|
HC ADAPTER PERFUSION STERILE
|
Facility
|
OP
|
$93.64
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.48
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.25
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.48
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Narrow Network |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,810.03 |
| Max. Negotiated Rate |
$9,080.04 |
| Rate for Payer: Aetna Commercial |
$8,172.04
|
| Rate for Payer: ASR ASR |
$8,807.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,456.53
|
| Rate for Payer: BCN Commercial |
$7,456.53
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Commercial |
$8,535.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,807.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,080.04
|
| Rate for Payer: Mclaren Commercial |
$8,172.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,990.44
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$9,080.04 |
| Rate for Payer: Aetna Commercial |
$8,172.04
|
| Rate for Payer: Aetna Medicare |
$3,359.61
|
| Rate for Payer: ASR ASR |
$8,807.64
|
| Rate for Payer: BCBS Complete |
$3,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$7,486.49
|
| Rate for Payer: BCN Commercial |
$7,486.49
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Commercial |
$8,535.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,807.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,080.04
|
| Rate for Payer: Mclaren Commercial |
$8,172.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,264.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,990.44
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,810.03 |
| Max. Negotiated Rate |
$9,080.04 |
| Rate for Payer: Aetna Commercial |
$8,172.04
|
| Rate for Payer: ASR ASR |
$8,807.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,456.53
|
| Rate for Payer: BCN Commercial |
$7,456.53
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Commercial |
$8,535.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,807.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,080.04
|
| Rate for Payer: Mclaren Commercial |
$8,172.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,990.44
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$9,080.04 |
| Rate for Payer: Aetna Commercial |
$8,172.04
|
| Rate for Payer: Aetna Medicare |
$3,359.61
|
| Rate for Payer: ASR ASR |
$8,807.64
|
| Rate for Payer: BCBS Complete |
$3,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$7,486.49
|
| Rate for Payer: BCN Commercial |
$7,486.49
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Commercial |
$8,535.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,807.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,080.04
|
| Rate for Payer: Mclaren Commercial |
$8,172.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,264.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Nomi Health Commercial |
$7,445.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,990.44
|
|
|
HC ADDL DOSE TC99M DOM PROD NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS C9176
|
| Hospital Charge Code |
34300041
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$55.71 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: ASR ASR |
$54.04
|
| Rate for Payer: BCBS Complete |
$5.49
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$45.93
|
| Rate for Payer: BCN Commercial |
$45.93
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$54.04
|
| Rate for Payer: Healthscope Whirlpool |
$55.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.00
|
| Rate for Payer: Mclaren Commercial |
$50.14
|
| Rate for Payer: Mclaren Medicaid |
$10.00
|
| Rate for Payer: Mclaren Medicare |
$10.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: Meridian Medicaid |
$5.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$45.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PACE Medicare |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$11.00
|
| Rate for Payer: PHP Medicaid |
$5.36
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.81
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health Narrow Network |
$39.05
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.00
|
| Rate for Payer: UHC Exchange |
$15.50
|
| Rate for Payer: UHC Medicaid |
$5.23
|
| Rate for Payer: UHCCP DNSP |
$10.00
|
| Rate for Payer: UHCCP Medicaid |
$5.23
|
| Rate for Payer: VA VA |
$10.00
|
|
|
HC ADDL DOSE TC99M DOM PROD NON HEU
|
Facility
|
IP
|
$55.71
|
|
|
Service Code
|
HCPCS C9176
|
| Hospital Charge Code |
34300041
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$41.78 |
| Max. Negotiated Rate |
$55.71 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: ASR ASR |
$54.04
|
| Rate for Payer: BCBS Trust/PPO |
$45.75
|
| Rate for Payer: BCN Commercial |
$45.75
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$54.04
|
| Rate for Payer: Healthscope Whirlpool |
$55.71
|
| Rate for Payer: Mclaren Commercial |
$50.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$45.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.02
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$41.78 |
| Max. Negotiated Rate |
$55.71 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: ASR ASR |
$54.04
|
| Rate for Payer: BCBS Trust/PPO |
$45.75
|
| Rate for Payer: BCN Commercial |
$45.75
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$54.04
|
| Rate for Payer: Healthscope Whirlpool |
$55.71
|
| Rate for Payer: Mclaren Commercial |
$50.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$45.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.02
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$55.71 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$20.61
|
| Rate for Payer: ASR ASR |
$54.04
|
| Rate for Payer: BCBS Complete |
$22.28
|
| Rate for Payer: BCBS Trust/PPO |
$45.93
|
| Rate for Payer: BCN Commercial |
$45.93
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$54.04
|
| Rate for Payer: Healthscope Whirlpool |
$55.71
|
| Rate for Payer: Mclaren Commercial |
$50.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$45.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.81
|
| Rate for Payer: Priority Health Narrow Network |
$39.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.02
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$87.50
|
| Rate for Payer: BCN Commercial |
$87.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$102.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.98
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$74.39
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$87.15
|
| Rate for Payer: BCN Commercial |
$87.15
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$102.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.12
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Aetna Commercial |
$94.55
|
| Rate for Payer: ASR ASR |
$101.91
|
| Rate for Payer: BCBS Trust/PPO |
$86.28
|
| Rate for Payer: BCN Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Healthscope Commercial |
$101.91
|
| Rate for Payer: Healthscope Whirlpool |
$105.06
|
| Rate for Payer: Mclaren Commercial |
