|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| 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 |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.93
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$4.32
|
| Rate for Payer: PHP Medicaid |
$2.15
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.12
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health Narrow Network |
$19.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: Aetna Commercial |
$8.44
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: ASR ASR |
$9.10
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$7.27
|
| Rate for Payer: BCN Commercial |
$7.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$9.38
|
| Rate for Payer: Healthscope Whirlpool |
$9.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$8.44
|
| Rate for Payer: Mclaren Medicaid |
$1.79
|
| Rate for Payer: Mclaren Medicare |
$3.28
|
| Rate for Payer: Meridian Medicaid |
$1.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PACE Medicare |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: PHP Medicaid |
$1.79
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.25
|
| Rate for Payer: UHC Medicare Advantage |
$3.38
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: Aetna Commercial |
$8.44
|
| Rate for Payer: ASR ASR |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$7.27
|
| Rate for Payer: BCN Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$9.38
|
| Rate for Payer: Healthscope Whirlpool |
$9.10
|
| Rate for Payer: Mclaren Commercial |
$8.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.25
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$71.49
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.38
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.99
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$31.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.55 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: BCBS Trust/PPO |
$71.49
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.89
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.52
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$51.12
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$67.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.71
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$5.31
|
| Rate for Payer: Mclaren Medicare |
$9.71
|
| Rate for Payer: Meridian Medicaid |
$5.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: PHP Medicaid |
$5.31
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.70
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health Narrow Network |
$53.36
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
| Rate for Payer: VA VA |
$9.71
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC GOLDENROD IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
OP
|
$600.43
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.17 |
| Max. Negotiated Rate |
$600.43 |
| Rate for Payer: Aetna Commercial |
$540.39
|
| Rate for Payer: ASR ASR |
$582.42
|
| Rate for Payer: BCBS Complete |
$240.17
|
| Rate for Payer: BCBS Trust/PPO |
$465.51
|
| Rate for Payer: BCN Commercial |
$465.51
|
| Rate for Payer: Cash Price |
$480.34
|
| Rate for Payer: Cofinity Commercial |
$564.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.34
|
| Rate for Payer: Healthscope Commercial |
$600.43
|
| Rate for Payer: Healthscope Whirlpool |
$582.42
|
| Rate for Payer: Mclaren Commercial |
$540.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.39
|
| Rate for Payer: Priority Health Narrow Network |
$426.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.38
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
IP
|
$600.43
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$420.30 |
| Max. Negotiated Rate |
$600.43 |
| Rate for Payer: Aetna Commercial |
$540.39
|
| Rate for Payer: ASR ASR |
$582.42
|
| Rate for Payer: BCBS Trust/PPO |
$465.51
|
| Rate for Payer: BCN Commercial |
$465.51
|
| Rate for Payer: Cash Price |
$480.34
|
| Rate for Payer: Cofinity Commercial |
$564.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.34
|
| Rate for Payer: Healthscope Commercial |
$600.43
|
| Rate for Payer: Healthscope Whirlpool |
$582.42
|
| Rate for Payer: Mclaren Commercial |
$540.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.38
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$748.01
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$523.61 |
| Max. Negotiated Rate |
$748.01 |
| Rate for Payer: Aetna Commercial |
$673.21
|
| Rate for Payer: ASR ASR |
$725.57
|
| Rate for Payer: BCBS Trust/PPO |
$579.93
|
| Rate for Payer: BCN Commercial |
$579.93
|
| Rate for Payer: Cash Price |
$598.41
|
| Rate for Payer: Cofinity Commercial |
$703.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.41
|
| Rate for Payer: Healthscope Commercial |
$748.01
|
| Rate for Payer: Healthscope Whirlpool |
$725.57
|
| Rate for Payer: Mclaren Commercial |
$673.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$635.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.25
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$748.01
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$748.01 |
| Rate for Payer: Aetna Commercial |
$673.21
|
| Rate for Payer: ASR ASR |
$725.57
|
