|
HC AERONEB SUPPLY
|
Facility
|
OP
|
$167.21
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$167.21 |
| Rate for Payer: Aetna Commercial |
$150.49
|
| Rate for Payer: Aetna Medicare |
$83.60
|
| Rate for Payer: ASR ASR |
$162.19
|
| Rate for Payer: ASR Commercial |
$162.19
|
| Rate for Payer: BCBS Complete |
$66.88
|
| Rate for Payer: BCBS Trust/PPO |
$136.93
|
| Rate for Payer: BCN Commercial |
$129.64
|
| Rate for Payer: Cash Price |
$133.77
|
| Rate for Payer: Cofinity Commercial |
$157.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.77
|
| Rate for Payer: Healthscope Commercial |
$167.21
|
| Rate for Payer: Healthscope Whirlpool |
$162.19
|
| Rate for Payer: Mclaren Commercial |
$150.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.13
|
| Rate for Payer: Nomi Health Commercial |
$137.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.51
|
| Rate for Payer: Priority Health Narrow Network |
$117.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.14
|
|
|
HC AERONEB SUPPLY
|
Facility
|
IP
|
$167.21
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$167.21 |
| Rate for Payer: Aetna Commercial |
$150.49
|
| Rate for Payer: ASR ASR |
$162.19
|
| Rate for Payer: ASR Commercial |
$162.19
|
| Rate for Payer: BCBS Trust/PPO |
$136.26
|
| Rate for Payer: BCN Commercial |
$129.64
|
| Rate for Payer: Cash Price |
$133.77
|
| Rate for Payer: Cofinity Commercial |
$157.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.77
|
| Rate for Payer: Healthscope Commercial |
$167.21
|
| Rate for Payer: Healthscope Whirlpool |
$162.19
|
| Rate for Payer: Mclaren Commercial |
$150.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.13
|
| Rate for Payer: Nomi Health Commercial |
$137.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.14
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
OP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| 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 |
$145.18
|
| Rate for Payer: ASR Commercial |
$145.18
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$122.56
|
| Rate for Payer: BCN Commercial |
$116.04
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$149.67
|
| Rate for Payer: Healthscope Whirlpool |
$145.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.28
|
| Rate for Payer: Mclaren Commercial |
$134.70
|
| 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 |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$122.73
|
| 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 |
$97.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.29
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$92.23
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.71
|
| 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 AEROSOLIZED MEDICATION
|
Facility
|
IP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$149.67 |
| Rate for Payer: Aetna Commercial |
$134.70
|
| Rate for Payer: ASR ASR |
$145.18
|
| Rate for Payer: ASR Commercial |
$145.18
|
| Rate for Payer: BCBS Trust/PPO |
$121.97
|
| Rate for Payer: BCN Commercial |
$116.04
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Healthscope Commercial |
$149.67
|
| Rate for Payer: Healthscope Whirlpool |
$145.18
|
| Rate for Payer: Mclaren Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$122.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.71
|
|
|
HC AFB CULTURE
|
Facility
|
IP
|
$91.19
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$91.19 |
| Rate for Payer: Aetna Commercial |
$82.07
|
| Rate for Payer: ASR ASR |
$88.45
|
| Rate for Payer: ASR Commercial |
$88.45
|
| Rate for Payer: BCBS Trust/PPO |
$74.31
|
| Rate for Payer: BCN Commercial |
$70.70
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.95
|
| Rate for Payer: Healthscope Commercial |
$91.19
|
| Rate for Payer: Healthscope Whirlpool |
$88.45
|
| Rate for Payer: Mclaren Commercial |
$82.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.51
|
| Rate for Payer: Nomi Health Commercial |
$74.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.25
|
|
|
HC AFB CULTURE
|
Facility
|
OP
|
$91.19
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$82.07
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: ASR ASR |
$88.45
|
| Rate for Payer: ASR Commercial |
$88.45
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$74.68
|
| Rate for Payer: BCN Commercial |
$70.70
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Cash Price |
$72.95
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$91.19
|
| Rate for Payer: Healthscope Whirlpool |
$88.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.80
|
| Rate for Payer: Mclaren Commercial |
$82.07
|
| Rate for Payer: Mclaren Medicaid |
$5.79
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$6.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.51
|
| Rate for Payer: Nomi Health Commercial |
$74.78
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$11.88
|
| Rate for Payer: PHP Medicaid |
$5.79
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.80
|
| Rate for Payer: UHC Exchange |
$16.74
|
| Rate for Payer: UHC Medicare Advantage |
$10.80
|
| Rate for Payer: UHCCP DNSP |
$10.80
|
| Rate for Payer: UHCCP Medicaid |
$5.79
|
| Rate for Payer: VA VA |
$10.80
|
|
|
HC AFB SMEAR
|
Facility
|
OP
|
$58.65
