|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
OP
|
$257.80
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.32 |
| Max. Negotiated Rate |
$257.80 |
| Rate for Payer: Aetna Commercial |
$232.02
|
| Rate for Payer: Aetna Medicare |
$135.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.82
|
| Rate for Payer: ASR ASR |
$250.07
|
| Rate for Payer: BCBS Complete |
$78.04
|
| Rate for Payer: BCBS MAPPO |
$135.86
|
| Rate for Payer: BCBS Trust/PPO |
$199.87
|
| Rate for Payer: BCN Commercial |
$199.87
|
| Rate for Payer: BCN Medicare Advantage |
$135.86
|
| Rate for Payer: Cash Price |
$206.24
|
| Rate for Payer: Cash Price |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$242.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.86
|
| Rate for Payer: Healthscope Commercial |
$257.80
|
| Rate for Payer: Healthscope Whirlpool |
$250.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$135.86
|
| Rate for Payer: Mclaren Commercial |
$232.02
|
| Rate for Payer: Mclaren Medicaid |
$74.32
|
| Rate for Payer: Mclaren Medicare |
$135.86
|
| Rate for Payer: Meridian Medicaid |
$78.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.13
|
| Rate for Payer: PACE Medicare |
$129.07
|
| Rate for Payer: PACE SWMI |
$135.86
|
| Rate for Payer: PHP Commercial |
$149.45
|
| Rate for Payer: PHP Medicaid |
$74.32
|
| Rate for Payer: PHP Medicare Advantage |
$135.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.60
|
| Rate for Payer: Priority Health Medicare |
$135.86
|
| Rate for Payer: Priority Health Narrow Network |
$183.04
|
| Rate for Payer: Railroad Medicare Medicare |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.86
|
| Rate for Payer: UHC Medicare Advantage |
$139.94
|
| Rate for Payer: VA VA |
$135.86
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
IP
|
$257.80
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$257.80 |
| Rate for Payer: Aetna Commercial |
$232.02
|
| Rate for Payer: ASR ASR |
$250.07
|
| Rate for Payer: BCBS Trust/PPO |
$199.87
|
| Rate for Payer: BCN Commercial |
$199.87
|
| Rate for Payer: Cash Price |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$242.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.24
|
| Rate for Payer: Healthscope Commercial |
$257.80
|
| Rate for Payer: Healthscope Whirlpool |
$250.07
|
| Rate for Payer: Mclaren Commercial |
$232.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.86
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.73 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: BCBS Trust/PPO |
$114.89
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$114.89
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Complete |
$81.93
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Medicaid |
$81.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$78.02
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.95
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$173.95
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
| Rate for Payer: UHC Medicare Advantage |
$146.91
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
OP
|
$4,054.86
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,621.94 |
| Max. Negotiated Rate |
$4,054.86 |
| Rate for Payer: Aetna Commercial |
$3,649.37
|
| Rate for Payer: ASR ASR |
$3,933.21
|
| Rate for Payer: BCBS Complete |
$1,621.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,143.73
|
| Rate for Payer: BCN Commercial |
$3,143.73
|
| Rate for Payer: Cash Price |
$3,243.89
|
| Rate for Payer: Cofinity Commercial |
$3,811.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,243.89
|
| Rate for Payer: Healthscope Commercial |
$4,054.86
|
| Rate for Payer: Healthscope Whirlpool |
$3,933.21
|
| Rate for Payer: Mclaren Commercial |
$3,649.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,446.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,689.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,878.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,568.28
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
IP
|
$4,054.86
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,838.40 |
| Max. Negotiated Rate |
$4,054.86 |
| Rate for Payer: Aetna Commercial |
$3,649.37
|
| Rate for Payer: ASR ASR |
$3,933.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,143.73
|
| Rate for Payer: BCN Commercial |
$3,143.73
|
| Rate for Payer: Cash Price |
$3,243.89
|
| Rate for Payer: Cofinity Commercial |
$3,811.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,243.89
|
| Rate for Payer: Healthscope Commercial |
$4,054.86
|
| Rate for Payer: Healthscope Whirlpool |
$3,933.21
|
| Rate for Payer: Mclaren Commercial |
$3,649.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,446.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,568.28
|
|
|
HC CERETEC PER DOSE
|
Facility
|
IP
|
$2,020.58
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,414.41 |
| Max. Negotiated Rate |
$2,020.58 |
| Rate for Payer: Aetna Commercial |
$1,818.52
|
| Rate for Payer: ASR ASR |
$1,959.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.56