$94.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Nomi Health Commercial |
$86.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.45
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Aetna Commercial |
$94.55
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$101.91
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$86.62
|
| Rate for Payer: BCN Commercial |
$86.62
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$101.91
|
| Rate for Payer: Healthscope Whirlpool |
$105.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$94.55
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Nomi Health Commercial |
$86.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.05
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$73.65
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$27.13 |
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: ASR ASR |
$26.32
|
| Rate for Payer: BCBS Trust/PPO |
$22.28
|
| Rate for Payer: BCN Commercial |
$22.28
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Healthscope Whirlpool |
$27.13
|
| Rate for Payer: Mclaren Commercial |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Nomi Health Commercial |
$22.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.87
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$27.13 |
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: Aetna Medicare |
$10.04
|
| Rate for Payer: ASR ASR |
$26.32
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Healthscope Whirlpool |
$27.13
|
| Rate for Payer: Mclaren Commercial |
$24.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Nomi Health Commercial |
$22.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.77
|
| Rate for Payer: Priority Health Narrow Network |
$19.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.87
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
IP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,018.07 |
| Max. Negotiated Rate |
$6,690.76 |
| Rate for Payer: Aetna Commercial |
$6,021.68
|
| Rate for Payer: ASR ASR |
$6,490.04
|
| Rate for Payer: BCBS Trust/PPO |
$5,494.45
|
| Rate for Payer: BCN Commercial |
$5,494.45
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Commercial |
$6,289.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Healthscope Commercial |
$6,490.04
|
| Rate for Payer: Healthscope Whirlpool |
$6,690.76
|
| Rate for Payer: Mclaren Commercial |
$6,021.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Nomi Health Commercial |
$5,486.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,887.87
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
OP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,690.76 |
| Rate for Payer: Aetna Commercial |
$6,021.68
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$6,490.04
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$5,516.53
|
| Rate for Payer: BCN Commercial |
$5,516.53
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Commercial |
$6,289.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$6,490.04
|
| Rate for Payer: Healthscope Whirlpool |
$6,690.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$6,021.68
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Nomi Health Commercial |
$5,486.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,862.44
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$4,690.22
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,887.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.56 |
| Max. Negotiated Rate |
$1,988.00 |
| Rate for Payer: Aetna Commercial |
$1,789.20
|
| Rate for Payer: Aetna Medicare |
$735.56
|
| Rate for Payer: ASR ASR |
$1,928.36
|
| Rate for Payer: BCBS Complete |
$795.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.11
|
| Rate for Payer: BCN Commercial |
$1,639.11
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Commercial |
$1,868.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,928.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,988.00
|
| Rate for Payer: Mclaren Commercial |
$1,789.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,590.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Nomi Health Commercial |
$1,630.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,741.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,393.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,749.44
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$1,988.00 |
| Rate for Payer: Aetna Commercial |
$1,789.20
|
| Rate for Payer: ASR ASR |
$1,928.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,632.55
|
| Rate for Payer: BCN Commercial |
$1,632.55
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Commercial |
$1,868.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,928.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,988.00
|
| Rate for Payer: Mclaren Commercial |
$1,789.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Nomi Health Commercial |
$1,630.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,749.44
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
OP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,515.06 |
| Rate for Payer: Aetna Commercial |
$3,163.55
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$3,409.61
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,898.17
|
| Rate for Payer: BCN Commercial |
$2,898.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Commercial |
$3,304.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$3,409.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,515.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$3,163.55
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$2,882.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,079.90
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,464.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,093.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
IP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,636.30 |
| Max. Negotiated Rate |
$3,515.06 |
| Rate for Payer: Aetna Commercial |
$3,163.55
|
| Rate for Payer: ASR ASR |
$3,409.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,886.57
|
| Rate for Payer: BCN Commercial |
$2,886.57
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Commercial |
$3,304.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Healthscope Commercial |
$3,409.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,515.06
|
| Rate for Payer: Mclaren Commercial |
$3,163.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$2,882.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,093.25
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Trust/PPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$85.40
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$100.88
|
| Rate for Payer: Healthscope Whirlpool |
$104.00
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS Trust/PPO |
$85.75
|
| Rate for Payer: BCN Commercial |
$85.75
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$100.88
|
| Rate for Payer: Healthscope Whirlpool |
$104.00
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.27
|
| Rate for Payer: Priority Health Narrow Network |
$61.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
|
