|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$488.11
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$488.11 |
| Rate for Payer: Aetna Commercial |
$439.30
|
| Rate for Payer: ASR ASR |
$473.47
|
| Rate for Payer: BCBS Trust/PPO |
$378.43
|
| Rate for Payer: BCN Commercial |
$378.43
|
| Rate for Payer: Cash Price |
$390.49
|
| Rate for Payer: Cofinity Commercial |
$458.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.49
|
| Rate for Payer: Healthscope Commercial |
$488.11
|
| Rate for Payer: Healthscope Whirlpool |
$473.47
|
| Rate for Payer: Mclaren Commercial |
$439.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.54
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$351.62
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$246.13 |
| Max. Negotiated Rate |
$351.62 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: ASR ASR |
$341.07
|
| Rate for Payer: BCBS Trust/PPO |
$272.61
|
| Rate for Payer: BCN Commercial |
$272.61
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.30
|
| Rate for Payer: Healthscope Commercial |
$351.62
|
| Rate for Payer: Healthscope Whirlpool |
$341.07
|
| Rate for Payer: Mclaren Commercial |
$316.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.43
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$351.62
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$130.58 |
| Max. Negotiated Rate |
$351.62 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna Medicare |
$238.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.40
|
| Rate for Payer: ASR ASR |
$341.07
|
| Rate for Payer: BCBS Complete |
$137.12
|
| Rate for Payer: BCBS MAPPO |
$238.72
|
| Rate for Payer: BCBS Trust/PPO |
$272.61
|
| Rate for Payer: BCN Commercial |
$272.61
|
| Rate for Payer: BCN Medicare Advantage |
$238.72
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.72
|
| Rate for Payer: Healthscope Commercial |
$351.62
|
| Rate for Payer: Healthscope Whirlpool |
$341.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.72
|
| Rate for Payer: Mclaren Commercial |
$316.46
|
| Rate for Payer: Mclaren Medicaid |
$130.58
|
| Rate for Payer: Mclaren Medicare |
$238.72
|
| Rate for Payer: Meridian Medicaid |
$137.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.88
|
| Rate for Payer: PACE Medicare |
$226.78
|
| Rate for Payer: PACE SWMI |
$238.72
|
| Rate for Payer: PHP Commercial |
$262.59
|
| Rate for Payer: PHP Medicaid |
$130.58
|
| Rate for Payer: PHP Medicare Advantage |
$238.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.97
|
| Rate for Payer: Priority Health Medicare |
$238.72
|
| Rate for Payer: Priority Health Narrow Network |
$249.65
|
| Rate for Payer: Railroad Medicare Medicare |
$238.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.43
|
| Rate for Payer: UHC Medicare Advantage |
$245.88
|
| Rate for Payer: VA VA |
$238.72
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$190.11
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$76.61 |
| Max. Negotiated Rate |
$190.11 |
| Rate for Payer: Aetna Commercial |
$171.10
|
| Rate for Payer: Aetna Medicare |
$140.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.08
|
| Rate for Payer: ASR ASR |
$184.41
|
| Rate for Payer: BCBS Complete |
$80.45
|
| Rate for Payer: BCBS MAPPO |
$140.06
|
| Rate for Payer: BCBS Trust/PPO |
$147.39
|
| Rate for Payer: BCN Commercial |
$147.39
|
| Rate for Payer: BCN Medicare Advantage |
$140.06
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$178.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.06
|
| Rate for Payer: Healthscope Commercial |
$190.11
|
| Rate for Payer: Healthscope Whirlpool |
$184.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$140.06
|
| Rate for Payer: Mclaren Commercial |
$171.10
|
| Rate for Payer: Mclaren Medicaid |
$76.61
|
| Rate for Payer: Mclaren Medicare |
$140.06
|
| Rate for Payer: Meridian Medicaid |
$80.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PACE Medicare |
$133.06
|
| Rate for Payer: PACE SWMI |
$140.06
|
| Rate for Payer: PHP Commercial |
$154.07
|
| Rate for Payer: PHP Medicaid |
$76.61
|
| Rate for Payer: PHP Medicare Advantage |
$140.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.00
|
| Rate for Payer: Priority Health Medicare |
$140.06
|
| Rate for Payer: Priority Health Narrow Network |
$134.98
|
| Rate for Payer: Railroad Medicare Medicare |
$140.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.30
|
| Rate for Payer: UHC Medicare Advantage |
$144.26
|
| Rate for Payer: VA VA |
$140.06
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$190.11
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$190.11 |
| Rate for Payer: Aetna Commercial |
$171.10
|
| Rate for Payer: ASR ASR |
$184.41
|
| Rate for Payer: BCBS Trust/PPO |
$147.39
|
| Rate for Payer: BCN Commercial |
$147.39
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$178.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.09
|