| Rate for Payer: BCBS Complete |
$299.20
|
| Rate for Payer: BCBS Trust/PPO |
$579.93
|
| Rate for Payer: BCN Commercial |
$579.93
|
| Rate for Payer: Cash Price |
$598.41
|
| Rate for Payer: Cash Price |
$598.41
|
| Rate for Payer: Cofinity Commercial |
$703.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.41
|
| Rate for Payer: Healthscope Commercial |
$748.01
|
| Rate for Payer: Healthscope Whirlpool |
$725.57
|
| Rate for Payer: Mclaren Commercial |
$673.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$635.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.06
|
| Rate for Payer: Priority Health Narrow Network |
$93.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.25
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$757.35
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$530.14 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Aetna Commercial |
$681.62
|
| Rate for Payer: ASR ASR |
$734.63
|
| Rate for Payer: BCBS Trust/PPO |
$587.17
|
| Rate for Payer: BCN Commercial |
$587.17
|
| Rate for Payer: Cash Price |
$605.88
|
| Rate for Payer: Cofinity Commercial |
$711.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.88
|
| Rate for Payer: Healthscope Commercial |
$757.35
|
| Rate for Payer: Healthscope Whirlpool |
$734.63
|
| Rate for Payer: Mclaren Commercial |
$681.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$643.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.47
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$757.35
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Aetna Commercial |
$681.62
|
| Rate for Payer: ASR ASR |
$734.63
|
| Rate for Payer: BCBS Complete |
$302.94
|
| Rate for Payer: BCBS Trust/PPO |
$587.17
|
| Rate for Payer: BCN Commercial |
$587.17
|
| Rate for Payer: Cash Price |
$605.88
|
| Rate for Payer: Cash Price |
$605.88
|
| Rate for Payer: Cofinity Commercial |
$711.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.88
|
| Rate for Payer: Healthscope Commercial |
$757.35
|
| Rate for Payer: Healthscope Whirlpool |
$734.63
|
| Rate for Payer: Mclaren Commercial |
$681.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$643.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.06
|
| Rate for Payer: Priority Health Narrow Network |
$93.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.47
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$467.51
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$327.26 |
| Max. Negotiated Rate |
$467.51 |
| Rate for Payer: Aetna Commercial |
$420.76
|
| Rate for Payer: ASR ASR |
$453.48
|
| Rate for Payer: BCBS Trust/PPO |
$362.46
|
| Rate for Payer: BCN Commercial |
$362.46
|
| Rate for Payer: Cash Price |
$374.01
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.01
|
| Rate for Payer: Healthscope Commercial |
$467.51
|
| Rate for Payer: Healthscope Whirlpool |
$453.48
|
| Rate for Payer: Mclaren Commercial |
$420.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.41
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$467.51
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$467.51 |
| Rate for Payer: Aetna Commercial |
$420.76
|
| Rate for Payer: ASR ASR |
$453.48
|
| Rate for Payer: BCBS Complete |
$187.00
|
| Rate for Payer: BCBS Trust/PPO |
$362.46
|
| Rate for Payer: BCN Commercial |
$362.46
|
| Rate for Payer: Cash Price |
$374.01
|
| Rate for Payer: Cash Price |
$374.01
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.01
|
| Rate for Payer: Healthscope Commercial |
$467.51
|
| Rate for Payer: Healthscope Whirlpool |
$453.48
|
| Rate for Payer: Mclaren Commercial |
$420.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.06
|
| Rate for Payer: Priority Health Narrow Network |
$93.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.41
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$272.53
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$272.53 |
| Rate for Payer: Aetna Commercial |
$245.28
|
| Rate for Payer: ASR ASR |
$264.35
|
| Rate for Payer: BCBS Complete |
$109.01
|
| Rate for Payer: BCBS Trust/PPO |
$211.29
|
| Rate for Payer: BCN Commercial |
$211.29
|
| Rate for Payer: Cash Price |
$218.02
|
| Rate for Payer: Cash Price |
$218.02
|
| Rate for Payer: Cofinity Commercial |
$256.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.02
|
| Rate for Payer: Healthscope Commercial |
$272.53
|
| Rate for Payer: Healthscope Whirlpool |
$264.35
|
| Rate for Payer: Mclaren Commercial |
$245.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.06
|
| Rate for Payer: Priority Health Narrow Network |
$93.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.83
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$272.53
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.77 |
| Max. Negotiated Rate |
$272.53 |
| Rate for Payer: Aetna Commercial |
$245.28
|
| Rate for Payer: ASR ASR |
$264.35
|
| Rate for Payer: BCBS Trust/PPO |
$211.29
|
| Rate for Payer: BCN Commercial |
$211.29
|
| Rate for Payer: Cash Price |
$218.02
|
| Rate for Payer: Cofinity Commercial |
$256.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.02
|
| Rate for Payer: Healthscope Commercial |
$272.53
|
| Rate for Payer: Healthscope Whirlpool |
$264.35
|
| Rate for Payer: Mclaren Commercial |
$245.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.83
|
|
