|
HC INFUSION CATH LVL 5
|
Facility
|
IP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.74 |
| Max. Negotiated Rate |
$595.35 |
| Rate for Payer: Aetna Commercial |
$535.82
|
| Rate for Payer: ASR ASR |
$577.49
|
| Rate for Payer: BCBS Trust/PPO |
$461.57
|
| Rate for Payer: BCN Commercial |
$461.57
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$559.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$595.35
|
| Rate for Payer: Healthscope Whirlpool |
$577.49
|
| Rate for Payer: Mclaren Commercial |
$535.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.91
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$595.35 |
| Rate for Payer: Aetna Commercial |
$535.82
|
| Rate for Payer: ASR ASR |
$577.49
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: BCBS Trust/PPO |
$461.57
|
| Rate for Payer: BCN Commercial |
$461.57
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$559.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$595.35
|
| Rate for Payer: Healthscope Whirlpool |
$577.49
|
| Rate for Payer: Mclaren Commercial |
$535.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.77
|
| Rate for Payer: Priority Health Narrow Network |
$422.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.91
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$826.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.88 |
| Max. Negotiated Rate |
$826.97 |
| Rate for Payer: Aetna Commercial |
$744.27
|
| Rate for Payer: ASR ASR |
$802.16
|
| Rate for Payer: BCBS Trust/PPO |
$641.15
|
| Rate for Payer: BCN Commercial |
$641.15
|
| Rate for Payer: Cash Price |
$661.58
|
| Rate for Payer: Cofinity Commercial |
$777.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.58
|
| Rate for Payer: Healthscope Commercial |
$826.97
|
| Rate for Payer: Healthscope Whirlpool |
$802.16
|
| Rate for Payer: Mclaren Commercial |
$744.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.73
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$826.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.79 |
| Max. Negotiated Rate |
$826.97 |
| Rate for Payer: Aetna Commercial |
$744.27
|
| Rate for Payer: ASR ASR |
$802.16
|
| Rate for Payer: BCBS Complete |
$330.79
|
| Rate for Payer: BCBS Trust/PPO |
$641.15
|
| Rate for Payer: BCN Commercial |
$641.15
|
| Rate for Payer: Cash Price |
$661.58
|
| Rate for Payer: Cofinity Commercial |
$777.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.58
|
| Rate for Payer: Healthscope Commercial |
$826.97
|
| Rate for Payer: Healthscope Whirlpool |
$802.16
|
| Rate for Payer: Mclaren Commercial |
$744.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.54
|
| Rate for Payer: Priority Health Narrow Network |
$587.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.73
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: ASR ASR |
$213.40
|
| Rate for Payer: BCBS Trust/PPO |
$170.57
|
| Rate for Payer: BCN Commercial |
$170.57
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$206.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$220.00
|
| Rate for Payer: Healthscope Whirlpool |
$213.40
|
| Rate for Payer: Mclaren Commercial |
$198.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.60
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: ASR ASR |
$213.40
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS Trust/PPO |
$170.57
|
| Rate for Payer: BCN Commercial |
$170.57
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$206.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$220.00
|
| Rate for Payer: Healthscope Whirlpool |
$213.40
|
| Rate for Payer: Mclaren Commercial |
$198.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.88
|
| Rate for Payer: Priority Health Narrow Network |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.60
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,401.95
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$981.36 |
| Max. Negotiated Rate |
$1,401.95 |
| Rate for Payer: Aetna Commercial |
$1,261.76
|
| Rate for Payer: ASR ASR |
$1,359.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.93
|
| Rate for Payer: BCN Commercial |
$1,086.93
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cofinity Commercial |
$1,317.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.56
|
| Rate for Payer: Healthscope Commercial |
$1,401.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,359.89
|
| Rate for Payer: Mclaren Commercial |
$1,261.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,233.72
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,401.95
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$259.02 |
| Max. Negotiated Rate |
$1,401.95 |
| Rate for Payer: Aetna Commercial |
$1,261.76
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$1,359.89
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.93
|
| Rate for Payer: BCN Commercial |
$1,086.93
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cofinity Commercial |
$1,317.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,401.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,359.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$1,261.76
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.66
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.78
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$259.02
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,233.72
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$485.34
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$595.52 |
| Rate for Payer: Aetna Commercial |
$436.81
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$470.78
