|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$72.60
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.82 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Aetna Commercial |
$65.34
|
| Rate for Payer: ASR ASR |
$70.42
|
| Rate for Payer: BCBS Trust/PPO |
$56.29
|
| Rate for Payer: BCN Commercial |
$56.29
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.08
|
| Rate for Payer: Healthscope Commercial |
$72.60
|
| Rate for Payer: Healthscope Whirlpool |
$70.42
|
| Rate for Payer: Mclaren Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.89
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$202.59
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$141.81 |
| Max. Negotiated Rate |
$202.59 |
| Rate for Payer: Aetna Commercial |
$182.33
|
| Rate for Payer: ASR ASR |
$196.51
|
| Rate for Payer: BCBS Trust/PPO |
$157.07
|
| Rate for Payer: BCN Commercial |
$157.07
|
| Rate for Payer: Cash Price |
$162.07
|
| Rate for Payer: Cofinity Commercial |
$190.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.07
|
| Rate for Payer: Healthscope Commercial |
$202.59
|
| Rate for Payer: Healthscope Whirlpool |
$196.51
|
| Rate for Payer: Mclaren Commercial |
$182.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.28
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$202.59
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$81.04 |
| Max. Negotiated Rate |
$202.59 |
| Rate for Payer: Aetna Commercial |
$182.33
|
| Rate for Payer: ASR ASR |
$196.51
|
| Rate for Payer: BCBS Complete |
$81.04
|
| Rate for Payer: BCBS Trust/PPO |
$157.07
|
| Rate for Payer: BCN Commercial |
$157.07
|
| Rate for Payer: Cash Price |
$162.07
|
| Rate for Payer: Cofinity Commercial |
$190.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.07
|
| Rate for Payer: Healthscope Commercial |
$202.59
|
| Rate for Payer: Healthscope Whirlpool |
$196.51
|
| Rate for Payer: Mclaren Commercial |
$182.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.36
|
| Rate for Payer: Priority Health Narrow Network |
$143.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.28
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$296.82
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$237.24
|
| Rate for Payer: BCN Commercial |
$237.24
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$287.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Healthscope Whirlpool |
$296.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$275.40
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.46
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$217.26
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: ASR ASR |
$296.82
|
| Rate for Payer: BCBS Trust/PPO |
$237.24
|
| Rate for Payer: BCN Commercial |
$237.24
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$287.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Healthscope Whirlpool |
$296.82
|
| Rate for Payer: Mclaren Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,055.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,438.77 |
| Max. Negotiated Rate |
$2,055.39 |
| Rate for Payer: Aetna Commercial |
$1,849.85
|
| Rate for Payer: ASR ASR |
$1,993.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.54
|
| Rate for Payer: BCN Commercial |
$1,593.54
|
| Rate for Payer: Cash Price |
$1,644.31
|
| Rate for Payer: Cofinity Commercial |
$1,932.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.31
|
| Rate for Payer: Healthscope Commercial |
$2,055.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,993.73
|
| Rate for Payer: Mclaren Commercial |
$1,849.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,808.74
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,055.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$822.16 |
| Max. Negotiated Rate |
$2,055.39 |
| Rate for Payer: Aetna Commercial |
$1,849.85
|
| Rate for Payer: ASR ASR |
$1,993.73
|
| Rate for Payer: BCBS Complete |
$822.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.54
|
| Rate for Payer: BCN Commercial |
$1,593.54
|
| Rate for Payer: Cash Price |
$1,644.31
|
| Rate for Payer: Cofinity Commercial |
$1,932.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.31
|
| Rate for Payer: Healthscope Commercial |
$2,055.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,993.73
|
| Rate for Payer: Mclaren Commercial |
$1,849.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,870.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,808.74
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,802.52
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,661.76 |
| Max. Negotiated Rate |
$3,802.52 |
| Rate for Payer: Aetna Commercial |
$3,422.27
|
| Rate for Payer: ASR ASR |
$3,688.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.09
|
| Rate for Payer: BCN Commercial |
$2,948.09
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,574.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,042.02
|
| Rate for Payer: Healthscope Commercial |
$3,802.52
|
| Rate for Payer: Healthscope Whirlpool |
$3,688.44
|
| Rate for Payer: Mclaren Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,346.22
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,802.52