| Rate for Payer: Healthscope Commercial |
$190.11
|
| Rate for Payer: Healthscope Whirlpool |
$184.41
|
| Rate for Payer: Mclaren Commercial |
$171.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.30
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$59.16
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$92.35 |
| Rate for Payer: Aetna Commercial |
$53.24
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: ASR ASR |
$57.39
|
| Rate for Payer: BCBS Complete |
$14.50
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$45.87
|
| Rate for Payer: BCN Commercial |
$45.87
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$59.16
|
| Rate for Payer: Healthscope Whirlpool |
$57.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$53.24
|
| Rate for Payer: Mclaren Medicaid |
$13.81
|
| Rate for Payer: Mclaren Medicare |
$25.25
|
| Rate for Payer: Meridian Medicaid |
$14.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.29
|
| Rate for Payer: PACE Medicare |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$27.78
|
| Rate for Payer: PHP Medicaid |
$13.81
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.35
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health Narrow Network |
$73.88
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.06
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: VA VA |
$25.25
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$59.16
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.41 |
| Max. Negotiated Rate |
$59.16 |
| Rate for Payer: Aetna Commercial |
$53.24
|
| Rate for Payer: ASR ASR |
$57.39
|
| Rate for Payer: BCBS Trust/PPO |
$45.87
|
| Rate for Payer: BCN Commercial |
$45.87
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.33
|
| Rate for Payer: Healthscope Commercial |
$59.16
|
| Rate for Payer: Healthscope Whirlpool |
$57.39
|
| Rate for Payer: Mclaren Commercial |
$53.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.06
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$56.71
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$56.71 |
| Rate for Payer: Aetna Commercial |
$51.04
|
| Rate for Payer: ASR ASR |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$43.97
|
| Rate for Payer: BCN Commercial |
$43.97
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cofinity Commercial |
$53.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.37
|
| Rate for Payer: Healthscope Commercial |
$56.71
|
| Rate for Payer: Healthscope Whirlpool |
$55.01
|
| Rate for Payer: Mclaren Commercial |
$51.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.90
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$56.71
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$56.71 |
| Rate for Payer: Aetna Commercial |
$51.04
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.12
|
| Rate for Payer: ASR ASR |
$55.01
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$43.97
|
| Rate for Payer: BCN Commercial |
$43.97
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cofinity Commercial |
$53.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$56.71
|
| Rate for Payer: Healthscope Whirlpool |
$55.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.30
|
| Rate for Payer: Mclaren Commercial |
$51.04
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Mclaren Medicare |
$27.30
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.20
|
| Rate for Payer: PACE Medicare |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$30.03
|
| Rate for Payer: PHP Medicaid |
$14.93
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.61
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health Narrow Network |
$40.26
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.90
|
| Rate for Payer: UHC Medicare Advantage |
$28.12
|
| Rate for Payer: VA VA |
$27.30
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.36
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$55.36
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.97
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$50.69
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
IP
|
$5,593.68
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,915.58 |
| Max. Negotiated Rate |
$5,593.68 |
| Rate for Payer: Aetna Commercial |
$5,034.31
|
| Rate for Payer: ASR ASR |
$5,425.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,336.78
|
| Rate for Payer: BCN Commercial |
$4,336.78
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cofinity Commercial |
$5,258.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,474.94
|
| Rate for Payer: Healthscope Commercial |
$5,593.68
|
| Rate for Payer: Healthscope Whirlpool |
$5,425.87
|
| Rate for Payer: Mclaren Commercial |
$5,034.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,754.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,915.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,922.44
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
OP
|
