|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$109.75 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: ASR ASR |
$106.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.09
|
| Rate for Payer: BCN Commercial |
$85.09
|
| 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: Healthscope Commercial |
$109.75
|
| Rate for Payer: Healthscope Whirlpool |
$106.46
|
| Rate for Payer: Mclaren Commercial |
$98.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.58
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$109.75 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: ASR ASR |
$106.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.09
|
| Rate for Payer: BCN Commercial |
$85.09
|
| 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: Healthscope Commercial |
$109.75
|
| Rate for Payer: Healthscope Whirlpool |
$106.46
|
| Rate for Payer: Mclaren Commercial |
$98.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.58
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
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
|
|
|
HC FLUTTER VALVE SUPPLY
|
Facility
|
OP
|
$116.36
|
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: ASR ASR |
$112.87
|
| Rate for Payer: BCBS Complete |
$46.54
|
| Rate for Payer: BCBS Trust/PPO |
$90.21
|
| Rate for Payer: BCN Commercial |
$90.21
|
| Rate for Payer: Cash Price |
$93.09
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.09
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Healthscope Whirlpool |
$112.87
|
| Rate for Payer: Mclaren Commercial |
$104.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.89
|
| Rate for Payer: Priority Health Narrow Network |
$82.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.40
|
|
|
HC FLUTTER VALVE SUPPLY
|
Facility
|
IP
|
$116.36
|
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: ASR ASR |
$112.87
|
| Rate for Payer: BCBS Trust/PPO |
$90.21
|
| Rate for Payer: BCN Commercial |
$90.21
|
| Rate for Payer: Cash Price |
$93.09
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.09
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Healthscope Whirlpool |
$112.87
|
| Rate for Payer: Mclaren Commercial |
$104.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.40
|
|
|
HC FLU VAC,SPLIT VIRUS, PT 3 YRS OR OLDER, IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT Q2038
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC FLU VAC,SPLIT VIRUS, PT 3 YRS OR OLDER, IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT Q2038
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC FNA BX 1ST LESION CT GUIDE
|
Facility
|
OP
|
$890.46
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
36100558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.09 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCCCP Commercial |
$445.03
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.89
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$495.91
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC FNA BX 1ST LESION CT GUIDE
|
Facility
|
IP
|
$890.46
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
36100558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$623.32 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
|
|
HC FNA BX 1ST LESION FLUORO GUIDE
|
Facility
|
IP
|
$890.46
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
36100556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$623.32 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
|
|
HC FNA BX 1ST LESION FLUORO GUIDE
|
Facility
|
OP
|
$890.46
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
36100556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.04 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCCCP Commercial |
$304.04
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.89
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$495.91
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC FNA BX 1ST LESION MR GUIDE
|
Facility
|
IP
|
$890.46
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
36100560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$623.32 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
|
|
HC FNA BX 1ST LESION MR GUIDE
|
Facility
|
OP
|
$890.46
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
36100560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.09 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCCCP Commercial |
$445.03
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.89
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$495.91
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC FNA BX 1ST LESION US GUIDE
|
Facility
|
IP
|
$890.46
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
36100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$623.32 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
|
|
HC FNA BX 1ST LESION US GUIDE
|
Facility
|
OP
|
$890.46
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
36100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$890.46 |
| Rate for Payer: Aetna Commercial |
$801.41
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$863.75
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$690.37
|
| Rate for Payer: BCCCP Commercial |
$141.12
|
| Rate for Payer: BCN Commercial |
$690.37
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$837.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$890.46
|
| Rate for Payer: Healthscope Whirlpool |
$863.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$801.41
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.89
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$495.91
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.60
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
IP
|
$147.90
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.53 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: ASR ASR |
$143.46
|
| Rate for Payer: BCBS Trust/PPO |
$114.67
|
| Rate for Payer: BCN Commercial |
$114.67
