|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
IP
|
$165.24
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$148.72
|
| Rate for Payer: ASR ASR |
$160.28
|
| Rate for Payer: BCBS Trust/PPO |
$128.11
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$155.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Healthscope Whirlpool |
$160.28
|
| Rate for Payer: Mclaren Commercial |
$148.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.41
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
OP
|
$165.24
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$148.72
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$160.28
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$128.11
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$155.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Healthscope Whirlpool |
$160.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$148.72
|
| Rate for Payer: Mclaren Medicaid |
$28.00
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Medicaid |
$29.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.45
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$28.00
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.37
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$117.32
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.41
|
| Rate for Payer: UHC Medicare Advantage |
$52.73
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISH PROBES
|
Facility
|
OP
|
$76.34
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$68.71
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$74.05
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$59.19
|
| Rate for Payer: BCN Commercial |
$59.19
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$76.34
|
| Rate for Payer: Healthscope Whirlpool |
$74.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$68.71
|
| Rate for Payer: Mclaren Medicaid |
$28.00
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Medicaid |
$29.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.89
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$28.00
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.47
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$54.20
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.18
|
| Rate for Payer: UHC Medicare Advantage |
$52.73
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISH PROBES
|
Facility
|
IP
|
$76.34
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$68.71
|
| Rate for Payer: ASR ASR |
$74.05
|
| Rate for Payer: BCBS Trust/PPO |
$59.19
|
| Rate for Payer: BCN Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cofinity Commercial |
$71.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.07
|
| Rate for Payer: Healthscope Commercial |
$76.34
|
| Rate for Payer: Healthscope Whirlpool |
$74.05
|
| Rate for Payer: Mclaren Commercial |
$68.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.18
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,209.94
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$883.98 |
| Max. Negotiated Rate |
$2,209.94 |
| Rate for Payer: Aetna Commercial |
$1,988.95
|
| Rate for Payer: ASR ASR |
$2,143.64
|
| Rate for Payer: BCBS Complete |
$883.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.37
|
| Rate for Payer: BCN Commercial |
$1,713.37
|
| Rate for Payer: Cash Price |
$1,767.95
|
| Rate for Payer: Cofinity Commercial |
$2,077.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.95
|
| Rate for Payer: Healthscope Commercial |
$2,209.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.64
|
| Rate for Payer: Mclaren Commercial |
$1,988.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,878.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,011.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,569.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.75
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,209.94
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,546.96 |
| Max. Negotiated Rate |
$2,209.94 |
| Rate for Payer: Aetna Commercial |
$1,988.95
|
| Rate for Payer: ASR ASR |
$2,143.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.37
|
| Rate for Payer: BCN Commercial |
$1,713.37
|
| Rate for Payer: Cash Price |
$1,767.95
|
| Rate for Payer: Cofinity Commercial |
$2,077.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.95
|
| Rate for Payer: Healthscope Commercial |
$2,209.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.64
|
| Rate for Payer: Mclaren Commercial |
$1,988.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,878.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.75
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$253.88
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$253.88 |
| Rate for Payer: Aetna Commercial |
$228.49
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$246.26
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$196.83
|
| Rate for Payer: BCN Commercial |
$196.83
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cofinity Commercial |
$238.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$253.88
|
| Rate for Payer: Healthscope Whirlpool |
$246.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$228.49
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.80
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.03
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$180.25
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.41
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$253.88
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$253.88 |
| Rate for Payer: Aetna Commercial |
$228.49
|
| Rate for Payer: ASR ASR |
$246.26
|
| Rate for Payer: BCBS Trust/PPO |
$196.83
|
| Rate for Payer: BCN Commercial |
$196.83
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cofinity Commercial |
$238.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.10
|
| Rate for Payer: Healthscope Commercial |
$253.88
|
| Rate for Payer: Healthscope Whirlpool |
$246.26
|
| Rate for Payer: Mclaren Commercial |
$228.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.41
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$514.66
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.26 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$463.19
|
| Rate for Payer: ASR ASR |
$499.22
|
| Rate for Payer: BCBS Trust/PPO |
$399.02
|
| Rate for Payer: BCN Commercial |
$399.02
|
| Rate for Payer: Cash Price |
$411.73
|
| Rate for Payer: Cofinity Commercial |
$483.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.73
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Healthscope Whirlpool |
$499.22
|
| Rate for Payer: Mclaren Commercial |
$463.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$452.90
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$514.66
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$463.19
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$499.22
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$399.02
|
| Rate for Payer: BCN Commercial |
$399.02
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$411.73
|
| Rate for Payer: Cash Price |
$411.73
|
| Rate for Payer: Cofinity Commercial |
$483.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Healthscope Whirlpool |