$5,593.68
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,237.47 |
| Max. Negotiated Rate |
$5,593.68 |
| Rate for Payer: Aetna Commercial |
$5,034.31
|
| Rate for Payer: ASR ASR |
$5,425.87
|
| Rate for Payer: BCBS Complete |
$2,237.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,336.78
|
| Rate for Payer: BCN Commercial |
$4,336.78
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cofinity Commercial |
$5,258.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,474.94
|
| Rate for Payer: Healthscope Commercial |
$5,593.68
|
| Rate for Payer: Healthscope Whirlpool |
$5,425.87
|
| Rate for Payer: Mclaren Commercial |
$5,034.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,754.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,915.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,090.25
|
| Rate for Payer: Priority Health Narrow Network |
$3,971.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,922.44
|
|
|
HC CATH BALLOON
|
Facility
|
OP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.66 |
| Max. Negotiated Rate |
$1,289.14 |
| Rate for Payer: Aetna Commercial |
$1,160.23
|
| Rate for Payer: ASR ASR |
$1,250.47
|
| Rate for Payer: BCBS Complete |
$515.66
|
| Rate for Payer: BCBS Trust/PPO |
$999.47
|
| Rate for Payer: BCN Commercial |
$999.47
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,211.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,289.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.47
|
| Rate for Payer: Mclaren Commercial |
$1,160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,173.12
|
| Rate for Payer: Priority Health Narrow Network |
$915.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.44
|
|
|
HC CATH BALLOON
|
Facility
|
IP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$1,289.14 |
| Rate for Payer: Aetna Commercial |
$1,160.23
|
| Rate for Payer: ASR ASR |
$1,250.47
|
| Rate for Payer: BCBS Trust/PPO |
$999.47
|
| Rate for Payer: BCN Commercial |
$999.47
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,211.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,289.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.47
|
| Rate for Payer: Mclaren Commercial |
$1,160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.44
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
IP
|
$145.26
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.68 |
| Max. Negotiated Rate |
$145.26 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: ASR ASR |
$140.90
|
| Rate for Payer: BCBS Trust/PPO |
$112.62
|
| Rate for Payer: BCN Commercial |
$112.62
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$136.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.21
|
| Rate for Payer: Healthscope Commercial |
$145.26
|
| Rate for Payer: Healthscope Whirlpool |
$140.90
|
| Rate for Payer: Mclaren Commercial |
$130.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.83
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
OP
|
$145.26
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$145.26 |
| Rate for Payer: Aetna Commercial |
$130.73
|
| Rate for Payer: ASR ASR |
$140.90
|
| Rate for Payer: BCBS Complete |
$58.10
|
| Rate for Payer: BCBS Trust/PPO |
$112.62
|
| Rate for Payer: BCN Commercial |
$112.62
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$136.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.21
|
| Rate for Payer: Healthscope Commercial |
$145.26
|
| Rate for Payer: Healthscope Whirlpool |
$140.90
|
| Rate for Payer: Mclaren Commercial |
$130.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.19
|
| Rate for Payer: Priority Health Narrow Network |
$103.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.83
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
IP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.97 |
| Max. Negotiated Rate |
$792.81 |
| Rate for Payer: Aetna Commercial |
$713.53
|
| Rate for Payer: ASR ASR |
$769.03
|
| Rate for Payer: BCBS Trust/PPO |
$614.67
|
| Rate for Payer: BCN Commercial |
$614.67
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Commercial |
$745.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Healthscope Commercial |
$792.81
|
| Rate for Payer: Healthscope Whirlpool |
$769.03
|
| Rate for Payer: Mclaren Commercial |
$713.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$673.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.67
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
OP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.12 |
| Max. Negotiated Rate |
$792.81 |
| Rate for Payer: Aetna Commercial |
$713.53
|
| Rate for Payer: ASR ASR |
$769.03
|
| Rate for Payer: BCBS Complete |
$317.12
|
| Rate for Payer: BCBS Trust/PPO |
$614.67
|
| Rate for Payer: BCN Commercial |
$614.67
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Commercial |
$745.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Healthscope Commercial |
$792.81
|
| Rate for Payer: Healthscope Whirlpool |
