|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
IP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$104.49 |
| Max. Negotiated Rate |
$160.75 |
| Rate for Payer: Aetna Commercial |
$144.68
|
| Rate for Payer: ASR ASR |
$155.93
|
| Rate for Payer: ASR Commercial |
$155.93
|
| Rate for Payer: BCBS Trust/PPO |
$131.00
|
| Rate for Payer: BCN Commercial |
$124.63
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$151.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Healthscope Commercial |
$160.75
|
| Rate for Payer: Healthscope Whirlpool |
$155.93
|
| Rate for Payer: Mclaren Commercial |
$144.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: Nomi Health Commercial |
$131.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.46
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
OP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$160.75 |
| Rate for Payer: Aetna Commercial |
$144.68
|
| Rate for Payer: Aetna Medicare |
$30.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: ASR ASR |
$155.93
|
| Rate for Payer: ASR Commercial |
$155.93
|
| Rate for Payer: BCBS Complete |
$17.37
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$131.64
|
| Rate for Payer: BCN Commercial |
$124.63
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$151.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$160.75
|
| Rate for Payer: Healthscope Whirlpool |
$155.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.86
|
| Rate for Payer: Mclaren Commercial |
$144.68
|
| Rate for Payer: Mclaren Medicaid |
$16.54
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: Nomi Health Commercial |
$131.82
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$33.95
|
| Rate for Payer: PHP Medicaid |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.85
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow Network |
$112.69
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Exchange |
$47.83
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP DNSP |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$16.54
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
IP
|
$8.86
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: ASR ASR |
$8.59
|
| Rate for Payer: ASR Commercial |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$7.22
|
| Rate for Payer: BCN Commercial |
$6.87
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$8.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$8.86
|
| Rate for Payer: Healthscope Whirlpool |
$8.59
|
| Rate for Payer: Mclaren Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.80
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
OP
|
$8.86
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna Medicare |
$4.43
|
| Rate for Payer: ASR ASR |
$8.59
|
| Rate for Payer: ASR Commercial |
$8.59
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.26
|
| Rate for Payer: BCN Commercial |
$6.87
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$8.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$8.86
|
| Rate for Payer: Healthscope Whirlpool |
$8.59
|
| Rate for Payer: Mclaren Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.76
|
| Rate for Payer: Priority Health Narrow Network |
$6.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.80
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
OP
|
$91.80
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
IP
|
$91.80
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna Commercial |
$11.02
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: ASR ASR |
$11.87
|
| Rate for Payer: ASR Commercial |
$11.87
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.02
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$11.87
|
| Rate for Payer: Mclaren Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.72
|
| Rate for Payer: Priority Health Narrow Network |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.77
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna Commercial |
$11.02
|
| Rate for Payer: ASR ASR |
$11.87
|
| Rate for Payer: ASR Commercial |
$11.87
|
| Rate for Payer: BCBS Trust/PPO |
$9.97
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$11.87
|
| Rate for Payer: Mclaren Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.77
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,902.00 |
| Rate for Payer: Aetna Commercial |
$8,011.80
|
| Rate for Payer: ASR ASR |
$8,634.94
|
| Rate for Payer: ASR Commercial |
$8,634.94
|
| Rate for Payer: BCBS Trust/PPO |
$7,254.24
|
| Rate for Payer: BCN Commercial |
$6,901.72
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$8,367.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,902.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,634.94
|
| Rate for Payer: Mclaren Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,833.76
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8,902.00 |
| Rate for Payer: Aetna Commercial |
$8,011.80
|
| Rate for Payer: Aetna Medicare |
$4,451.00
|
| Rate for Payer: ASR ASR |
$8,634.94
|
| Rate for Payer: ASR Commercial |
$8,634.94
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,289.85
|
| Rate for Payer: BCN Commercial |
$6,901.72
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$8,367.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,902.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,634.94
|
| Rate for Payer: Mclaren Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: 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 |
$7,833.76
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8,902.00 |
| Rate for Payer: Aetna Commercial |
$8,011.80
|
| Rate for Payer: Aetna Medicare |
$4,451.00
|
| Rate for Payer: ASR ASR |
$8,634.94
|
| Rate for Payer: ASR Commercial |
$8,634.94
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,289.85
|
| Rate for Payer: BCN Commercial |
$6,901.72
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$8,367.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,902.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,634.94
|
| Rate for Payer: Mclaren Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: 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 |
$7,833.76
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,902.00 |
| Rate for Payer: Aetna Commercial |
$8,011.80
|
| Rate for Payer: ASR ASR |
$8,634.94
|
| Rate for Payer: ASR Commercial |
$8,634.94
|
| Rate for Payer: BCBS Trust/PPO |
$7,254.24
|
| Rate for Payer: BCN Commercial |
$6,901.72
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$8,367.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,902.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,634.94
|
| Rate for Payer: Mclaren Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,833.76
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$54.62 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| 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 |
$52.98
|
| Rate for Payer: ASR Commercial |
$52.98
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$44.73
|
| Rate for Payer: BCN Commercial |
$42.35
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$51.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$54.62
|
| Rate for Payer: Healthscope Whirlpool |
$52.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.00
|
| Rate for Payer: Mclaren Commercial |
