|
HC CANNULA RETROGRD 15 FR
|
Facility
|
OP
|
$304.91
|
|
| Hospital Charge Code |
27000447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.96 |
| Max. Negotiated Rate |
$304.91 |
| Rate for Payer: Aetna Commercial |
$274.42
|
| Rate for Payer: ASR ASR |
$295.76
|
| Rate for Payer: BCBS Complete |
$121.96
|
| Rate for Payer: BCBS Trust/PPO |
$236.40
|
| Rate for Payer: BCN Commercial |
$236.40
|
| Rate for Payer: Cash Price |
$243.93
|
| Rate for Payer: Cofinity Commercial |
$286.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.93
|
| Rate for Payer: Healthscope Commercial |
$304.91
|
| Rate for Payer: Healthscope Whirlpool |
$295.76
|
| Rate for Payer: Mclaren Commercial |
$274.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.47
|
| Rate for Payer: Priority Health Narrow Network |
$216.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.32
|
|
|
HC CANNULA RETROGRD 15 FR
|
Facility
|
IP
|
$304.91
|
|
| Hospital Charge Code |
27000447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.44 |
| Max. Negotiated Rate |
$304.91 |
| Rate for Payer: Aetna Commercial |
$274.42
|
| Rate for Payer: ASR ASR |
$295.76
|
| Rate for Payer: BCBS Trust/PPO |
$236.40
|
| Rate for Payer: BCN Commercial |
$236.40
|
| Rate for Payer: Cash Price |
$243.93
|
| Rate for Payer: Cofinity Commercial |
$286.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.93
|
| Rate for Payer: Healthscope Commercial |
$304.91
|
| Rate for Payer: Healthscope Whirlpool |
$295.76
|
| Rate for Payer: Mclaren Commercial |
$274.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.32
|
|
|
HC CANNULA VEIN GRAFT
|
Facility
|
OP
|
$34.50
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Aetna Commercial |
$31.05
|
| Rate for Payer: ASR ASR |
$33.46
|
| Rate for Payer: BCBS Complete |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$26.75
|
| Rate for Payer: BCN Commercial |
$26.75
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$34.50
|
| Rate for Payer: Healthscope Whirlpool |
$33.46
|
| Rate for Payer: Mclaren Commercial |
$31.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.40
|
| Rate for Payer: Priority Health Narrow Network |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.36
|
|
|
HC CANNULA VEIN GRAFT
|
Facility
|
IP
|
$34.50
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Aetna Commercial |
$31.05
|
| Rate for Payer: ASR ASR |
$33.46
|
| Rate for Payer: BCBS Trust/PPO |
$26.75
|
| Rate for Payer: BCN Commercial |
$26.75
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$34.50
|
| Rate for Payer: Healthscope Whirlpool |
$33.46
|
| Rate for Payer: Mclaren Commercial |
$31.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.36
|
|
|
HC CANNULA VENOUS RT PVC
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: ASR ASR |
$81.48
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS Trust/PPO |
$65.13
|
| Rate for Payer: BCN Commercial |
$65.13
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$84.00
|
| Rate for Payer: Healthscope Whirlpool |
$81.48
|
| Rate for Payer: Mclaren Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.44
|
| Rate for Payer: Priority Health Narrow Network |
$59.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.92
|
|
|
HC CANNULA VENOUS RT PVC
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: ASR ASR |
$81.48
|
| Rate for Payer: BCBS Trust/PPO |
$65.13
|
| Rate for Payer: BCN Commercial |
$65.13
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$78.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$84.00
|
| Rate for Payer: Healthscope Whirlpool |
$81.48
|
| Rate for Payer: Mclaren Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.92
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.52
|
| Rate for Payer: Priority Health Narrow Network |
$51.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: ASR ASR |
$93.12
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS Trust/PPO |
$74.43
|
| Rate for Payer: BCN Commercial |
$74.43
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$90.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$96.00
|
| Rate for Payer: Healthscope Whirlpool |
$93.12
|
| Rate for Payer: Mclaren Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.36
|
| Rate for Payer: Priority Health Narrow Network |
$68.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.48
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: ASR ASR |
$93.12
|
| Rate for Payer: BCBS Trust/PPO |
$74.43
|
| Rate for Payer: BCN Commercial |
$74.43
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$90.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$96.00
|
| Rate for Payer: Healthscope Whirlpool |
$93.12
|
| Rate for Payer: Mclaren Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.48
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.52
|
| Rate for Payer: Priority Health Narrow Network |
$51.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
IP
|
$43.88
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$39.49
|
| Rate for Payer: ASR ASR |
$42.56
|
| Rate for Payer: BCBS Trust/PPO |
$34.02
|
| Rate for Payer: BCN Commercial |
$34.02
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cofinity Commercial |
$41.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.10
|
| Rate for Payer: Healthscope Commercial |
$43.88
|
| Rate for Payer: Healthscope Whirlpool |
$42.56
|
| Rate for Payer: Mclaren Commercial |
$39.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.61
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
OP
|
$43.88
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$39.49
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$42.56
