|
HC HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.06
|
| Rate for Payer: Priority Health Narrow Network |
$158.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC HEM/ONC CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC HEM/ONC CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.50
|
| Rate for Payer: Priority Health Narrow Network |
$319.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$1,139.69 |
| Rate for Payer: Aetna Commercial |
$1,025.72
|
| Rate for Payer: Aetna Medicare |
$812.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: ASR ASR |
$1,105.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$883.60
|
| Rate for Payer: BCN Commercial |
$883.60
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$1,071.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$1,139.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$1,025.72
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$893.64
|
| Rate for Payer: PHP Medicaid |
$444.38
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.70
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$680.56
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.93
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.78 |
| Max. Negotiated Rate |
$1,139.69 |
| Rate for Payer: Aetna Commercial |
$1,025.72
|
| Rate for Payer: ASR ASR |
$1,105.50
|
| Rate for Payer: BCBS Trust/PPO |
$883.60
|
| Rate for Payer: BCN Commercial |
$883.60
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$1,071.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Healthscope Commercial |
$1,139.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.50
|
| Rate for Payer: Mclaren Commercial |
$1,025.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.93
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: ASR ASR |
$22.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.83
|
| Rate for Payer: BCN Commercial |
$17.83
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$21.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$23.00
|
| Rate for Payer: Healthscope Whirlpool |
$22.31
|
| Rate for Payer: Mclaren Commercial |
$20.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.24
|
|
|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: ASR ASR |
$22.31
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.83
|
| Rate for Payer: BCN Commercial |
$17.83
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$21.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$23.00
|
| Rate for Payer: Healthscope Whirlpool |
$22.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$20.70
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.22
|
| Rate for Payer: PHP Medicaid |
$2.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.93
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$16.33
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.24
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$476.74
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.70 |
| Max. Negotiated Rate |
$476.74 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: ASR ASR |
$462.44
|
| Rate for Payer: BCBS Complete |
$190.70
|
| Rate for Payer: BCBS Trust/PPO |
$369.62
|
| Rate for Payer: BCN Commercial |
$369.62
|
| Rate for Payer: Cash Price |
$381.39
|
| Rate for Payer: Cofinity Commercial |
$448.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.39
|
| Rate for Payer: Healthscope Commercial |
$476.74
|
| Rate for Payer: Healthscope Whirlpool |
$462.44
|
| Rate for Payer: Mclaren Commercial |
$429.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.83
|
| Rate for Payer: Priority Health Narrow Network |
$338.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.53
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$476.74
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.72 |
| Max. Negotiated Rate |
$476.74 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: ASR ASR |
$462.44
|
| Rate for Payer: BCBS Trust/PPO |
$369.62
|
| Rate for Payer: BCN Commercial |
$369.62
|
| Rate for Payer: Cash Price |
$381.39
|
| Rate for Payer: Cofinity Commercial |
$448.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.39
|
| Rate for Payer: Healthscope Commercial |
$476.74
|
| Rate for Payer: Healthscope Whirlpool |
$462.44
|
| Rate for Payer: Mclaren Commercial |
$429.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.53
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.90 |
| Max. Negotiated Rate |
$5,357.00 |
| Rate for Payer: Aetna Commercial |
$4,821.30
|
| Rate for Payer: ASR ASR |
$5,196.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,153.28
|
| Rate for Payer: BCN Commercial |
$4,153.28
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$5,035.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$5,357.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,196.29
|
| Rate for Payer: Mclaren Commercial |
$4,821.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,553.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,749.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,714.16
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,142.80 |
| Max. Negotiated Rate |
$5,357.00 |
| Rate for Payer: Aetna Commercial |
$4,821.30
|
| Rate for Payer: ASR ASR |
$5,196.29
|
| Rate for Payer: BCBS Complete |
$2,142.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,153.28
|
| Rate for Payer: BCN Commercial |
$4,153.28
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$5,035.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$5,357.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,196.29
|
| Rate for Payer: Mclaren Commercial |
$4,821.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,553.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,749.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,874.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,803.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,714.16
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$118.62
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.23
|
| Rate for Payer: Priority Health Narrow Network |
$108.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$118.62
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$13.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.09
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$7.16
|
| Rate for Payer: Mclaren Medicare |
$13.09
|
| Rate for Payer: Meridian Medicaid |
$7.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$12.44
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Medicaid |
$7.16
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.62
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow Network |
$54.32
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: VA VA |
$13.09
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.80
|
| Rate for Payer: ASR ASR |
$44.04
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$11.84
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$35.20
|
| Rate for Payer: BCN Medicare Advantage |
$11.84
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$40.86
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$11.84
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Medicare |
$11.25
|
| Rate for Payer: PACE SWMI |
$11.84
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Medicaid |
$6.48
|
| Rate for Payer: PHP Medicare Advantage |
$11.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.31
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health Narrow Network |
$32.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.20
|
| Rate for Payer: VA VA |
$11.84
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: ASR ASR |
$44.04
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.04
|
| Rate for Payer: Mclaren Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.95
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$167.79 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: ASR ASR |
$232.51
|
| Rate for Payer: BCBS Trust/PPO |
$185.84
|
| Rate for Payer: BCN Commercial |
$185.84
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$225.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$239.70
|
| Rate for Payer: Healthscope Whirlpool |
$232.51
|
| Rate for Payer: Mclaren Commercial |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.94
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$232.51
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$185.84
|
| Rate for Payer: BCN Commercial |
$185.84
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$225.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$239.70
|
| Rate for Payer: Healthscope Whirlpool |
$232.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$215.73
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$10.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.48
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$187.58
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.94
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$90.82 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$8.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$4.69
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.17
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$4.47
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$8.99
|
| Rate for Payer: PHP Medicaid |
$4.47
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.82
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$72.66
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.42
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,481.61
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,437.13 |
| Max. Negotiated Rate |
$3,481.61 |
| Rate for Payer: Aetna Commercial |
$3,133.45
|
| Rate for Payer: ASR ASR |
$3,377.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,699.29
|
| Rate for Payer: BCN Commercial |
$2,699.29
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cofinity Commercial |
$3,272.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,785.29
|
| Rate for Payer: Healthscope Commercial |
$3,481.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,377.16
|
| Rate for Payer: Mclaren Commercial |
$3,133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,959.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,437.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,063.82
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,481.61
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$3,133.45
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$3,377.16
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,699.29
|
| Rate for Payer: BCN Commercial |
$2,699.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cofinity Commercial |
$3,272.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,785.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,481.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,377.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,133.45
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,959.37
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,437.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,168.27
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,471.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,063.82
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
