|
HC BLD DRAW CENTRAL/PERIPH VENOUS CATH
|
Facility
|
IP
|
$127.01
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$127.01 |
| Rate for Payer: Aetna Commercial |
$114.31
|
| Rate for Payer: ASR ASR |
$123.20
|
| Rate for Payer: BCBS Trust/PPO |
$104.30
|
| Rate for Payer: BCN Commercial |
$104.30
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cofinity Commercial |
$119.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.61
|
| Rate for Payer: Healthscope Commercial |
$123.20
|
| Rate for Payer: Healthscope Whirlpool |
$127.01
|
| Rate for Payer: Mclaren Commercial |
$114.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.96
|
| Rate for Payer: Nomi Health Commercial |
$104.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.77
|
|
|
HC BLD DRAW CENTRAL/PERIPH VENOUS CATH
|
Facility
|
OP
|
$127.01
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$114.31
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$123.20
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$104.72
|
| Rate for Payer: BCN Commercial |
$104.72
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cofinity Commercial |
$119.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$123.20
|
| Rate for Payer: Healthscope Whirlpool |
$127.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$114.31
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.96
|
| Rate for Payer: Nomi Health Commercial |
$104.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.26
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.33
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$84.26
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC BLEEDING TIME
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
30500001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: Aetna Medicare |
$4.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.03
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: BCBS MAPPO |
$4.82
|
| Rate for Payer: BCBS Trust/PPO |
$64.68
|
| Rate for Payer: BCN Commercial |
$64.68
|
| Rate for Payer: BCN Medicare Advantage |
$4.82
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.82
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$4.82
|
| Rate for Payer: Mclaren Medicare |
$4.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.06
|
| Rate for Payer: Meridian Medicaid |
$2.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$4.58
|
| Rate for Payer: PACE SWMI |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: PHP Medicaid |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$4.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.62
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow Network |
$39.70
|
| Rate for Payer: Railroad Medicare Medicare |
$4.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.82
|
| Rate for Payer: UHC Exchange |
$7.47
|
| Rate for Payer: UHC Medicaid |
$2.52
|
| Rate for Payer: UHCCP DNSP |
$4.82
|
| Rate for Payer: UHCCP Medicaid |
$2.52
|
| Rate for Payer: VA VA |
$4.82
|
|
|
HC BLEEDING TIME
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
30500001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$64.42
|
| Rate for Payer: BCN Commercial |
$64.42
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Facility
|
OP
|
$943.50
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Aetna Commercial |
$849.15
|
| Rate for Payer: Aetna Medicare |
$316.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$395.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$395.32
|
| Rate for Payer: ASR ASR |
$915.20
|
| Rate for Payer: BCBS Complete |
$173.69
|
| Rate for Payer: BCBS MAPPO |
$316.26
|
| Rate for Payer: BCBS Trust/PPO |
$777.92
|
| Rate for Payer: BCN Commercial |
$777.92
|
| Rate for Payer: BCN Medicare Advantage |
$316.26
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cofinity Commercial |
$886.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.26
|
| Rate for Payer: Healthscope Commercial |
$915.20
|
| Rate for Payer: Healthscope Whirlpool |
$943.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$316.26
|
| Rate for Payer: Mclaren Commercial |
$849.15
|
| Rate for Payer: Mclaren Medicaid |
$316.26
|
| Rate for Payer: Mclaren Medicare |
$316.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.07
|
| Rate for Payer: Meridian Medicaid |
$173.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$347.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.98
|
| Rate for Payer: Nomi Health Commercial |
$773.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.62
|
| Rate for Payer: PACE Medicare |
$300.45
|
| Rate for Payer: PACE SWMI |
$316.26
|
| Rate for Payer: PHP Commercial |
$347.89
|
| Rate for Payer: PHP Medicaid |
$169.52
|
| Rate for Payer: PHP Medicare Advantage |
$316.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$542.34
|
| Rate for Payer: Priority Health Medicare |
$316.26
|
| Rate for Payer: Priority Health Narrow Network |
$433.87
|
| Rate for Payer: Railroad Medicare Medicare |
$316.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$316.26
|
| Rate for Payer: UHC Exchange |
$490.20
|
| Rate for Payer: UHC Medicaid |
$165.40
|
| Rate for Payer: UHCCP DNSP |
$316.26
|
| Rate for Payer: UHCCP Medicaid |
$165.40
|
| Rate for Payer: VA VA |
$316.26
|
|
|
HC BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Facility
|
IP
|
$943.50
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$707.62 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Aetna Commercial |
$849.15
|
| Rate for Payer: ASR ASR |
$915.20
|
| Rate for Payer: BCBS Trust/PPO |
$774.80
|
| Rate for Payer: BCN Commercial |
$774.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cofinity Commercial |
$886.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.80
|
| Rate for Payer: Healthscope Commercial |
$915.20
|
| Rate for Payer: Healthscope Whirlpool |
$943.50
|
| Rate for Payer: Mclaren Commercial |
$849.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.98
|
| Rate for Payer: Nomi Health Commercial |
$773.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.28
|
|
|
HC BLOOD CULTURE
|
Facility
|
IP
|
$99.65
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