$499.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$463.19
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.46
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.90
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$184.72
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$452.90
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,743.04
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$697.22 |
| Max. Negotiated Rate |
$1,743.04 |
| Rate for Payer: Aetna Commercial |
$1,568.74
|
| Rate for Payer: ASR ASR |
$1,690.75
|
| Rate for Payer: BCBS Complete |
$697.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.38
|
| Rate for Payer: BCN Commercial |
$1,351.38
|
| Rate for Payer: Cash Price |
$1,394.43
|
| Rate for Payer: Cofinity Commercial |
$1,638.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,394.43
|
| Rate for Payer: Healthscope Commercial |
$1,743.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.75
|
| Rate for Payer: Mclaren Commercial |
$1,568.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,481.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,220.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,237.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,533.88
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,743.04
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,220.13 |
| Max. Negotiated Rate |
$1,743.04 |
| Rate for Payer: Aetna Commercial |
$1,568.74
|
| Rate for Payer: ASR ASR |
$1,690.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.38
|
| Rate for Payer: BCN Commercial |
$1,351.38
|
| Rate for Payer: Cash Price |
$1,394.43
|
| Rate for Payer: Cofinity Commercial |
$1,638.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,394.43
|
| Rate for Payer: Healthscope Commercial |
$1,743.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.75
|
| Rate for Payer: Mclaren Commercial |
$1,568.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,481.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,220.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,533.88
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
IP
|
$249.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.95 |
| Max. Negotiated Rate |
$249.93 |
| Rate for Payer: Aetna Commercial |
$224.94
|
| Rate for Payer: ASR ASR |
$242.43
|
| Rate for Payer: BCBS Trust/PPO |
$193.77
|
| Rate for Payer: BCN Commercial |
$193.77
|
| Rate for Payer: Cash Price |
$199.94
|
| Rate for Payer: Cofinity Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.94
|
| Rate for Payer: Healthscope Commercial |
$249.93
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Mclaren Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.94
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
OP
|
$249.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$249.93 |
| Rate for Payer: Aetna Commercial |
$224.94
|
| Rate for Payer: ASR ASR |
$242.43
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$193.77
|
| Rate for Payer: BCN Commercial |
$193.77
|
| Rate for Payer: Cash Price |
$199.94
|
| Rate for Payer: Cofinity Commercial |
$234.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.94
|
| Rate for Payer: Healthscope Commercial |
$249.93
|
| Rate for Payer: Healthscope Whirlpool |
$242.43
|
| Rate for Payer: Mclaren Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.44
|
| Rate for Payer: Priority Health Narrow Network |
$177.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.94
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
IP
|
$730.90
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.63 |
| Max. Negotiated Rate |
$730.90 |
| Rate for Payer: Aetna Commercial |
$657.81
|
| Rate for Payer: ASR ASR |
$708.97
|
| Rate for Payer: BCBS Trust/PPO |
$566.67
|
| Rate for Payer: BCN Commercial |
$566.67
|
| Rate for Payer: Cash Price |
$584.72
|
| Rate for Payer: Cofinity Commercial |
$687.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.72
|
| Rate for Payer: Healthscope Commercial |
$730.90
|
| Rate for Payer: Healthscope Whirlpool |
$708.97
|
| Rate for Payer: Mclaren Commercial |
$657.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$621.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$643.19
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
OP
|
$730.90
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.36 |
| Max. Negotiated Rate |
$730.90 |
| Rate for Payer: Aetna Commercial |
$657.81
|
| Rate for Payer: ASR ASR |
$708.97
|
| Rate for Payer: BCBS Complete |
$292.36
|
| Rate for Payer: BCBS Trust/PPO |
$566.67
|
| Rate for Payer: BCN Commercial |
$566.67
|
| Rate for Payer: Cash Price |
$584.72
|
| Rate for Payer: Cofinity Commercial |
$687.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.72
|
| Rate for Payer: Healthscope Commercial |
$730.90
|
| Rate for Payer: Healthscope Whirlpool |
$708.97
|
| Rate for Payer: Mclaren Commercial |
$657.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$621.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$665.12
|
| Rate for Payer: Priority Health Narrow Network |
$518.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$643.19
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC FLUID CREATININE
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
HC FLUID CREATININE
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$128.27 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$16.32
|
| 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: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: ASR ASR |
$102.90
|
| Rate for Payer: BCBS Trust/PPO |
$82.24
|
| Rate for Payer: BCN Commercial |
$82.24
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$99.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$106.08
|
| Rate for Payer: Healthscope Whirlpool |
$102.90
|
| Rate for Payer: Mclaren Commercial |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.35
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: ASR ASR |
$102.90
|
| Rate for Payer: BCBS Complete |
$42.43
|
| Rate for Payer: BCBS Trust/PPO |
$82.24
|
| Rate for Payer: BCN Commercial |
$82.24
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$99.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$106.08
|
| Rate for Payer: Healthscope Whirlpool |
$102.90
|
| Rate for Payer: Mclaren Commercial |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.21
|
| Rate for Payer: Priority Health Narrow Network |
$37.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.35
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$109.75 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$106.46
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$85.09
|
| Rate for Payer: BCN Commercial |
$85.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$103.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$109.75
|
| Rate for Payer: Healthscope Whirlpool |
$106.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$98.78
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.29
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.87
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$77.92
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.58
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