|
| Rate for Payer: BCN Commercial |
$1,566.56
|
| Rate for Payer: Cash Price |
$1,616.46
|
| Rate for Payer: Cofinity Commercial |
$1,899.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,616.46
|
| Rate for Payer: Healthscope Commercial |
$2,020.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,959.96
|
| Rate for Payer: Mclaren Commercial |
$1,818.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,778.11
|
|
|
HC CERETEC PER DOSE
|
Facility
|
OP
|
$2,020.58
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$808.23 |
| Max. Negotiated Rate |
$2,052.36 |
| Rate for Payer: Aetna Commercial |
$1,818.52
|
| Rate for Payer: ASR ASR |
$1,959.96
|
| Rate for Payer: BCBS Complete |
$808.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.56
|
| Rate for Payer: BCN Commercial |
$1,566.56
|
| Rate for Payer: Cash Price |
$1,616.46
|
| Rate for Payer: Cash Price |
$1,616.46
|
| Rate for Payer: Cofinity Commercial |
$1,899.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,616.46
|
| Rate for Payer: Healthscope Commercial |
$2,020.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,959.96
|
| Rate for Payer: Mclaren Commercial |
$1,818.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,052.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,641.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,778.11
|
|
|
HC CERTOLIZUMAB
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$158.11
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$126.37
|
| Rate for Payer: BCN Commercial |
$126.37
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$153.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$163.00
|
| Rate for Payer: Healthscope Whirlpool |
$158.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$146.70
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.46
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.44
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC CERTOLIZUMAB
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: ASR ASR |
$158.11
|
| Rate for Payer: BCBS Trust/PPO |
$126.37
|
| Rate for Payer: BCN Commercial |
$126.37
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$153.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
| Rate for Payer: Healthscope Commercial |
$163.00
|
| Rate for Payer: Healthscope Whirlpool |
$158.11
|
| Rate for Payer: Mclaren Commercial |
$146.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.44
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| 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 |
$124.16
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$99.24
|
| Rate for Payer: BCN Commercial |
$99.24
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$120.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$128.00
|
| Rate for Payer: Healthscope Whirlpool |
$124.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$115.20
|
| 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 |
$108.80
|
| 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 |
$89.60
|
| 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 |
$112.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: ASR ASR |
$124.16
|
| Rate for Payer: BCBS Trust/PPO |
$99.24
|
| Rate for Payer: BCN Commercial |
$99.24
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$120.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Healthscope Commercial |
$128.00
|
| Rate for Payer: Healthscope Whirlpool |
$124.16
|
| Rate for Payer: Mclaren Commercial |
$115.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.64
|
|
|
HC CERULOPLASMIN
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$41.82 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.42
|
| Rate for Payer: ASR ASR |
$40.57
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$32.42
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$41.82
|
| Rate for Payer: Healthscope Whirlpool |
$40.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$37.64
|
| Rate for Payer: Mclaren Medicaid |
$5.87
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Medicaid |
$6.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$11.81
|
| Rate for Payer: PHP Medicaid |
$5.87
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.80
|
| Rate for Payer: UHC Medicare Advantage |
$11.06
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$41.82 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: ASR ASR |
$40.57
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$41.82
|
| Rate for Payer: Healthscope Whirlpool |
$40.57
|
| Rate for Payer: Mclaren Commercial |
$37.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.80
|
|
|
HC CERVILENZ
|
Facility
|
OP
|
$167.34
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.94 |
| Max. Negotiated Rate |
$167.34 |
| Rate for Payer: Aetna Commercial |
$150.61
|
| Rate for Payer: ASR ASR |
$162.32
|
| Rate for Payer: BCBS Complete |
$66.94
|
| Rate for Payer: BCBS Trust/PPO |
$129.74
|
| Rate for Payer: BCN Commercial |
$129.74
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Cofinity Commercial |