30600072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.74 |
| Max. Negotiated Rate |
$99.65 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: ASR ASR |
$96.66
|
| Rate for Payer: BCBS Trust/PPO |
$81.83
|
| Rate for Payer: BCN Commercial |
$81.83
|
| Rate for Payer: Cash Price |
$79.72
|
| Rate for Payer: Cofinity Commercial |
$93.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.72
|
| Rate for Payer: Healthscope Commercial |
$96.66
|
| Rate for Payer: Healthscope Whirlpool |
$99.65
|
| Rate for Payer: Mclaren Commercial |
$89.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.70
|
| Rate for Payer: Nomi Health Commercial |
$81.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.69
|
|
|
HC BLOOD CULTURE
|
Facility
|
OP
|
$99.65
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
30600072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$143.46 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: ASR ASR |
$96.66
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$82.16
|
| Rate for Payer: BCN Commercial |
$82.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$79.72
|
| Rate for Payer: Cash Price |
$79.72
|
| Rate for Payer: Cofinity Commercial |
$93.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$96.66
|
| Rate for Payer: Healthscope Whirlpool |
$99.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.32
|
| Rate for Payer: Mclaren Commercial |
$89.69
|
| Rate for Payer: Mclaren Medicaid |
$10.32
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$5.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.70
|
| Rate for Payer: Nomi Health Commercial |
$81.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.74
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$11.35
|
| Rate for Payer: PHP Medicaid |
$5.53
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.46
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health Narrow Network |
$114.77
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.32
|
| Rate for Payer: UHC Exchange |
$16.00
|
| Rate for Payer: UHC Medicaid |
$5.40
|
| Rate for Payer: UHCCP DNSP |
$10.32
|
| Rate for Payer: UHCCP Medicaid |
$5.40
|
| Rate for Payer: VA VA |
$10.32
|
|
|
HC BLOOD DRAW IMPLANTED DEVICE
|
Facility
|
OP
|
$171.13
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$154.02
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$166.00
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$141.10
|
| Rate for Payer: BCN Commercial |
$141.10
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Cofinity Commercial |
$160.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$166.00
|
| Rate for Payer: Healthscope Whirlpool |
$171.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$154.02
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.46
|
| Rate for Payer: Nomi Health Commercial |
$140.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.35
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.33
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$84.26
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC BLOOD DRAW IMPLANTED DEVICE
|
Facility
|
IP
|
$171.13
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$171.13 |
| Rate for Payer: Aetna Commercial |
$154.02
|
| Rate for Payer: ASR ASR |
$166.00
|
| Rate for Payer: BCBS Trust/PPO |
$140.53
|
| Rate for Payer: BCN Commercial |
$140.53
|
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Cofinity Commercial |
$160.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.90
|
| Rate for Payer: Healthscope Commercial |
$166.00
|
| Rate for Payer: Healthscope Whirlpool |
$171.13
|
| Rate for Payer: Mclaren Commercial |
$154.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.46
|
| Rate for Payer: Nomi Health Commercial |
$140.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.59
|
|
|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
OP
|
$180.51
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna Commercial |
$162.46
|
| Rate for Payer: Aetna Medicare |
$26.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.59
|
| Rate for Payer: ASR ASR |
$175.09
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$148.83
|
| Rate for Payer: BCN Commercial |
$148.83
|
| Rate for Payer: BCN Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cofinity Commercial |
$169.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Healthscope Whirlpool |
$180.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.07
|
| Rate for Payer: Mclaren Commercial |
$162.46
|
| Rate for Payer: Mclaren Medicaid |
$26.07
|
| Rate for Payer: Mclaren Medicare |
$26.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.37
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.43
|
| Rate for Payer: Nomi Health Commercial |
$148.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.38
|
| Rate for Payer: PACE Medicare |
$24.77
|
| Rate for Payer: PACE SWMI |
$26.07
|
| Rate for Payer: PHP Commercial |
$28.68
|
| Rate for Payer: PHP Medicaid |
$13.97
|
| Rate for Payer: PHP Medicare Advantage |
$26.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.77
|
| Rate for Payer: Priority Health Medicare |
$26.07
|
| Rate for Payer: Priority Health Narrow Network |
$143.82
|
| Rate for Payer: Railroad Medicare Medicare |
$26.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.07
|
| Rate for Payer: UHC Exchange |
$40.41
|
| Rate for Payer: UHC Medicaid |
$13.63
|
| Rate for Payer: UHCCP DNSP |
$26.07
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: VA VA |
$26.07
|
|
|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
IP
|
$180.51
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna Commercial |
$162.46
|
| Rate for Payer: ASR ASR |
$175.09
|
| Rate for Payer: BCBS Trust/PPO |
$148.23
|
| Rate for Payer: BCN Commercial |
$148.23
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cofinity Commercial |
$169.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.41
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Healthscope Whirlpool |
$180.51
|
| Rate for Payer: Mclaren Commercial |
$162.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.43
|
| Rate for Payer: Nomi Health Commercial |
$148.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.85
