|
HC ESOPHAGEAL MAPPING CATHETER
|
Facility
|
IP
|
$1,410.81
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$987.57 |
| Max. Negotiated Rate |
$1,410.81 |
| Rate for Payer: Aetna Commercial |
$1,269.73
|
| Rate for Payer: ASR ASR |
$1,368.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.80
|
| Rate for Payer: BCN Commercial |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,326.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Healthscope Commercial |
$1,410.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,368.49
|
| Rate for Payer: Mclaren Commercial |
$1,269.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,199.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,241.51
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,350.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.16 |
| Max. Negotiated Rate |
$1,350.23 |
| Rate for Payer: Aetna Commercial |
$1,215.21
|
| Rate for Payer: ASR ASR |
$1,309.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.83
|
| Rate for Payer: BCN Commercial |
$1,046.83
|
| Rate for Payer: Cash Price |
$1,080.18
|
| Rate for Payer: Cofinity Commercial |
$1,269.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.18
|
| Rate for Payer: Healthscope Commercial |
$1,350.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,309.72
|
| Rate for Payer: Mclaren Commercial |
$1,215.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.20
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,350.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.09 |
| Max. Negotiated Rate |
$1,350.23 |
| Rate for Payer: Aetna Commercial |
$1,215.21
|
| Rate for Payer: ASR ASR |
$1,309.72
|
| Rate for Payer: BCBS Complete |
$540.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.83
|
| Rate for Payer: BCN Commercial |
$1,046.83
|
| Rate for Payer: Cash Price |
$1,080.18
|
| Rate for Payer: Cofinity Commercial |
$1,269.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.18
|
| Rate for Payer: Healthscope Commercial |
$1,350.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,309.72
|
| Rate for Payer: Mclaren Commercial |
$1,215.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.71
|
| Rate for Payer: Priority Health Narrow Network |
$958.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.20
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,208.70
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.48 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna Commercial |
$1,087.83
|
| Rate for Payer: ASR ASR |
$1,172.44
|
| Rate for Payer: BCBS Complete |
$483.48
|
| Rate for Payer: BCBS Trust/PPO |
$937.11
|
| Rate for Payer: BCN Commercial |
$937.11
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.44
|
| Rate for Payer: Mclaren Commercial |
$1,087.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.92
|
| Rate for Payer: Priority Health Narrow Network |
$858.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.66
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,208.70
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.09 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna Commercial |
$1,087.83
|
| Rate for Payer: ASR ASR |
$1,172.44
|
| Rate for Payer: BCBS Trust/PPO |
$937.11
|
| Rate for Payer: BCN Commercial |
$937.11
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.44
|
| Rate for Payer: Mclaren Commercial |
$1,087.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.66
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$80.66
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.05
|
| Rate for Payer: Priority Health Narrow Network |
$32.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.83 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$80.66
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Medicare |
$27.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: ASR ASR |
$52.38
|
| Rate for Payer: BCBS Complete |
$16.05
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$41.87
|
| Rate for Payer: BCN Commercial |
$41.87
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Healthscope Whirlpool |
$52.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$48.60
|
| Rate for Payer: Mclaren Medicaid |
$15.28
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicaid |
$15.28
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.52
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: ASR ASR |
$52.38
|
| Rate for Payer: BCBS Trust/PPO |
$41.87
|
| Rate for Payer: BCN Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Healthscope Whirlpool |
$52.38
|
| Rate for Payer: Mclaren Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.52
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$27.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$16.05
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$15.28
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicaid |
$15.28
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.22
|
| Rate for Payer: ASR ASR |
$48.48
|
| Rate for Payer: BCBS Complete |
$13.89
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$38.75
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$46.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$49.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.18
|
| Rate for Payer: Mclaren Commercial |
$44.98
|
| Rate for Payer: Mclaren Medicaid |
$13.23
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Medicaid |
$13.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicaid |
$13.23
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.13
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow Network |
$160.90
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.98
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: VA VA |
$24.18
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| Rate for Payer: ASR ASR |
$48.48
|
| Rate for Payer: BCBS Trust/PPO |
$38.75
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$46.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$49.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.48
|
