|
HC CANNULA VEIN GRAFT
|
Facility
|
IP
|
$35.89
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: ASR ASR |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$29.47
|
| Rate for Payer: BCN Commercial |
$29.47
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.71
|
| Rate for Payer: Healthscope Commercial |
$34.81
|
| Rate for Payer: Healthscope Whirlpool |
$35.89
|
| Rate for Payer: Mclaren Commercial |
$32.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.51
|
| Rate for Payer: Nomi Health Commercial |
$29.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.58
|
|
|
HC CANNULA VEIN GRAFT
|
Facility
|
OP
|
$35.89
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: ASR ASR |
$34.81
|
| Rate for Payer: BCBS Complete |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$29.59
|
| Rate for Payer: BCN Commercial |
$29.59
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cofinity Commercial |
$33.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.71
|
| Rate for Payer: Healthscope Commercial |
$34.81
|
| Rate for Payer: Healthscope Whirlpool |
$35.89
|
| Rate for Payer: Mclaren Commercial |
$32.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.51
|
| Rate for Payer: Nomi Health Commercial |
$29.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.45
|
| Rate for Payer: Priority Health Narrow Network |
$25.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.58
|
|
|
HC CANNULA VENOUS 26FR
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
27000715
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: ASR ASR |
$180.42
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: BCBS Trust/PPO |
$153.36
|
| Rate for Payer: BCN Commercial |
$153.36
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$186.00
|
| Rate for Payer: Mclaren Commercial |
$167.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.10
|
| Rate for Payer: Nomi Health Commercial |
$152.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.97
|
| Rate for Payer: Priority Health Narrow Network |
$130.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.68
|
|
|
HC CANNULA VENOUS 26FR
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
27000715
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: ASR ASR |
$180.42
|
| Rate for Payer: BCBS Trust/PPO |
$152.74
|
| Rate for Payer: BCN Commercial |
$152.74
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$186.00
|
| Rate for Payer: Mclaren Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.10
|
| Rate for Payer: Nomi Health Commercial |
$152.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.68
|
|
|
HC CANNULA VENOUS RT PVC
|
Facility
|
IP
|
$87.39
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.54 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$78.65
|
| Rate for Payer: ASR ASR |
$84.77
|
| Rate for Payer: BCBS Trust/PPO |
$71.76
|
| Rate for Payer: BCN Commercial |
$71.76
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Healthscope Whirlpool |
$87.39
|
| Rate for Payer: Mclaren Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.90
|
|
|
HC CANNULA VENOUS RT PVC
|
Facility
|
OP
|
$87.39
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$78.65
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: ASR ASR |
$84.77
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$72.05
|
| Rate for Payer: BCN Commercial |
$72.05
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Healthscope Whirlpool |
$87.39
|
| Rate for Payer: Mclaren Commercial |
$78.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.57
|
| Rate for Payer: Priority Health Narrow Network |
$61.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.90
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
OP
|
$74.91
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: BCBS Complete |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$61.76
|
| Rate for Payer: BCN Commercial |
$61.76
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$72.66
|
| Rate for Payer: Healthscope Whirlpool |
$74.91
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.64
|
| Rate for Payer: Priority Health Narrow Network |
$52.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
IP
|
$74.91
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: BCBS Trust/PPO |
$61.52
|
| Rate for Payer: BCN Commercial |
$61.52
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$72.66
|
| Rate for Payer: Healthscope Whirlpool |
$74.91
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
OP
|
$99.88
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$99.88 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: ASR ASR |
$96.88
|
| Rate for Payer: BCBS Complete |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$82.35
|
| Rate for Payer: BCN Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$93.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$96.88
|
| Rate for Payer: Healthscope Whirlpool |
$99.88
|
| Rate for Payer: Mclaren Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.51
|
| Rate for Payer: Priority Health Narrow Network |
$70.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.89
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
IP
|
$99.88
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$99.88 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: ASR ASR |
$96.88
|
| Rate for Payer: BCBS Trust/PPO |
$82.02
|
| Rate for Payer: BCN Commercial |
$82.02
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$93.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$96.88
|
| Rate for Payer: Healthscope Whirlpool |
$99.88
|
| Rate for Payer: Mclaren Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.89
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
OP
|
$74.91
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: BCBS Complete |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$61.76
|
| Rate for Payer: BCN Commercial |
$61.76
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$72.66
|
| Rate for Payer: Healthscope Whirlpool |
$74.91
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.64
|
| Rate for Payer: Priority Health Narrow Network |
$52.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
IP
|
$74.91
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: BCBS Trust/PPO |
$61.52
|
| Rate for Payer: BCN Commercial |
$61.52
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$72.66
|
| Rate for Payer: Healthscope Whirlpool |
$74.91
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
OP
|
$45.66
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$45.66 |
| Rate for Payer: Aetna Commercial |
$41.09
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$44.29
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$37.65
|
| Rate for Payer: BCN Commercial |
$37.65