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna Commercial |
$52.78
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: ASR ASR |
$56.89
|
| Rate for Payer: ASR Commercial |
$56.89
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$48.03
|
| Rate for Payer: BCN Commercial |
$45.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$58.65
|
| Rate for Payer: Healthscope Whirlpool |
$56.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.39
|
| Rate for Payer: Mclaren Commercial |
$52.78
|
| Rate for Payer: Mclaren Medicaid |
$2.89
|
| Rate for Payer: Mclaren Medicare |
$5.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: Meridian Medicaid |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| Rate for Payer: PACE Medicare |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$5.93
|
| Rate for Payer: PHP Medicaid |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.73
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Narrow Network |
$69.38
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.39
|
| Rate for Payer: UHC Exchange |
$8.35
|
| Rate for Payer: UHC Medicare Advantage |
$5.39
|
| Rate for Payer: UHCCP DNSP |
$5.39
|
| Rate for Payer: UHCCP Medicaid |
$2.89
|
| Rate for Payer: VA VA |
$5.39
|
|
|
HC AFB SMEAR
|
Facility
|
IP
|
$58.65
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$56.89
|
| Rate for Payer: ASR Commercial |
$56.89
|
| Rate for Payer: BCBS Trust/PPO |
$47.79
|
| Rate for Payer: BCN Commercial |
$45.47
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Healthscope Commercial |
$58.65
|
| Rate for Payer: Healthscope Whirlpool |
$56.89
|
| Rate for Payer: Mclaren Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.61
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Medicare |
$360.50
|
| Rate for Payer: ASR ASR |
$699.37
|
| Rate for Payer: ASR Commercial |
$699.37
|
| Rate for Payer: BCBS Complete |
$288.40
|
| Rate for Payer: BCBS Trust/PPO |
$590.43
|
| Rate for Payer: BCN Commercial |
$558.99
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: Cofinity Commercial |
$677.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.80
|
| Rate for Payer: Healthscope Commercial |
$721.00
|
| Rate for Payer: Healthscope Whirlpool |
$699.37
|
| Rate for Payer: Mclaren Commercial |
$648.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.85
|
| Rate for Payer: Nomi Health Commercial |
$591.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.85
|
| Rate for Payer: Priority Health Narrow Network |
$218.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.48
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$468.65 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: ASR ASR |
$699.37
|
| Rate for Payer: ASR Commercial |
$699.37
|
| Rate for Payer: BCBS Trust/PPO |
$587.54
|
| Rate for Payer: BCN Commercial |
$558.99
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: Cofinity Commercial |
$677.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.80
|
| Rate for Payer: Healthscope Commercial |
$721.00
|
| Rate for Payer: Healthscope Whirlpool |
$699.37
|
| Rate for Payer: Mclaren Commercial |
$648.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.85
|
| Rate for Payer: Nomi Health Commercial |
$591.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.48
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
OP
|
$434.79
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.92 |
| Max. Negotiated Rate |
$434.79 |
| Rate for Payer: Aetna Commercial |
$391.31
|
| Rate for Payer: Aetna Medicare |
$217.40
|
| Rate for Payer: ASR ASR |
$421.75
|
| Rate for Payer: ASR Commercial |
$421.75
|
| Rate for Payer: BCBS Complete |
$173.92
|
| Rate for Payer: BCBS Trust/PPO |
$356.05
|
| Rate for Payer: BCN Commercial |
$337.09
|
| Rate for Payer: Cash Price |
$347.83
|
| Rate for Payer: Cash Price |
$347.83
|
| Rate for Payer: Cofinity Commercial |
$408.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.83
|
| Rate for Payer: Healthscope Commercial |
$434.79
|
| Rate for Payer: Healthscope Whirlpool |
$421.75
|
| Rate for Payer: Mclaren Commercial |
$391.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.57
|
| Rate for Payer: Nomi Health Commercial |
$356.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.85
|
| Rate for Payer: Priority Health Narrow Network |
$218.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.62
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
IP
|
$434.79
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.61 |
| Max. Negotiated Rate |
$434.79 |
| Rate for Payer: Aetna Commercial |
$391.31
|
| Rate for Payer: ASR ASR |
$421.75
|
| Rate for Payer: ASR Commercial |
$421.75
|
| Rate for Payer: BCBS Trust/PPO |
$354.31
|
| Rate for Payer: BCN Commercial |
$337.09
|
| Rate for Payer: Cash Price |
$347.83
|
| Rate for Payer: Cofinity Commercial |
$408.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.83
|
| Rate for Payer: Healthscope Commercial |
$434.79
|
| Rate for Payer: Healthscope Whirlpool |
$421.75
|
| Rate for Payer: Mclaren Commercial |
$391.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.57
|
| Rate for Payer: Nomi Health Commercial |
$356.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.62
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$113.09 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Medicare |