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,521.01 |
| Max. Negotiated Rate |
$3,802.52 |
| Rate for Payer: Aetna Commercial |
$3,422.27
|
| Rate for Payer: ASR ASR |
$3,688.44
|
| Rate for Payer: BCBS Complete |
$1,521.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.09
|
| Rate for Payer: BCN Commercial |
$2,948.09
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,574.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,042.02
|
| Rate for Payer: Healthscope Commercial |
$3,802.52
|
| Rate for Payer: Healthscope Whirlpool |
$3,688.44
|
| Rate for Payer: Mclaren Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,460.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,699.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,346.22
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$824.08
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$329.63 |
| Max. Negotiated Rate |
$824.08 |
| Rate for Payer: Aetna Commercial |
$741.67
|
| Rate for Payer: ASR ASR |
$799.36
|
| Rate for Payer: BCBS Complete |
$329.63
|
| Rate for Payer: BCBS Trust/PPO |
$638.91
|
| Rate for Payer: BCN Commercial |
$638.91
|
| Rate for Payer: Cash Price |
$659.26
|
| Rate for Payer: Cofinity Commercial |
$774.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$659.26
|
| Rate for Payer: Healthscope Commercial |
$824.08
|
| Rate for Payer: Healthscope Whirlpool |
$799.36
|
| Rate for Payer: Mclaren Commercial |
$741.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$700.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.91
|
| Rate for Payer: Priority Health Narrow Network |
$585.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$725.19
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$824.08
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$576.86 |
| Max. Negotiated Rate |
$824.08 |
| Rate for Payer: Aetna Commercial |
$741.67
|
| Rate for Payer: ASR ASR |
$799.36
|
| Rate for Payer: BCBS Trust/PPO |
$638.91
|
| Rate for Payer: BCN Commercial |
$638.91
|
| Rate for Payer: Cash Price |
$659.26
|
| Rate for Payer: Cofinity Commercial |
$774.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$659.26
|
| Rate for Payer: Healthscope Commercial |
$824.08
|
| Rate for Payer: Healthscope Whirlpool |
$799.36
|
| Rate for Payer: Mclaren Commercial |
$741.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$700.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$725.19
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,623.95
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,049.58 |
| Max. Negotiated Rate |
$2,623.95 |
| Rate for Payer: Aetna Commercial |
$2,361.56
|
| Rate for Payer: ASR ASR |
$2,545.23
|
| Rate for Payer: BCBS Complete |
$1,049.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.35
|
| Rate for Payer: BCN Commercial |
$2,034.35
|
| Rate for Payer: Cash Price |
$2,099.16
|
| Rate for Payer: Cofinity Commercial |
$2,466.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,099.16
|
| Rate for Payer: Healthscope Commercial |
$2,623.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,545.23
|
| Rate for Payer: Mclaren Commercial |
$2,361.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,230.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,387.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,863.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,309.08
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,623.95
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,836.76 |
| Max. Negotiated Rate |
$2,623.95 |
| Rate for Payer: Aetna Commercial |
$2,361.56
|
| Rate for Payer: ASR ASR |
$2,545.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.35
|
| Rate for Payer: BCN Commercial |
$2,034.35
|
| Rate for Payer: Cash Price |
$2,099.16
|
| Rate for Payer: Cofinity Commercial |
$2,466.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,099.16
|
| Rate for Payer: Healthscope Commercial |
$2,623.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,545.23
|
| Rate for Payer: Mclaren Commercial |
$2,361.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,230.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,309.08
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.72
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Medicaid |
$5.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$10.69
|
| Rate for Payer: PHP Medicaid |
$5.32
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.73
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$54.18
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
| Rate for Payer: UHC Medicare Advantage |
$10.01
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Trust/PPO |
$220.96
|
| Rate for Payer: BCN Commercial |
$220.96
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$285.00
|
| Rate for Payer: Healthscope Whirlpool |
$276.45
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.24
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Complete |
$41.47
|
| Rate for Payer: BCBS MAPPO |
$72.19
|
| Rate for Payer: BCBS Trust/PPO |
$220.96
|
| Rate for Payer: BCN Commercial |
$220.96
|
| Rate for Payer: BCN Medicare Advantage |
$72.19
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$285.00
|
| Rate for Payer: Healthscope Whirlpool |
