|
HC CYCLOSPORA DETECTION
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600071
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: ASR ASR |
$18.53
|
| Rate for Payer: BCBS Trust/PPO |
$15.68
|
| Rate for Payer: BCN Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Whirlpool |
$19.10
|
| Rate for Payer: Mclaren Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.81
|
|
|
HC CYCLOSPORA DETECTION
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600071
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: ASR ASR |
$18.53
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.75
|
| Rate for Payer: BCN Commercial |
$15.75
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Whirlpool |
$19.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$17.19
|
| Rate for Payer: Mclaren Medicaid |
$6.68
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$3.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Medicare |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.35
|
| Rate for Payer: PHP Medicaid |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.01
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow Network |
$18.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.68
|
| Rate for Payer: UHC Exchange |
$10.35
|
| Rate for Payer: UHC Medicaid |
$3.49
|
| Rate for Payer: UHCCP DNSP |
$6.68
|
| Rate for Payer: UHCCP Medicaid |
$3.49
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC CYCLOSPORA DETECTION CMPT
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: BCBS Complete |
$3.29
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$40.32
|
| Rate for Payer: BCN Commercial |
$40.32
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$47.43
|
| Rate for Payer: Healthscope Whirlpool |
$48.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.99
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Medicaid |
$3.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Medicaid |
$3.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.00
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health Narrow Network |
$110.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.99
|
| Rate for Payer: UHC Exchange |
$9.28
|
| Rate for Payer: UHC Medicaid |
$3.13
|
| Rate for Payer: UHCCP DNSP |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$3.13
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC CYCLOSPORA DETECTION CMPT
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.67 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$40.16
|
| Rate for Payer: BCN Commercial |
$40.16
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$47.43
|
| Rate for Payer: Healthscope Whirlpool |
$48.90
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
|
|
HC CYCLOSPORINE
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC CYCLOSPORINE
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.05
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$18.05
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: PHP Medicaid |
$9.67
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.43
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow Network |
$112.34
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.05
|
| Rate for Payer: UHC Exchange |
$27.98
|
| Rate for Payer: UHC Medicaid |
$9.44
|
| Rate for Payer: UHCCP DNSP |
$18.05
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$18.05
|
|
|
HC CYGNUS MATRIX 2X3 PER SQ CM
|
Facility
|
IP
|
$337.88
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$253.41 |
| Max. Negotiated Rate |
$337.88 |
| Rate for Payer: Aetna Commercial |
$304.09
|
| Rate for Payer: ASR ASR |
$327.74
|
| Rate for Payer: BCBS Trust/PPO |
$277.47
|
| Rate for Payer: BCN Commercial |
$277.47
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cofinity Commercial |
$317.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.30
|
| Rate for Payer: Healthscope Commercial |
$327.74
|
| Rate for Payer: Healthscope Whirlpool |
$337.88
|
| Rate for Payer: Mclaren Commercial |
$304.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.20
|
| Rate for Payer: Nomi Health Commercial |
$277.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.33
|
|
|
HC CYGNUS MATRIX 2X3 PER SQ CM
|
Facility
|
OP
|
$337.88
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$337.88 |
| Rate for Payer: Aetna Commercial |
$304.09
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$327.74
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$278.58
|
| Rate for Payer: BCN Commercial |
$278.58
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cofinity Commercial |
$317.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$327.74
|
| Rate for Payer: Healthscope Whirlpool |
$337.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$304.09
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.20
|
| Rate for Payer: Nomi Health Commercial |
$277.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.41
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$296.05
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$236.85
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC CYGNUS MATRIX 4X4 PER SQ CM
|
Facility
|
IP
|
$227.11
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.33 |
| Max. Negotiated Rate |
$227.11 |
| Rate for Payer: Aetna Commercial |
$204.40
|
| Rate for Payer: ASR ASR |
$220.30
|
| Rate for Payer: BCBS Trust/PPO |
$186.50
|
| Rate for Payer: BCN Commercial |
$186.50
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Commercial |
$213.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Healthscope Commercial |
$220.30
|
| Rate for Payer: Healthscope Whirlpool |
$227.11
|
| Rate for Payer: Mclaren Commercial |
$204.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.04
|
| Rate for Payer: Nomi Health Commercial |
$186.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.86
|
|
|
HC CYGNUS MATRIX 4X4 PER SQ CM
|
Facility
|
OP
|
$227.11
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$227.11 |