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$376.28
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cofinity Commercial |
$456.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$485.34
|
| Rate for Payer: Healthscope Whirlpool |
$470.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$436.81
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.54
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$441.66
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$344.59
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.10
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$485.34
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$339.74 |
| Max. Negotiated Rate |
$485.34 |
| Rate for Payer: Aetna Commercial |
$436.81
|
| Rate for Payer: ASR ASR |
$470.78
|
| Rate for Payer: BCBS Trust/PPO |
$376.28
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cofinity Commercial |
$456.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.27
|
| Rate for Payer: Healthscope Commercial |
$485.34
|
| Rate for Payer: Healthscope Whirlpool |
$470.78
|
| Rate for Payer: Mclaren Commercial |
$436.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.10
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| 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 INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$98.51 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.49
|
| Rate for Payer: ASR ASR |
$69.84
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: BCN Medicare Advantage |
$15.59
|
| 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 |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Healthscope Whirlpool |
$69.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.59
|
| Rate for Payer: Mclaren Commercial |
$64.80
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| Rate for Payer: Mclaren Medicare |
$15.59
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PACE Medicare |
$14.81
|
| Rate for Payer: PACE SWMI |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.15
|
| Rate for Payer: PHP Medicaid |
$8.53
|
| Rate for Payer: PHP Medicare Advantage |
$15.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.51
|
| Rate for Payer: Priority Health Medicare |
$15.59
|
| Rate for Payer: Priority Health Narrow Network |
$78.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.06
|
| Rate for Payer: VA VA |
$15.59
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.46
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$177.38
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Aetna Commercial |
$159.64
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$172.06
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$137.52
|
| Rate for Payer: BCN Commercial |
$137.52
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$166.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$177.38
|
| Rate for Payer: Healthscope Whirlpool |
$172.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$159.64
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.77
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.42
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$125.94
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.09
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$177.38
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.17 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Aetna Commercial |
$159.64
|
| Rate for Payer: ASR ASR |
$172.06
|
| Rate for Payer: BCBS Trust/PPO |
$137.52
|
| Rate for Payer: BCN Commercial |
$137.52
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$166.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.90
|
| Rate for Payer: Healthscope Commercial |
$177.38
|
| Rate for Payer: Healthscope Whirlpool |
$172.06
|
| Rate for Payer: Mclaren Commercial |
$159.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.09
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$568.31
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$568.31 |
| Rate for Payer: Aetna Commercial |
$511.48
|
| Rate for Payer: Aetna Medicare |
$301.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: ASR ASR |
$551.26
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$440.61
|
| Rate for Payer: BCN Commercial |
$440.61
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cofinity Commercial |
$534.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$568.31
|
| Rate for Payer: Healthscope Whirlpool |
$551.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$301.03
|
| Rate for Payer: Mclaren Commercial |
$511.48
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.06
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$331.13
|
| Rate for Payer: PHP Medicaid |
$164.66
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.16
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$403.50
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.11
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: VA VA |
$301.03
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$568.31
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$397.82 |
| Max. Negotiated Rate |
$568.31 |
| Rate for Payer: Aetna Commercial |
$511.48
|
| Rate for Payer: ASR ASR |
$551.26
|
| Rate for Payer: BCBS Trust/PPO |
$440.61
|
| Rate for Payer: BCN Commercial |
$440.61
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cofinity Commercial |
$534.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.65
|
| Rate for Payer: Healthscope Commercial |
$568.31
|
| Rate for Payer: Healthscope Whirlpool |
$551.26
|
| Rate for Payer: Mclaren Commercial |
