/PPO |
$135.65
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$156.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$166.46
|
| Rate for Payer: Healthscope Whirlpool |
$161.47
|
| Rate for Payer: Mclaren Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.48
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| 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 |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$94.39
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| 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 |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| 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 |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.99
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$80.80
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Trust/PPO |
$93.93
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
|