| Rate for Payer: Aetna Commercial |
$204.40
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$220.30
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.25
|
| Rate for Payer: BCN Commercial |
$187.25
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Commercial |
$213.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$220.30
|
| Rate for Payer: Healthscope Whirlpool |
$227.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$204.40
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.04
|
| Rate for Payer: Nomi Health Commercial |
$186.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.33
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$198.99
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$159.20
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
IP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$159.89 |
| Rate for Payer: Aetna Commercial |
$143.90
|
| Rate for Payer: ASR ASR |
$155.09
|
| Rate for Payer: BCBS Trust/PPO |
$131.30
|
| Rate for Payer: BCN Commercial |
$131.30
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$150.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Healthscope Commercial |
$155.09
|
| Rate for Payer: Healthscope Whirlpool |
$159.89
|
| Rate for Payer: Mclaren Commercial |
$143.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Nomi Health Commercial |
$131.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.70
|
|
|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
OP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$143.90
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$155.09
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.83
|
| Rate for Payer: BCN Commercial |
$131.83
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$150.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$155.09
|
| Rate for Payer: Healthscope Whirlpool |
$159.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$143.90
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Nomi Health Commercial |
$131.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.10
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$112.08
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$67.08
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$57.01
|
| Rate for Payer: BCN Commercial |
$57.01
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$67.08
|
| Rate for Payer: Healthscope Whirlpool |
$69.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$62.23
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$60.59
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$48.47
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.86 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: ASR ASR |
$67.08
|
| Rate for Payer: BCBS Trust/PPO |
$56.79
|
| Rate for Payer: BCN Commercial |
$56.79
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$67.08
|
| Rate for Payer: Healthscope Whirlpool |
$69.15
|
| Rate for Payer: Mclaren Commercial |
$62.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.85
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
OP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$291.10 |
| Max. Negotiated Rate |
$1,909.44 |
| Rate for Payer: Aetna Commercial |
$1,718.50
|
| Rate for Payer: Aetna Medicare |
$556.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$695.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$695.75
|
| Rate for Payer: ASR ASR |
$1,852.16
|
| Rate for Payer: BCBS Complete |
$305.68
|
| Rate for Payer: BCBS MAPPO |
$556.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.33
|
| Rate for Payer: BCN Commercial |
$1,574.33
|
| Rate for Payer: BCN Medicare Advantage |
$556.60
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Commercial |
$1,794.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.60
|
| Rate for Payer: Healthscope Commercial |
$1,852.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,909.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$556.60
|
| Rate for Payer: Mclaren Commercial |
$1,718.50
|
| Rate for Payer: Mclaren Medicaid |
$556.60
|
| Rate for Payer: Mclaren Medicare |
$556.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.43
|
| Rate for Payer: Meridian Medicaid |
$305.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$612.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Nomi Health Commercial |
$1,565.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PACE Medicare |
$528.77
|
| Rate for Payer: PACE SWMI |
$556.60
|
| Rate for Payer: PHP Commercial |
$612.26
|
| Rate for Payer: PHP Medicaid |
$298.34
|
| Rate for Payer: PHP Medicare Advantage |
$556.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$942.91
|
| Rate for Payer: Priority Health Medicare |
$556.60
|
| Rate for Payer: Priority Health Narrow Network |
$754.33
|
| Rate for Payer: Railroad Medicare Medicare |
$556.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,680.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$556.60
|
| Rate for Payer: UHC Exchange |
$862.73
|
| Rate for Payer: UHC Medicaid |
$291.10
|
| Rate for Payer: UHCCP DNSP |
$556.60
|
| Rate for Payer: UHCCP Medicaid |
$291.10
|
| Rate for Payer: VA VA |
$556.60
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
IP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,432.08 |
| Max. Negotiated Rate |
$1,909.44 |
| Rate for Payer: Aetna Commercial |
$1,718.50
|
| Rate for Payer: ASR ASR |
$1,852.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,568.03
|
| Rate for Payer: BCN Commercial |
$1,568.03
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Commercial |
$1,794.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Healthscope Commercial |
$1,852.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,909.44
|
| Rate for Payer: Mclaren Commercial |
$1,718.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Nomi Health Commercial |
$1,565.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,680.31