$16.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.96
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$16.77
|
| Rate for Payer: BCBS Trust/PPO |
$40.04
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: BCN Medicare Advantage |
$16.77
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.77
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Mclaren Medicare |
$16.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.61
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: PACE Medicare |
$15.93
|
| Rate for Payer: PACE SWMI |
$16.77
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: PHP Medicaid |
$8.99
|
| Rate for Payer: PHP Medicare Advantage |
$16.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.09
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health Narrow Network |
$90.47
|
| Rate for Payer: Railroad Medicare Medicare |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.77
|
| Rate for Payer: UHC Exchange |
$25.99
|
| Rate for Payer: UHC Medicare Advantage |
$16.77
|
| Rate for Payer: UHCCP DNSP |
$16.77
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: VA VA |
$16.77
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.85
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: ASR Commercial |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: ASR Commercial |
$19.79
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.71
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.87
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC ALBUMIN SERUM
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
|
|
HC ALBUMIN SERUM
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$31.66
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: PHP Medicaid |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.02
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$13.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP DNSP |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
IP
|
$41.30
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$41.30 |
| Rate for Payer: Aetna Commercial |
$37.17
|
| Rate for Payer: ASR ASR |
$40.06
|
| Rate for Payer: ASR Commercial |
$40.06
|
| Rate for Payer: BCBS Trust/PPO |
$33.66
|
| Rate for Payer: BCN Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cofinity Commercial |
$38.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.04
|
| Rate for Payer: Healthscope Commercial |
$41.30
|
| Rate for Payer: Healthscope Whirlpool |
$40.06
|
| Rate for Payer: Mclaren Commercial |
$37.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Nomi Health Commercial |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.34
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
OP
|
$41.30
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$41.30 |
| Rate for Payer: Aetna Commercial |
$37.17
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$40.06
|
| Rate for Payer: ASR Commercial |
$40.06
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$33.82
|
| Rate for Payer: BCN Commercial |
$32.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: Cofinity Commercial |
$38.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$41.30
|
| Rate for Payer: Healthscope Whirlpool |
$40.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$37.17
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Nomi Health Commercial |
$33.87
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.19
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$28.95
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$12.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.78
|
| Rate for Payer: UHCCP DNSP |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: ASR ASR |
$6.05
|
| Rate for Payer: ASR Commercial |
$6.05
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$5.11
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$6.24
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Mclaren Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.49
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: ASR ASR |
$6.05
|
| Rate for Payer: ASR Commercial |
$6.05
|
| Rate for Payer: BCBS Trust/PPO |
$5.08
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$6.24
|
| Rate for Payer: Healthscope Whirlpool |
$6.05
|
| Rate for Payer: Mclaren Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.49
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.20
|
| Rate for Payer: Priority Health Narrow Network |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
IP
|
$125.88
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.82 |
| Max. Negotiated Rate |
$125.88 |
| Rate for Payer: Aetna Commercial |
$113.29
|
| Rate for Payer: ASR ASR |
$122.10
|
| Rate for Payer: ASR Commercial |
$122.10
|
| Rate for Payer: BCBS Trust/PPO |
$102.58
|
| Rate for Payer: BCN Commercial |
$97.59
|
| Rate for Payer: Cash Price |
$100.70
|
| Rate for Payer: Cofinity Commercial |
$118.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.70
|
| Rate for Payer: Healthscope Commercial |
$125.88
|
| Rate for Payer: Healthscope Whirlpool |
$122.10
|
| Rate for Payer: Mclaren Commercial |
$113.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.00
|
| Rate for Payer: Nomi Health Commercial |
$103.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.77
|
|