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
OP
|
$191.76
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$191.76 |
| Rate for Payer: Aetna Commercial |
$172.58
|
| Rate for Payer: Aetna Medicare |
$78.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.46
|
| Rate for Payer: ASR ASR |
$186.01
|
| Rate for Payer: BCBS Complete |
$43.26
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$158.11
|
| Rate for Payer: BCN Commercial |
$158.11
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Commercial |
$180.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$186.01
|
| Rate for Payer: Healthscope Whirlpool |
$191.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$78.77
|
| Rate for Payer: Mclaren Commercial |
$172.58
|
| Rate for Payer: Mclaren Medicaid |
$78.77
|
| Rate for Payer: Mclaren Medicare |
$78.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.71
|
| Rate for Payer: Meridian Medicaid |
$43.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.00
|
| Rate for Payer: Nomi Health Commercial |
$157.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.82
|
| Rate for Payer: PACE Medicare |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$86.65
|
| Rate for Payer: PHP Medicaid |
$42.22
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.02
|
| Rate for Payer: Priority Health Medicare |
$78.77
|
| Rate for Payer: Priority Health Narrow Network |
$134.42
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.77
|
| Rate for Payer: UHC Exchange |
$122.09
|
| Rate for Payer: UHC Medicaid |
$41.20
|
| Rate for Payer: UHCCP DNSP |
$78.77
|
| Rate for Payer: UHCCP Medicaid |
$41.20
|
| Rate for Payer: VA VA |
$78.77
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
IP
|
$191.76
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.82 |
| Max. Negotiated Rate |
$191.76 |
| Rate for Payer: Aetna Commercial |
$172.58
|
| Rate for Payer: ASR ASR |
$186.01
|
| Rate for Payer: BCBS Trust/PPO |
$157.47
|
| Rate for Payer: BCN Commercial |
$157.47
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Commercial |
$180.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Healthscope Commercial |
$186.01
|
| Rate for Payer: Healthscope Whirlpool |
$191.76
|
| Rate for Payer: Mclaren Commercial |
$172.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.00
|
| Rate for Payer: Nomi Health Commercial |
$157.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.75
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$26.32
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$30.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$31.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.05
|
| Rate for Payer: Mclaren Commercial |
$28.73
|
| Rate for Payer: Mclaren Medicaid |
$18.05
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.94
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: PHP Medicaid |
$9.67
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.97
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow Network |
$22.38
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.05
|
| Rate for Payer: UHC Exchange |
$27.98
|
| Rate for Payer: UHC Medicaid |
$9.44
|
| Rate for Payer: UHCCP DNSP |
$18.05
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$18.05
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
IP
|
$31.92
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.21
|
| Rate for Payer: BCN Commercial |
$26.21
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$30.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$30.96
|
| Rate for Payer: Healthscope Whirlpool |
$31.92
|
| Rate for Payer: Mclaren Commercial |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
|
|
HC BLOOD PATCH
|
Facility
|
OP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,455.08 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$1,234.95
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.70
|
| Rate for Payer: BCN Commercial |
$1,049.70
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Commercial |
$1,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,234.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$1,145.83
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Nomi Health Commercial |
$1,043.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,455.08
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.06
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,120.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC BLOOD PATCH
|
Facility
|
IP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.86 |
| Max. Negotiated Rate |
$1,273.14 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: ASR ASR |
$1,234.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,045.50
|
| Rate for Payer: BCN Commercial |
$1,045.50
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Commercial |
$1,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Healthscope Commercial |
$1,234.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.14
|
| Rate for Payer: Mclaren Commercial |
$1,145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Nomi Health Commercial |
$1,043.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,120.36
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
IP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.86 |
| Max. Negotiated Rate |
$1,273.14 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: ASR ASR |
$1,234.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,045.50
|
| Rate for Payer: BCN Commercial |
$1,045.50
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Commercial |
$1,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Healthscope Commercial |
$1,234.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.14
|
| Rate for Payer: Mclaren Commercial |
$1,145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Nomi Health Commercial |
$1,043.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,120.36
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
OP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,455.08 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$1,234.95
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.70
|
| Rate for Payer: BCN Commercial |
$1,049.70