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.51
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.61
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Mclaren Medicaid |
$19.61
|
| Rate for Payer: Mclaren Medicare |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: Meridian Medicaid |
$10.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Medicare |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$21.57
|
| Rate for Payer: PHP Medicaid |
$10.51
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.61
|
| Rate for Payer: UHC Exchange |
$30.40
|
| Rate for Payer: UHC Medicaid |
$10.26
|
| Rate for Payer: UHCCP DNSP |
$19.61
|
| Rate for Payer: UHCCP Medicaid |
$10.26
|
| Rate for Payer: VA VA |
$19.61
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.90
|
| Rate for Payer: BCN Commercial |
$76.90
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna Commercial |
$0.26
|
| Rate for Payer: Aetna Medicare |
$0.11
|
| Rate for Payer: ASR ASR |
$0.28
|
| Rate for Payer: BCBS Complete |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.24
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.28
|
| Rate for Payer: Healthscope Whirlpool |
$0.29
|
| Rate for Payer: Mclaren Commercial |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.25
|
| Rate for Payer: Priority Health Narrow Network |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.26
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna Commercial |
$0.26
|
| Rate for Payer: ASR ASR |
$0.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.24
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.28
|
| Rate for Payer: Healthscope Whirlpool |
$0.29
|
| Rate for Payer: Mclaren Commercial |
$0.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.26
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$8,280.91 |
| Rate for Payer: Aetna Commercial |
$5,759.95
|
| Rate for Payer: Aetna Medicare |
$5,342.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: ASR ASR |
$6,207.95
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$5,276.76
|
| Rate for Payer: BCN Commercial |
$5,276.76
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Commercial |
$6,015.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$6,207.95
|
| Rate for Payer: Healthscope Whirlpool |
$6,399.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,342.52
|
| Rate for Payer: Mclaren Commercial |
$5,759.95
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$2,934.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Nomi Health Commercial |
$5,247.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$5,876.77
|
| Rate for Payer: PHP Medicaid |
$2,863.59
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,607.64
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Narrow Network |
$4,486.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,631.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Exchange |
$8,280.91
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP DNSP |
$5,342.52
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,799.96 |
| Max. Negotiated Rate |
$6,399.95 |
| Rate for Payer: Aetna Commercial |
$5,759.95
|
| Rate for Payer: ASR ASR |
$6,207.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,255.64
|
| Rate for Payer: BCN Commercial |
$5,255.64
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Commercial |
$6,015.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Healthscope Commercial |
$6,207.95
|
| Rate for Payer: Healthscope Whirlpool |
$6,399.95
|
| Rate for Payer: Mclaren Commercial |
$5,759.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Nomi Health Commercial |
$5,247.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,631.96
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,933.16 |
| Max. Negotiated Rate |
$14,620.25 |
| Rate for Payer: Aetna Commercial |
$11,558.38
|
| Rate for Payer: Aetna Medicare |
$9,432.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,790.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,790.52
|
| Rate for Payer: ASR ASR |
$12,457.36
|
| Rate for Payer: BCBS Complete |
$5,180.29
|
| Rate for Payer: BCBS MAPPO |
$9,432.42
|
| Rate for Payer: BCBS Trust/PPO |
$10,588.76
|
| Rate for Payer: BCN Commercial |
$10,588.76
|
| Rate for Payer: BCN Medicare Advantage |
$9,432.42
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Commercial |
$12,072.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,432.42
|
| Rate for Payer: Healthscope Commercial |
$12,457.36
|
| Rate for Payer: Healthscope Whirlpool |
$12,842.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,432.42
|
| Rate for Payer: Mclaren Commercial |
$11,558.38
|
| Rate for Payer: Mclaren Medicaid |
$9,432.42
|
| Rate for Payer: Mclaren Medicare |
$9,432.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,904.04
|
| Rate for Payer: Meridian Medicaid |
$5,180.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,847.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,375.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Nomi Health Commercial |
$10,530.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PACE Medicare |
$8,960.80
|
| Rate for Payer: PACE SWMI |
$9,432.42
|
| Rate for Payer: PHP Commercial |
$10,375.66
|
| Rate for Payer: PHP Medicaid |
$5,055.78
|
| Rate for Payer: PHP Medicare Advantage |
$9,432.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,933.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,252.72
|
| Rate for Payer: Priority Health Medicare |
$9,432.42
|
| Rate for Payer: Priority Health Narrow Network |
$9,002.69
|
| Rate for Payer: Railroad Medicare Medicare |
$9,432.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,301.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,432.42
|
| Rate for Payer: UHC Exchange |
$14,620.25
|
| Rate for Payer: UHC Medicaid |
$4,933.16
|
| Rate for Payer: UHCCP DNSP |
$9,432.42
|
| Rate for Payer: UHCCP Medicaid |
$4,933.16
|
| Rate for Payer: VA VA |
$9,432.42
|
|