$769.03
|
| Rate for Payer: Mclaren Commercial |
$713.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$673.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.46
|
| Rate for Payer: Priority Health Narrow Network |
$562.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.67
|
|
|
HC CATHETER INTRADISCAL
|
Facility
|
OP
|
$1,502.05
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,502.05 |
| Rate for Payer: Aetna Commercial |
$1,351.84
|
| Rate for Payer: ASR ASR |
$1,456.99
|
| Rate for Payer: BCBS Complete |
$600.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.54
|
| Rate for Payer: BCN Commercial |
$1,164.54
|
| Rate for Payer: Cash Price |
$1,201.64
|
| Rate for Payer: Cofinity Commercial |
$1,411.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.64
|
| Rate for Payer: Healthscope Commercial |
$1,502.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,456.99
|
| Rate for Payer: Mclaren Commercial |
$1,351.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,066.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,321.80
|
|
|
HC CATHETER INTRADISCAL
|
Facility
|
IP
|
$1,502.05
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,051.44 |
| Max. Negotiated Rate |
$1,502.05 |
| Rate for Payer: Aetna Commercial |
$1,351.84
|
| Rate for Payer: ASR ASR |
$1,456.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.54
|
| Rate for Payer: BCN Commercial |
$1,164.54
|
| Rate for Payer: Cash Price |
$1,201.64
|
| Rate for Payer: Cofinity Commercial |
$1,411.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.64
|
| Rate for Payer: Healthscope Commercial |
$1,502.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,456.99
|
| Rate for Payer: Mclaren Commercial |
$1,351.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,321.80
|
|
|
HC CATHETERIZATION FOR COLLECTION OF SPECIMEN
|
Facility
|
IP
|
$29.58
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Aetna Commercial |
$26.62
|
| Rate for Payer: ASR ASR |
$28.69
|
| Rate for Payer: BCBS Trust/PPO |
$22.93
|
| Rate for Payer: BCN Commercial |
$22.93
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$27.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.66
|
| Rate for Payer: Healthscope Commercial |
$29.58
|
| Rate for Payer: Healthscope Whirlpool |
$28.69
|
| Rate for Payer: Mclaren Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.03
|
|
|
HC CATHETERIZATION FOR COLLECTION OF SPECIMEN
|
Facility
|
OP
|
$29.58
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Aetna Commercial |
$26.62
|
| Rate for Payer: Aetna Medicare |
$8.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.71
|
| Rate for Payer: ASR ASR |
$28.69
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: BCBS MAPPO |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$22.93
|
| Rate for Payer: BCN Commercial |
$22.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.57
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$27.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$29.58
|
| Rate for Payer: Healthscope Whirlpool |
$28.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.57
|
| Rate for Payer: Mclaren Commercial |
$26.62
|
| Rate for Payer: Mclaren Medicaid |
$4.69
|
| Rate for Payer: Mclaren Medicare |
$8.57
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PACE Medicare |
$8.14
|
| Rate for Payer: PACE SWMI |
$8.57
|
| Rate for Payer: PHP Commercial |
$9.43
|
| Rate for Payer: PHP Medicaid |
$4.69
|
| Rate for Payer: PHP Medicare Advantage |
$8.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.18
|
| Rate for Payer: Priority Health Medicare |
$8.57
|
| Rate for Payer: Priority Health Narrow Network |
$5.74
|
| Rate for Payer: Railroad Medicare Medicare |
$8.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.03
|
| Rate for Payer: UHC Medicare Advantage |
$8.83
|
| Rate for Payer: VA VA |
$8.57
|
|
|
HC CATHETER NOS LVL 1
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: ASR ASR |
$64.02
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Trust/PPO |
$51.17
|
| Rate for Payer: BCN Commercial |
$51.17
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$62.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$66.00
|
| Rate for Payer: Healthscope Whirlpool |
$64.02
|
| Rate for Payer: Mclaren Commercial |
$59.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.06
|
| Rate for Payer: Priority Health Narrow Network |
$46.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.08
|
|
|
HC CATHETER NOS LVL 1
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: ASR ASR |
$64.02
|
| Rate for Payer: BCBS Trust/PPO |
$51.17
|
| Rate for Payer: BCN Commercial |
$51.17
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$62.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$66.00
|
| Rate for Payer: Healthscope Whirlpool |
$64.02
|
| Rate for Payer: Mclaren Commercial |
$59.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.08
|
|