| Rate for Payer: Mclaren Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.98
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$115.87
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$115.87 |
| Rate for Payer: Aetna Commercial |
$104.28
|
| Rate for Payer: ASR ASR |
$112.39
|
| Rate for Payer: BCBS Trust/PPO |
$89.83
|
| Rate for Payer: BCN Commercial |
$89.83
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.70
|
| Rate for Payer: Healthscope Commercial |
$115.87
|
| Rate for Payer: Healthscope Whirlpool |
$112.39
|
| Rate for Payer: Mclaren Commercial |
$104.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.97
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$115.87
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$189.84 |
| Rate for Payer: Aetna Commercial |
$104.28
|
| Rate for Payer: Aetna Medicare |
$87.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.85
|
| Rate for Payer: ASR ASR |
$112.39
|
| Rate for Payer: BCBS Complete |
$50.48
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCBS Trust/PPO |
$89.83
|
| Rate for Payer: BCN Commercial |
$89.83
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$115.87
|
| Rate for Payer: Healthscope Whirlpool |
$112.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$87.88
|
| Rate for Payer: Mclaren Commercial |
$104.28
|
| Rate for Payer: Mclaren Medicaid |
$48.07
|
| Rate for Payer: Mclaren Medicare |
$87.88
|
| Rate for Payer: Meridian Medicaid |
$50.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.49
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$96.67
|
| Rate for Payer: PHP Medicaid |
$48.07
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.84
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health Narrow Network |
$151.87
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.97
|
| Rate for Payer: UHC Medicare Advantage |
$90.52
|
| Rate for Payer: VA VA |
$87.88
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$116.69 |
| Rate for Payer: Aetna Commercial |
$105.02
|
| Rate for Payer: Aetna Medicare |
$64.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.10
|
| Rate for Payer: ASR ASR |
$113.19
|
| Rate for Payer: BCBS Complete |
$37.27
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCBS Trust/PPO |
$90.47
|
| Rate for Payer: BCN Commercial |
$90.47
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$109.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$116.69
|
| Rate for Payer: Healthscope Whirlpool |
$113.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.88
|
| Rate for Payer: Mclaren Commercial |
$105.02
|
| Rate for Payer: Mclaren Medicaid |
$35.49
|
| Rate for Payer: Mclaren Medicare |
$64.88
|
| Rate for Payer: Meridian Medicaid |
$37.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.19
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$71.37
|
| Rate for Payer: PHP Medicaid |
$35.49
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.19
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health Narrow Network |
$82.85
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.69
|
| Rate for Payer: UHC Medicare Advantage |
$66.83
|
| Rate for Payer: VA VA |
$64.88
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.68 |
| Max. Negotiated Rate |
$116.69 |
| Rate for Payer: Aetna Commercial |
$105.02
|
| Rate for Payer: ASR ASR |
$113.19
|
| Rate for Payer: BCBS Trust/PPO |
$90.47
|
| Rate for Payer: BCN Commercial |
$90.47
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$109.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$116.69
|
| Rate for Payer: Healthscope Whirlpool |
$113.19
|
| Rate for Payer: Mclaren Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.69
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$127.24 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.95
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$24.95
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$27.44
|
| Rate for Payer: PHP Medicaid |
$13.65
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.24
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health Narrow Network |
$101.79
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.70
|
| Rate for Payer: VA VA |
$24.95
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.50
|
| Rate for Payer: Priority Health Narrow Network |
$106.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$64.65 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicaid |
$8.94
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.65
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$51.72
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: ASR ASR |
$156.17
|
| Rate for Payer: BCBS Trust/PPO |
$124.82
|
| Rate for Payer: BCN Commercial |
$124.82
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$151.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$161.00
|
| Rate for Payer: Healthscope Whirlpool |
$156.17
|
| Rate for Payer: Mclaren Commercial |
$144.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.68
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$156.17
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$124.82
|
| Rate for Payer: BCN Commercial |
$124.82
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$151.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$161.00
|
| Rate for Payer: Healthscope Whirlpool |
$156.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.90
|
| Rate for Payer: Mclaren Commercial |
$144.90
|
| Rate for Payer: Mclaren Medicaid |
$8.15
|
| Rate for Payer: Mclaren Medicare |
$14.90
|
| Rate for Payer: Meridian Medicaid |
$8.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: PACE Medicare |
$14.16
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$16.39
|
| Rate for Payer: PHP Medicaid |
$8.15
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.51
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health Narrow Network |
$114.31
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.68
|
| Rate for Payer: UHC Medicare Advantage |
$15.35
|
| Rate for Payer: VA VA |
$14.90
|
|