$49.16
|
| Rate for Payer: Mclaren Medicaid |
$5.36
|
| 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 |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: Nomi Health Commercial |
$44.79
|
| 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 |
$5.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.45
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health Narrow Network |
$9.16
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.00
|
| Rate for Payer: UHC Exchange |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
| Rate for Payer: UHCCP DNSP |
$10.00
|
| Rate for Payer: UHCCP Medicaid |
$5.36
|
| Rate for Payer: VA VA |
$10.00
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$54.62 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: ASR ASR |
$52.98
|
| Rate for Payer: ASR Commercial |
$52.98
|
| Rate for Payer: BCBS Trust/PPO |
$44.51
|
| Rate for Payer: BCN Commercial |
$42.35
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$51.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Healthscope Commercial |
$54.62
|
| Rate for Payer: Healthscope Whirlpool |
$52.98
|
| Rate for Payer: Mclaren Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: Nomi Health Commercial |
$44.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.07
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: ASR Commercial |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$84.78
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| 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 |
$100.92
|
| Rate for Payer: ASR Commercial |
$100.92
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$85.20
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| 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 |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.16
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$72.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| 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 |
$99.91
|
| Rate for Payer: ASR Commercial |
$99.91
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCN Commercial |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Healthscope Whirlpool |
$99.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$92.70
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| 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 |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.25
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$72.20
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: ASR ASR |
$99.91
|
| Rate for Payer: ASR Commercial |
$99.91
|
| Rate for Payer: BCBS Trust/PPO |
$83.93
|
| Rate for Payer: BCN Commercial |
$79.86
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Healthscope Whirlpool |
$99.91
|
| Rate for Payer: Mclaren Commercial |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.64
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$26.60
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna Medicare |
$13.30
|
| Rate for Payer: ASR ASR |
$25.80
|
| Rate for Payer: ASR Commercial |
$25.80
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS Trust/PPO |
$21.78
|
| Rate for Payer: BCN Commercial |
$20.62
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$26.60
|
| Rate for Payer: Healthscope Whirlpool |
$25.80
|
| Rate for Payer: Mclaren Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.61
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.31
|
| Rate for Payer: Priority Health Narrow Network |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.41
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$26.60
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: ASR ASR |
$25.80
|
| Rate for Payer: ASR Commercial |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$21.68
|
| Rate for Payer: BCN Commercial |
$20.62
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$26.60
|
| Rate for Payer: Healthscope Whirlpool |
$25.80
|
| Rate for Payer: Mclaren Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.61
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.41
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: ASR Commercial |
$98.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.09
|
| Rate for Payer: BCN Commercial |
$79.05
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$101.96
|
| Rate for Payer: Healthscope Whirlpool |
$98.90
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: Aetna Medicare |
$50.98
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: ASR Commercial |
$98.90
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$83.50
|
| Rate for Payer: BCN Commercial |
$79.05
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$101.96
|
| Rate for Payer: Healthscope Whirlpool |
$98.90
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.18
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$585.48
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$585.48 |
| Rate for Payer: Aetna Commercial |
$526.93
|
| Rate for Payer: ASR ASR |
$567.92
|
| Rate for Payer: ASR Commercial |
$567.92
|
| Rate for Payer: BCBS Trust/PPO |
$477.11
|
| Rate for Payer: BCN Commercial |
$453.92
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$550.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.38
|
| Rate for Payer: Healthscope Commercial |
$585.48
|
| Rate for Payer: Healthscope Whirlpool |
$567.92
|
| Rate for Payer: Mclaren Commercial |
$526.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.66
|
| Rate for Payer: Nomi Health Commercial |
$480.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.22
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$585.48
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$106.81 |
| Max. Negotiated Rate |
$585.48 |
| Rate for Payer: Aetna Commercial |
$526.93
|
| Rate for Payer: Aetna Medicare |
$199.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: ASR ASR |
$567.92
|
| Rate for Payer: ASR Commercial |
$567.92
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$479.45
|
| Rate for Payer: BCN Commercial |
$453.92
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$550.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$585.48
|
| Rate for Payer: Healthscope Whirlpool |
$567.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.28
|
| Rate for Payer: Mclaren Commercial |
$526.93
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.66
|
| Rate for Payer: Nomi Health Commercial |
$480.09
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$219.21
|
| Rate for Payer: PHP Medicaid |
$106.81
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.00
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$410.42
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP DNSP |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: ASR ASR |
$82.16
|
| Rate for Payer: ASR Commercial |
$82.16
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: BCBS Trust/PPO |
$69.36
|
| Rate for Payer: BCN Commercial |
$65.67
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$79.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$84.70
|
| Rate for Payer: Healthscope Whirlpool |
$82.16
|
| Rate for Payer: Mclaren Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.21
|
| Rate for Payer: Priority Health Narrow Network |
$59.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.54
|
|