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$139.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.32
|
| Rate for Payer: Healthscope Commercial |
$147.90
|
| Rate for Payer: Healthscope Whirlpool |
$143.46
|
| Rate for Payer: Mclaren Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.15
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
OP
|
$147.90
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$245.50 |
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: ASR ASR |
$143.46
|
| Rate for Payer: BCBS Complete |
$59.16
|
| Rate for Payer: BCBS Trust/PPO |
$114.67
|
| Rate for Payer: BCCCP Commercial |
$245.50
|
| Rate for Payer: BCN Commercial |
$114.67
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$139.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.32
|
| Rate for Payer: Healthscope Commercial |
$147.90
|
| Rate for Payer: Healthscope Whirlpool |
$143.46
|
| Rate for Payer: Mclaren Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.59
|
| Rate for Payer: Priority Health Narrow Network |
$105.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.15
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
IP
|
$162.69
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.88 |
| Max. Negotiated Rate |
$162.69 |
| Rate for Payer: Aetna Commercial |
$146.42
|
| Rate for Payer: ASR ASR |
$157.81
|
| Rate for Payer: BCBS Trust/PPO |
$126.13
|
| Rate for Payer: BCN Commercial |
$126.13
|
| Rate for Payer: Cash Price |
$130.15
|
| Rate for Payer: Cofinity Commercial |
$152.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.15
|
| Rate for Payer: Healthscope Commercial |
$162.69
|
| Rate for Payer: Healthscope Whirlpool |
$157.81
|
| Rate for Payer: Mclaren Commercial |
$146.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.17
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
OP
|
$162.69
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.08 |
| Max. Negotiated Rate |
$162.69 |
| Rate for Payer: Aetna Commercial |
$146.42
|
| Rate for Payer: ASR ASR |
$157.81
|
| Rate for Payer: BCBS Complete |
$65.08
|
| Rate for Payer: BCBS Trust/PPO |
$126.13
|
| Rate for Payer: BCCCP Commercial |
$149.11
|
| Rate for Payer: BCN Commercial |
$126.13
|
| Rate for Payer: Cash Price |
$130.15
|
| Rate for Payer: Cash Price |
$130.15
|
| Rate for Payer: Cofinity Commercial |
$152.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.15
|
| Rate for Payer: Healthscope Commercial |
$162.69
|
| Rate for Payer: Healthscope Whirlpool |
$157.81
|
| Rate for Payer: Mclaren Commercial |
$146.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.05
|
| Rate for Payer: Priority Health Narrow Network |
$115.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.17
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$195.23
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$195.23 |
| Rate for Payer: Aetna Commercial |
$175.71
|
| Rate for Payer: ASR ASR |
$189.37
|
| Rate for Payer: BCBS Complete |
$78.09
|
| Rate for Payer: BCBS Trust/PPO |
$151.36
|
| Rate for Payer: BCCCP Commercial |
$62.74
|
| Rate for Payer: BCN Commercial |
$151.36
|
| Rate for Payer: Cash Price |
$156.18
|
| Rate for Payer: Cash Price |
$156.18
|
| Rate for Payer: Cofinity Commercial |
$183.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.18
|
| Rate for Payer: Healthscope Commercial |
$195.23
|
| Rate for Payer: Healthscope Whirlpool |
$189.37
|
| Rate for Payer: Mclaren Commercial |
$175.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.66
|
| Rate for Payer: Priority Health Narrow Network |
$138.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.80
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$195.23
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.66 |
| Max. Negotiated Rate |
$195.23 |
| Rate for Payer: Aetna Commercial |
$175.71
|
| Rate for Payer: ASR ASR |
$189.37
|
| Rate for Payer: BCBS Trust/PPO |
$151.36
|
| Rate for Payer: BCN Commercial |
$151.36
|
| Rate for Payer: Cash Price |
$156.18
|
| Rate for Payer: Cofinity Commercial |
$183.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.18
|
| Rate for Payer: Healthscope Commercial |
$195.23
|
| Rate for Payer: Healthscope Whirlpool |
$189.37
|
| Rate for Payer: Mclaren Commercial |
$175.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.80
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$73.24
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$51.27 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: ASR ASR |
$71.04
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$68.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.59
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$71.04
|
| Rate for Payer: Mclaren Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.45
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$73.24
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$51.27 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$71.04
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCCCP Commercial |
$56.11
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$68.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$71.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$65.92
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.25
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.65
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$52.00
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.45
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: ASR ASR |
$21.77
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCCCP Commercial |
$29.59
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$21.77
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.75
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: ASR ASR |
$21.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$22.44
|
| Rate for Payer: Healthscope Whirlpool |
$21.77
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.75
|
|