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$42.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$44.29
|
| Rate for Payer: Healthscope Whirlpool |
$45.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$41.09
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Nomi Health Commercial |
$37.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.01
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$32.01
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
IP
|
$45.66
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$45.66 |
| Rate for Payer: Aetna Commercial |
$41.09
|
| Rate for Payer: ASR ASR |
$44.29
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$42.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$44.29
|
| Rate for Payer: Healthscope Whirlpool |
$45.66
|
| Rate for Payer: Mclaren Commercial |
$41.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Nomi Health Commercial |
$37.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.18
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Trust/PPO |
$38.35
|
| Rate for Payer: BCN Commercial |
$38.35
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$14.57
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicaid |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.14
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$85.71
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$37.62
|
| Rate for Payer: BCN Commercial |
$37.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$45.63 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$37.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
IP
|
$22.07
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$22.07 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: ASR ASR |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$18.12
|
| Rate for Payer: BCN Commercial |
$18.12
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$21.41
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Mclaren Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Nomi Health Commercial |
$18.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.42
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
OP
|
$22.07
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: ASR ASR |
$21.41
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$21.41
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.88
|
| Rate for Payer: Mclaren Commercial |
$19.86
|
| Rate for Payer: Mclaren Medicaid |
$4.88
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Nomi Health Commercial |
$18.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$5.37
|
| Rate for Payer: PHP Medicaid |
$2.62
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.25
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$21.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.88
|
| Rate for Payer: UHC Exchange |
$7.56
|
| Rate for Payer: UHC Medicaid |
$2.55
|
| Rate for Payer: UHCCP DNSP |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$80.02
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$102.29 |
| Rate for Payer: Aetna Commercial |
$72.02
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: ASR ASR |
$77.62
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$65.98
|
| Rate for Payer: BCN Commercial |
$65.98
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.32
|
| Rate for Payer: Mclaren Commercial |
$72.02
|
| Rate for Payer: Mclaren Medicaid |
$12.32
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$6.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Nomi Health Commercial |
$65.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$13.55
|
| Rate for Payer: PHP Medicaid |
$6.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.29
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$81.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.32
|
| Rate for Payer: UHC Exchange |
$19.10
|
| Rate for Payer: UHC Medicaid |
$6.44
|
| Rate for Payer: UHCCP DNSP |
$12.32
|
| Rate for Payer: UHCCP Medicaid |
$6.44
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$80.02
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$80.02 |
| Rate for Payer: Aetna Commercial |
$72.02
|
| Rate for Payer: ASR ASR |
$77.62
|
| Rate for Payer: BCBS Trust/PPO |
$65.71
|
| Rate for Payer: BCN Commercial |
$65.71
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.02
|
| Rate for Payer: Mclaren Commercial |
$72.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Nomi Health Commercial |
$65.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.42
|
|
|
HC CARDIAC PET CT STRESS TEST
|
Facility
|
OP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,002.35 |
| Rate for Payer: Aetna Commercial |
$870.51
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$938.21
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$797.48
|
| Rate for Payer: BCN Commercial |
$797.48
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Commercial |
$909.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$938.21
|
| Rate for Payer: Healthscope Whirlpool |
$967.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$870.51
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$793.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,002.35
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$801.88
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC CARDIAC PET CT STRESS TEST
|
Facility
|
IP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$725.42 |
| Max. Negotiated Rate |
$967.23 |
| Rate for Payer: Aetna Commercial |
$870.51
|
| Rate for Payer: ASR ASR |
$938.21
|
| Rate for Payer: BCBS Trust/PPO |
$794.29
|
| Rate for Payer: BCN Commercial |
$794.29
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Commercial |
$909.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Healthscope Commercial |
$938.21
|
| Rate for Payer: Healthscope Whirlpool |
$967.23
|
| Rate for Payer: Mclaren Commercial |
$870.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$793.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.16
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
IP
|
$201.87
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$201.87 |
| Rate for Payer: Aetna Commercial |
$181.68
|
| Rate for Payer: ASR ASR |
$195.81
|
| Rate for Payer: BCBS Trust/PPO |
$165.78
|
| Rate for Payer: BCN Commercial |
$165.78
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cofinity Commercial |
$189.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.50
|
| Rate for Payer: Healthscope Commercial |
$195.81
|
| Rate for Payer: Healthscope Whirlpool |
$201.87
|
| Rate for Payer: Mclaren Commercial |
$181.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.59
|
| Rate for Payer: Nomi Health Commercial |
$165.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.65
|
|