$157.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.87
|
| Rate for Payer: Healthscope Commercial |
$167.34
|
| Rate for Payer: Healthscope Whirlpool |
$162.32
|
| Rate for Payer: Mclaren Commercial |
$150.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.28
|
| Rate for Payer: Priority Health Narrow Network |
$118.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.26
|
|
|
HC CERVILENZ
|
Facility
|
IP
|
$167.34
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$167.34 |
| Rate for Payer: Aetna Commercial |
$150.61
|
| Rate for Payer: ASR ASR |
$162.32
|
| Rate for Payer: BCBS Trust/PPO |
$129.74
|
| Rate for Payer: BCN Commercial |
$129.74
|
| Rate for Payer: Cash Price |
$133.87
|
| Rate for Payer: Cofinity Commercial |
$157.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.87
|
| Rate for Payer: Healthscope Commercial |
$167.34
|
| Rate for Payer: Healthscope Whirlpool |
$162.32
|
| Rate for Payer: Mclaren Commercial |
$150.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.26
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
OP
|
$138.02
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$138.02 |
| Rate for Payer: Aetna Commercial |
$124.22
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.04
|
| Rate for Payer: ASR ASR |
$133.88
|
| Rate for Payer: BCBS Complete |
$45.51
|
| Rate for Payer: BCBS MAPPO |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$107.01
|
| Rate for Payer: BCN Commercial |
$107.01
|
| Rate for Payer: BCN Medicare Advantage |
$79.23
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$129.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$138.02
|
| Rate for Payer: Healthscope Whirlpool |
$133.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$79.23
|
| Rate for Payer: Mclaren Commercial |
$124.22
|
| Rate for Payer: Mclaren Medicaid |
$43.34
|
| Rate for Payer: Mclaren Medicare |
$79.23
|
| Rate for Payer: Meridian Medicaid |
$45.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.32
|
| Rate for Payer: PACE Medicare |
$75.27
|
| Rate for Payer: PACE SWMI |
$79.23
|
| Rate for Payer: PHP Commercial |
$87.15
|
| Rate for Payer: PHP Medicaid |
$43.34
|
| Rate for Payer: PHP Medicare Advantage |
$79.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.60
|
| Rate for Payer: Priority Health Medicare |
$79.23
|
| Rate for Payer: Priority Health Narrow Network |
$97.99
|
| Rate for Payer: Railroad Medicare Medicare |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.46
|
| Rate for Payer: UHC Medicare Advantage |
$81.61
|
| Rate for Payer: VA VA |
$79.23
|
|
|
HC CERV OR VAG CA SCREEN PELVIC/BREAST EXAM
|
Facility
|
IP
|
$138.02
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
77000001
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$96.61 |
| Max. Negotiated Rate |
$138.02 |
| Rate for Payer: Aetna Commercial |
$124.22
|
| Rate for Payer: ASR ASR |
$133.88
|
| Rate for Payer: BCBS Trust/PPO |
$107.01
|
| Rate for Payer: BCN Commercial |
$107.01
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$129.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.42
|
| Rate for Payer: Healthscope Commercial |
$138.02
|
| Rate for Payer: Healthscope Whirlpool |
$133.88
|
| Rate for Payer: Mclaren Commercial |
$124.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.46
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
IP
|
$762.46
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$762.46 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: ASR ASR |
$739.59
|
| Rate for Payer: BCBS Trust/PPO |
$591.14
|
| Rate for Payer: BCN Commercial |
$591.14
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$716.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$762.46
|
| Rate for Payer: Healthscope Whirlpool |
$739.59
|
| Rate for Payer: Mclaren Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.96
|
|
|
HC CESIUM 137 PER SOURCE
|
Facility
|
OP
|
$762.46
|
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$304.98 |
| Max. Negotiated Rate |
$762.46 |
| Rate for Payer: Aetna Commercial |
$686.21
|
| Rate for Payer: ASR ASR |
$739.59
|
| Rate for Payer: BCBS Complete |
$304.98
|
| Rate for Payer: BCBS Trust/PPO |
$591.14
|
| Rate for Payer: BCN Commercial |
$591.14
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$716.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$762.46
|
| Rate for Payer: Healthscope Whirlpool |
$739.59
|
| Rate for Payer: Mclaren Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$693.84
|
| Rate for Payer: Priority Health Narrow Network |
$541.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$670.96
|
|
|
HC CHAMBER HOLDING OPTI CHAMBER
|
Facility
|
OP
|
$21.88
|
|
| Hospital Charge Code |
27000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$19.69
|
| Rate for Payer: ASR ASR |
$21.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.88
|
| Rate for Payer: Healthscope Whirlpool |
$21.22
|
| Rate for Payer: Mclaren Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Narrow Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