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$34.02
|
| Rate for Payer: BCN Commercial |
$34.02
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cofinity Commercial |
$41.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$43.88
|
| Rate for Payer: Healthscope Whirlpool |
$42.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$39.49
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.30
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$31.15
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$90.82 |
| Rate for Payer: Aetna Commercial |
$40.39
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: ASR ASR |
$43.53
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Whirlpool |
$43.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$7.97
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Medicaid |
$8.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicaid |
$7.97
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.82
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$72.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.49
|
| Rate for Payer: UHC Medicare Advantage |
$15.01
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Aetna Commercial |
$40.39
|
| Rate for Payer: ASR ASR |
$43.53
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Whirlpool |
$43.53
|
| Rate for Payer: Mclaren Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.49
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.87
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$23.09 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.88
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$2.67
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Medicaid |
$2.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$5.37
|
| Rate for Payer: PHP Medicaid |
$2.67
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.09
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$18.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$86.71 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$59.63
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.32
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$13.55
|
| Rate for Payer: PHP Medicaid |
$6.74
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.71
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$69.37
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.69
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$59.63
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
OP
|
$194.03
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$194.03 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Aetna Medicare |
$117.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.81
|
| Rate for Payer: ASR ASR |
$188.21
|
| Rate for Payer: BCBS Complete |
$67.46
|
| Rate for Payer: BCBS MAPPO |
$117.45
|
| Rate for Payer: BCBS Trust/PPO |
$150.43
|
| Rate for Payer: BCN Commercial |
$150.43
|
| Rate for Payer: BCN Medicare Advantage |
$117.45
|
| Rate for Payer: Cash Price |
$155.22
|
| Rate for Payer: Cash Price |
$155.22
|
| Rate for Payer: Cofinity Commercial |
$182.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$194.03
|
| Rate for Payer: Healthscope Whirlpool |
$188.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.45
|
| Rate for Payer: Mclaren Commercial |
$174.63
|
| Rate for Payer: Mclaren Medicaid |
$64.25
|
| Rate for Payer: Mclaren Medicare |
$117.45
|
| Rate for Payer: Meridian Medicaid |
$67.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.93
|
| Rate for Payer: PACE Medicare |
$111.58
|
| Rate for Payer: PACE SWMI |
$117.45
|
| Rate for Payer: PHP Commercial |
$129.20
|
| Rate for Payer: PHP Medicaid |
$64.25
|
| Rate for Payer: PHP Medicare Advantage |
$117.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.16
|
| Rate for Payer: Priority Health Medicare |
$117.45
|
| Rate for Payer: Priority Health Narrow Network |
$130.53
|
| Rate for Payer: Railroad Medicare Medicare |
$117.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.75
|
| Rate for Payer: UHC Medicare Advantage |
$120.97
|
| Rate for Payer: VA VA |
$117.45
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
IP
|
$194.03
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$194.03 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: ASR ASR |
$188.21
|
| Rate for Payer: BCBS Trust/PPO |
$150.43
|
| Rate for Payer: BCN Commercial |
$150.43
|
| Rate for Payer: Cash Price |
$155.22
|
| Rate for Payer: Cofinity Commercial |
$182.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.22
|
| Rate for Payer: Healthscope Commercial |
$194.03
|
| Rate for Payer: Healthscope Whirlpool |
$188.21
|
| Rate for Payer: Mclaren Commercial |
$174.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.75
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
OP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$130.33 |
| Rate for Payer: Aetna Commercial |
$45.15
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: ASR ASR |
$48.66
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$38.90
|
| Rate for Payer: BCN Commercial |
$38.90
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$47.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$50.17
|
| Rate for Payer: Healthscope Whirlpool |
$48.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$45.15
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$28.00
|
| Rate for Payer: PHP Medicaid |
$13.92
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.33
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$104.26
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.15
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