$276.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$72.19
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Mclaren Medicaid |
$39.49
|
| Rate for Payer: Mclaren Medicare |
$72.19
|
| Rate for Payer: Meridian Medicaid |
$41.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: PACE Medicare |
$68.58
|
| Rate for Payer: PACE SWMI |
$72.19
|
| Rate for Payer: PHP Commercial |
$79.41
|
| Rate for Payer: PHP Medicaid |
$39.49
|
| Rate for Payer: PHP Medicare Advantage |
$72.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.24
|
| Rate for Payer: Priority Health Medicare |
$72.19
|
| Rate for Payer: Priority Health Narrow Network |
$61.79
|
| Rate for Payer: Railroad Medicare Medicare |
$72.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
| Rate for Payer: UHC Medicare Advantage |
$74.36
|
| Rate for Payer: VA VA |
$72.19
|
|
|
HC FILSHIE CLIP
|
Facility
|
OP
|
$329.24
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.70 |
| Max. Negotiated Rate |
$329.24 |
| Rate for Payer: Aetna Commercial |
$296.32
|
| Rate for Payer: ASR ASR |
$319.36
|
| Rate for Payer: BCBS Complete |
$131.70
|
| Rate for Payer: BCBS Trust/PPO |
$255.26
|
| Rate for Payer: BCN Commercial |
$255.26
|
| Rate for Payer: Cash Price |
$263.39
|
| Rate for Payer: Cofinity Commercial |
$309.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.39
|
| Rate for Payer: Healthscope Commercial |
$329.24
|
| Rate for Payer: Healthscope Whirlpool |
$319.36
|
| Rate for Payer: Mclaren Commercial |
$296.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.61
|
| Rate for Payer: Priority Health Narrow Network |
$233.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.73
|
|
|
HC FILSHIE CLIP
|
Facility
|
IP
|
$329.24
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$329.24 |
| Rate for Payer: Aetna Commercial |
$296.32
|
| Rate for Payer: ASR ASR |
$319.36
|
| Rate for Payer: BCBS Trust/PPO |
$255.26
|
| Rate for Payer: BCN Commercial |
$255.26
|
| Rate for Payer: Cash Price |
$263.39
|
| Rate for Payer: Cofinity Commercial |
$309.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.39
|
| Rate for Payer: Healthscope Commercial |
$329.24
|
| Rate for Payer: Healthscope Whirlpool |
$319.36
|
| Rate for Payer: Mclaren Commercial |
$296.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.73
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: ASR ASR |
$55.29
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$44.19
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Healthscope Commercial |
$57.00
|
| Rate for Payer: Healthscope Whirlpool |
$55.29
|
| Rate for Payer: Mclaren Commercial |
$51.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.87
|
| Rate for Payer: Priority Health Narrow Network |
$40.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.16
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: ASR ASR |
$55.29
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$44.19
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$53.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Healthscope Commercial |
$57.00
|
| Rate for Payer: Healthscope Whirlpool |
$55.29
|
| Rate for Payer: Mclaren Commercial |
$51.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.16
|
|
|
HC FILTERWIRE
|
Facility
|
IP
|
$3,739.66
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.76 |
| Max. Negotiated Rate |
$3,739.66 |
| Rate for Payer: Aetna Commercial |
$3,365.69
|
| Rate for Payer: ASR ASR |
$3,627.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,899.36
|
| Rate for Payer: BCN Commercial |
$2,899.36
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,515.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,739.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,627.47
|
| Rate for Payer: Mclaren Commercial |
$3,365.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,617.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,290.90
|
|
|
HC FILTERWIRE
|
Facility
|
OP
|
$3,739.66
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.86 |
| Max. Negotiated Rate |
$3,739.66 |
| Rate for Payer: Aetna Commercial |
$3,365.69
|
| Rate for Payer: ASR ASR |
$3,627.47
|
| Rate for Payer: BCBS Complete |
$1,495.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,899.36
|
| Rate for Payer: BCN Commercial |
$2,899.36
|
| Rate for Payer: Cash Price |
$2,991.73
|
| Rate for Payer: Cofinity Commercial |
$3,515.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,991.73
|
| Rate for Payer: Healthscope Commercial |
$3,739.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,627.47
|
| Rate for Payer: Mclaren Commercial |
$3,365.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,178.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,617.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,403.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,655.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,290.90
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
OP
|
$20.40
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.56
|
| Rate for Payer: Priority Health Narrow Network |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
IP
|
$20.40
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