$511.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.11
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: ASR ASR |
$150.35
|
| Rate for Payer: BCBS Trust/PPO |
$120.17
|
| Rate for Payer: BCN Commercial |
$120.17
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$145.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$155.00
|
| Rate for Payer: Healthscope Whirlpool |
$150.35
|
| Rate for Payer: Mclaren Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.40
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: ASR ASR |
$150.35
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS Trust/PPO |
$120.17
|
| Rate for Payer: BCN Commercial |
$120.17
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$145.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$155.00
|
| Rate for Payer: Healthscope Whirlpool |
$150.35
|
| Rate for Payer: Mclaren Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.05
|
| Rate for Payer: Priority Health Narrow Network |
$110.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.40
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$124.44
|
|
|
Service Code
|
CPT G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$124.44 |
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.04
|
| Rate for Payer: ASR ASR |
$120.71
|
| Rate for Payer: BCBS Complete |
$45.51
|
| Rate for Payer: BCBS MAPPO |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$96.48
|
| Rate for Payer: BCN Commercial |
$96.48
|
| Rate for Payer: BCN Medicare Advantage |
$79.23
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cofinity Commercial |
$116.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$124.44
|
| Rate for Payer: Healthscope Whirlpool |
$120.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$79.23
|
| Rate for Payer: Mclaren Commercial |
$112.00
|
| Rate for Payer: Mclaren Medicaid |
$43.34
|
| Rate for Payer: Mclaren Medicare |
$79.23
|
| Rate for Payer: Meridian Medicaid |
$45.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.77
|
| Rate for Payer: PACE Medicare |
$75.27
|
| Rate for Payer: PACE SWMI |
$79.23
|
| Rate for Payer: PHP Commercial |
$87.15
|
| Rate for Payer: PHP Medicaid |
$43.34
|
| Rate for Payer: PHP Medicare Advantage |
$79.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.24
|
| Rate for Payer: Priority Health Medicare |
$79.23
|
| Rate for Payer: Priority Health Narrow Network |
$88.35
|
| Rate for Payer: Railroad Medicare Medicare |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.51
|
| Rate for Payer: UHC Medicare Advantage |
$81.61
|
| Rate for Payer: VA VA |
$79.23
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$124.44
|
|
|
Service Code
|
CPT G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$124.44 |
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: ASR ASR |
$120.71
|
| Rate for Payer: BCBS Trust/PPO |
$96.48
|
| Rate for Payer: BCN Commercial |
$96.48
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cofinity Commercial |
$116.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.55
|
| Rate for Payer: Healthscope Commercial |
$124.44
|
| Rate for Payer: Healthscope Whirlpool |
$120.71
|
| Rate for Payer: Mclaren Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.51
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$945.56
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$661.89 |
| Max. Negotiated Rate |
$945.56 |
| Rate for Payer: Aetna Commercial |
$851.00
|
| Rate for Payer: ASR ASR |
$917.19
|
| Rate for Payer: BCBS Trust/PPO |
$733.09
|
| Rate for Payer: BCN Commercial |
$733.09
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cofinity Commercial |
$888.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.45
|
| Rate for Payer: Healthscope Commercial |
$945.56
|
| Rate for Payer: Healthscope Whirlpool |
$917.19
|
| Rate for Payer: Mclaren Commercial |
$851.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$803.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.09
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$945.56
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.22 |
| Max. Negotiated Rate |
$945.56 |
| Rate for Payer: Aetna Commercial |
$851.00
|
| Rate for Payer: ASR ASR |
$917.19
|
| Rate for Payer: BCBS Complete |
$378.22
|
| Rate for Payer: BCBS Trust/PPO |
$733.09
|
| Rate for Payer: BCN Commercial |
$733.09
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cofinity Commercial |
$888.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.45
|
| Rate for Payer: Healthscope Commercial |
$945.56
|
| Rate for Payer: Healthscope Whirlpool |
$917.19
|
| Rate for Payer: Mclaren Commercial |
$851.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$803.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$860.46
|
| Rate for Payer: Priority Health Narrow Network |
$671.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.09
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,242.36
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$869.65 |
| Max. Negotiated Rate |
$1,242.36 |
| Rate for Payer: Aetna Commercial |
$1,118.12
|
| Rate for Payer: ASR ASR |
$1,205.09
|
| Rate for Payer: BCBS Trust/PPO |
$963.20
|
| Rate for Payer: BCN Commercial |
$963.20
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cofinity Commercial |
$1,167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$993.89
|
| Rate for Payer: Healthscope Commercial |
$1,242.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,205.09
|
| Rate for Payer: Mclaren Commercial |
$1,118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,093.28
|
|