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Commercial |
$1,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,234.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,273.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$1,145.83
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Nomi Health Commercial |
$1,043.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,455.08
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.06
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,120.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
OP
|
$23.51
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$23.51 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$3.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.29
|
| Rate for Payer: ASR ASR |
$22.80
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$3.43
|
| Rate for Payer: BCBS Trust/PPO |
$19.38
|
| Rate for Payer: BCN Commercial |
$19.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.43
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$22.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$22.80
|
| Rate for Payer: Healthscope Whirlpool |
$23.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.43
|
| Rate for Payer: Mclaren Commercial |
$21.16
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Mclaren Medicare |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.60
|
| Rate for Payer: Meridian Medicaid |
$1.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.63
|
| Rate for Payer: PACE Medicare |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: PHP Medicaid |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$3.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.60
|
| Rate for Payer: Priority Health Medicare |
$3.43
|
| Rate for Payer: Priority Health Narrow Network |
$16.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.43
|
| Rate for Payer: UHC Exchange |
$5.32
|
| Rate for Payer: UHC Medicaid |
$1.79
|
| Rate for Payer: UHCCP DNSP |
$3.43
|
| Rate for Payer: UHCCP Medicaid |
$1.79
|
| Rate for Payer: VA VA |
$3.43
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
IP
|
$23.51
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$23.51 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: ASR ASR |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$19.31
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$22.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.81
|
| Rate for Payer: Healthscope Commercial |
$22.80
|
| Rate for Payer: Healthscope Whirlpool |
$23.51
|
| Rate for Payer: Mclaren Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.69
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
OP
|
$253.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$79.49 |
| Max. Negotiated Rate |
$253.78 |
| Rate for Payer: Aetna Commercial |
$228.40
|
| Rate for Payer: Aetna Medicare |
$151.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: ASR ASR |
$246.17
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$209.24
|
| Rate for Payer: BCN Commercial |
$209.24
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$203.02
|
| Rate for Payer: Cash Price |
$203.02
|
| Rate for Payer: Cofinity Commercial |
$238.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$246.17
|
| Rate for Payer: Healthscope Whirlpool |
$253.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.99
|
| Rate for Payer: Mclaren Commercial |
$228.40
|
| Rate for Payer: Mclaren Medicaid |
$151.99
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$83.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.71
|
| Rate for Payer: Nomi Health Commercial |
$208.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.34
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$167.19
|
| Rate for Payer: PHP Medicaid |
$81.47
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$222.36
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health Narrow Network |
$177.90
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$235.58
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP DNSP |
$151.99
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
IP
|
$253.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$190.34 |
| Max. Negotiated Rate |
$253.78 |
| Rate for Payer: Aetna Commercial |
$228.40
|
| Rate for Payer: ASR ASR |
$246.17
|
| Rate for Payer: BCBS Trust/PPO |
$208.40
|
| Rate for Payer: BCN Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$203.02
|
| Rate for Payer: Cofinity Commercial |
$238.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.02
|
| Rate for Payer: Healthscope Commercial |
$246.17
|
| Rate for Payer: Healthscope Whirlpool |
$253.78
|
| Rate for Payer: Mclaren Commercial |
$228.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.71
|
| Rate for Payer: Nomi Health Commercial |
$208.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.33
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
OP
|
$47.36
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$235.58 |
| Rate for Payer: Aetna Commercial |
$42.62
|
| Rate for Payer: Aetna Medicare |
$151.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: ASR ASR |
$45.94
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$39.05
|
| Rate for Payer: BCN Commercial |
$39.05
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Cofinity Commercial |
$44.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$45.94
|
| Rate for Payer: Healthscope Whirlpool |
$47.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.99
|
| Rate for Payer: Mclaren Commercial |
$42.62
|
| Rate for Payer: Mclaren Medicaid |
$151.99
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$83.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.26
|
| Rate for Payer: Nomi Health Commercial |
$38.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.52
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$167.19
|
| Rate for Payer: PHP Medicaid |
$81.47
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health Narrow Network |
$33.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$235.58
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP DNSP |
$151.99
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
