|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.46
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$76.04
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: ASR ASR |
$151.32
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$120.95
|
| Rate for Payer: BCN Commercial |
$120.95
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$156.00
|
| Rate for Payer: Healthscope Whirlpool |
$151.32
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.96
|
| Rate for Payer: Priority Health Narrow Network |
$110.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: ASR ASR |
$151.32
|
| Rate for Payer: BCBS Trust/PPO |
$120.95
|
| Rate for Payer: BCN Commercial |
$120.95
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$156.00
|
| Rate for Payer: Healthscope Whirlpool |
$151.32
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: ASR ASR |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Healthscope Whirlpool |
$2.28
|
| Rate for Payer: Mclaren Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.07
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: ASR ASR |
$2.28
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Healthscope Whirlpool |
$2.28
|
| Rate for Payer: Mclaren Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.14
|
| Rate for Payer: Priority Health Narrow Network |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.07
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.98
|
| Rate for Payer: Priority Health Narrow Network |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: ASR ASR |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.47
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Whirlpool |
$1.84
|
| Rate for Payer: Mclaren Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.67
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: ASR ASR |
$1.84
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.47
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Whirlpool |
$1.84
|
| Rate for Payer: Mclaren Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.05
|
| Rate for Payer: Priority Health Narrow Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.67
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna Commercial |
$1.48
|
| Rate for Payer: ASR ASR |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.27
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.64
|
| Rate for Payer: Healthscope Whirlpool |
$1.59
|
| Rate for Payer: Mclaren Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.44
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.48
|
| Rate for Payer: ASR ASR |
$1.59
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$1.27
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.64
|
| Rate for Payer: Healthscope Whirlpool |
$1.59
|
| Rate for Payer: Mclaren Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.05
|
| Rate for Payer: Priority Health Narrow Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.44
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| Rate for Payer: BCN Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.80
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.05
|
| Rate for Payer: Priority Health Narrow Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.64
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| Rate for Payer: BCN Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.80
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.64
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$307.84
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.98 |
| Max. Negotiated Rate |
$356.45 |
| Rate for Payer: Aetna Commercial |
$277.06
|
| Rate for Payer: Aetna Medicare |
$285.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: ASR ASR |
$298.60
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$238.67
|
| Rate for Payer: BCN Commercial |
$238.67
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cofinity Commercial |
$289.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Healthscope Commercial |
$307.84
|
| Rate for Payer: Healthscope Whirlpool |
$298.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$285.16
|
| Rate for Payer: Mclaren Commercial |
$277.06
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.66
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Commercial |
$313.68
|
| Rate for Payer: PHP Medicaid |
$155.98
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.90
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$184.72
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.90
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: VA VA |
$285.16
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$307.84
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.49 |
| Max. Negotiated Rate |
$307.84 |
| Rate for Payer: Aetna Commercial |
$277.06
|
| Rate for Payer: ASR ASR |
$298.60
|
| Rate for Payer: BCBS Trust/PPO |
$238.67
|
| Rate for Payer: BCN Commercial |
$238.67
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cofinity Commercial |
$289.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.27
|
| Rate for Payer: Healthscope Commercial |
$307.84
|
| Rate for Payer: Healthscope Whirlpool |
$298.60
|
| Rate for Payer: Mclaren Commercial |
$277.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.90
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$117.37
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Aetna Commercial |
$105.63
|
| Rate for Payer: ASR ASR |
$113.85
|
| Rate for Payer: BCBS Complete |
$46.95
|
| Rate for Payer: BCBS Trust/PPO |
$91.00
|
| Rate for Payer: BCN Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.90
|
| Rate for Payer: Healthscope Commercial |
$117.37
|
| Rate for Payer: Healthscope Whirlpool |
$113.85
|
| Rate for Payer: Mclaren Commercial |
$105.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.81
|
| Rate for Payer: Priority Health Narrow Network |
$83.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.29
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$117.37
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Aetna Commercial |
$105.63
|
| Rate for Payer: ASR ASR |
$113.85
|
| Rate for Payer: BCBS Trust/PPO |
$91.00
|
| Rate for Payer: BCN Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.90
|
| Rate for Payer: Healthscope Commercial |
$117.37
|
| Rate for Payer: Healthscope Whirlpool |
$113.85
|
| Rate for Payer: Mclaren Commercial |
$105.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.29
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$83.74
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$78.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$83.74
|
| Rate for Payer: Healthscope Whirlpool |
$81.23
|
| Rate for Payer: Mclaren Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.20
|
| Rate for Payer: Priority Health Narrow Network |
$59.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$83.74
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$83.74 |
| Rate for Payer: Aetna Commercial |
$75.37
|
| Rate for Payer: ASR ASR |
$81.23
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$78.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$83.74
|
| Rate for Payer: Healthscope Whirlpool |
$81.23
|
| Rate for Payer: Mclaren Commercial |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.69
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$199.58
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$139.71 |
| Max. Negotiated Rate |
$199.58 |
| Rate for Payer: Aetna Commercial |
$179.62
|
| Rate for Payer: ASR ASR |
$193.59
|
| Rate for Payer: BCBS Trust/PPO |
$154.73
|
| Rate for Payer: BCN Commercial |
$154.73
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$187.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$199.58
|
| Rate for Payer: Healthscope Whirlpool |
$193.59
|
| Rate for Payer: Mclaren Commercial |
$179.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.63
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$199.58
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$199.58 |
| Rate for Payer: Aetna Commercial |
$179.62
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$193.59
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$154.73
|
| Rate for Payer: BCN Commercial |
$154.73
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$187.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$199.58
|
| Rate for Payer: Healthscope Whirlpool |
$193.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$179.62
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.64
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.60
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$50.08
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.63
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$500.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Aetna Commercial |
$450.22
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$485.23
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$387.84
|
| Rate for Payer: BCN Commercial |
$387.84
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$470.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$500.24
|
| Rate for Payer: Healthscope Whirlpool |
$485.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$450.22
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.96
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$123.97
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.21
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$500.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$350.17 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Aetna Commercial |
$450.22
|
| Rate for Payer: ASR ASR |
$485.23
|
| Rate for Payer: BCBS Trust/PPO |
$387.84
|
| Rate for Payer: BCN Commercial |
$387.84
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$470.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Healthscope Commercial |
$500.24
|
| Rate for Payer: Healthscope Whirlpool |
$485.23
|
| Rate for Payer: Mclaren Commercial |
$450.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.21
|
|
