|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,956.14
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,463.77 |
| Max. Negotiated Rate |
$3,956.14 |
| Rate for Payer: Aetna Commercial |
$3,560.53
|
| Rate for Payer: Aetna Medicare |
$1,463.77
|
| Rate for Payer: ASR ASR |
$3,837.46
|
| Rate for Payer: BCBS Complete |
$1,582.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,261.84
|
| Rate for Payer: BCN Commercial |
$3,261.84
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Commercial |
$3,718.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,837.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,956.14
|
| Rate for Payer: Mclaren Commercial |
$3,560.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,164.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Nomi Health Commercial |
$3,244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,466.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,773.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,481.40
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,956.14
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,967.11 |
| Max. Negotiated Rate |
$3,956.14 |
| Rate for Payer: Aetna Commercial |
$3,560.53
|
| Rate for Payer: ASR ASR |
$3,837.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,248.78
|
| Rate for Payer: BCN Commercial |
$3,248.78
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Commercial |
$3,718.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,837.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,956.14
|
| Rate for Payer: Mclaren Commercial |
$3,560.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Nomi Health Commercial |
$3,244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,481.40
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$857.37
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$643.03 |
| Max. Negotiated Rate |
$857.37 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: ASR ASR |
$831.65
|
| Rate for Payer: BCBS Trust/PPO |
$704.07
|
| Rate for Payer: BCN Commercial |
$704.07
|
| Rate for Payer: Cash Price |
$685.90
|
| Rate for Payer: Cofinity Commercial |
$805.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.90
|
| Rate for Payer: Healthscope Commercial |
$831.65
|
| Rate for Payer: Healthscope Whirlpool |
$857.37
|
| Rate for Payer: Mclaren Commercial |
$771.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.76
|
| Rate for Payer: Nomi Health Commercial |
$703.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.49
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$857.37
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$317.23 |
| Max. Negotiated Rate |
$857.37 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna Medicare |
$317.23
|
| Rate for Payer: ASR ASR |
$831.65
|
| Rate for Payer: BCBS Complete |
$342.95
|
| Rate for Payer: BCBS Trust/PPO |
$706.90
|
| Rate for Payer: BCN Commercial |
$706.90
|
| Rate for Payer: Cash Price |
$685.90
|
| Rate for Payer: Cofinity Commercial |
$805.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.90
|
| Rate for Payer: Healthscope Commercial |
$831.65
|
| Rate for Payer: Healthscope Whirlpool |
$857.37
|
| Rate for Payer: Mclaren Commercial |
$771.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$685.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.76
|
| Rate for Payer: Nomi Health Commercial |
$703.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$751.23
|
| Rate for Payer: Priority Health Narrow Network |
$601.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.49
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,729.96
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.09 |
| Max. Negotiated Rate |
$2,729.96 |
| Rate for Payer: Aetna Commercial |
$2,456.96
|
| Rate for Payer: Aetna Medicare |
$1,010.09
|
| Rate for Payer: ASR ASR |
$2,648.06
|
| Rate for Payer: BCBS Complete |
$1,091.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.85
|
| Rate for Payer: BCN Commercial |
$2,250.85
|
| Rate for Payer: Cash Price |
$2,183.97
|
| Rate for Payer: Cofinity Commercial |
$2,566.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,183.97
|
| Rate for Payer: Healthscope Commercial |
$2,648.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,729.96
|
| Rate for Payer: Mclaren Commercial |
$2,456.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,183.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,320.47
|
| Rate for Payer: Nomi Health Commercial |
$2,238.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,047.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,391.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,913.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,402.36
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,729.96
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,047.47 |
| Max. Negotiated Rate |
$2,729.96 |
| Rate for Payer: Aetna Commercial |
$2,456.96
|
| Rate for Payer: ASR ASR |
$2,648.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,241.84
|
| Rate for Payer: BCN Commercial |
$2,241.84
|
| Rate for Payer: Cash Price |
$2,183.97
|
| Rate for Payer: Cofinity Commercial |
$2,566.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,183.97
|
| Rate for Payer: Healthscope Commercial |
$2,648.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,729.96
|
| Rate for Payer: Mclaren Commercial |
$2,456.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,320.47
|
| Rate for Payer: Nomi Health Commercial |
$2,238.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,047.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,402.36
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$64.42
|
| Rate for Payer: BCN Commercial |
$64.42
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$64.68
|
| Rate for Payer: BCN Commercial |
$64.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.72
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$10.69
|
| Rate for Payer: PHP Medicaid |
$5.21
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79.89
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.72
|
| Rate for Payer: UHC Exchange |
$15.07
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHCCP DNSP |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
OP
|
$296.51
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$296.51 |
| Rate for Payer: Aetna Commercial |
$266.86
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.24
|
| Rate for Payer: ASR ASR |
$287.61
|
| Rate for Payer: BCBS Complete |
$39.65
|
| Rate for Payer: BCBS MAPPO |
$72.19
|
| Rate for Payer: BCBS Trust/PPO |
$244.47
|
| Rate for Payer: BCN Commercial |
$244.47
|
| Rate for Payer: BCN Medicare Advantage |
$72.19
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Commercial |
$278.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$287.61
|
| Rate for Payer: Healthscope Whirlpool |
$296.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$72.19
|
| Rate for Payer: Mclaren Commercial |
$266.86
|
| Rate for Payer: Mclaren Medicaid |
$72.19
|
| Rate for Payer: Mclaren Medicare |
$72.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.80
|
| Rate for Payer: Meridian Medicaid |
$39.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: PACE Medicare |
$68.58
|
| Rate for Payer: PACE SWMI |
$72.19
|
| Rate for Payer: PHP Commercial |
$79.41
|
| Rate for Payer: PHP Medicaid |
$38.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.12
|
| Rate for Payer: Priority Health Medicare |
$72.19
|
| Rate for Payer: Priority Health Narrow Network |
$72.90
|
| Rate for Payer: Railroad Medicare Medicare |
$72.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.19
|
| Rate for Payer: UHC Exchange |
$111.89
|
| Rate for Payer: UHC Medicaid |
$37.76
|
| Rate for Payer: UHCCP DNSP |
$72.19
|
| Rate for Payer: UHCCP Medicaid |
$37.76
|
| Rate for Payer: VA VA |
$72.19
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
IP
|
$296.51
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$222.38 |
| Max. Negotiated Rate |
$296.51 |
| Rate for Payer: Aetna Commercial |
$266.86
|
| Rate for Payer: ASR ASR |
$287.61
|
| Rate for Payer: BCBS Trust/PPO |
$243.49
|
| Rate for Payer: BCN Commercial |
$243.49
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Commercial |
$278.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Healthscope Commercial |
$287.61
|
| Rate for Payer: Healthscope Whirlpool |
$296.51
|
| Rate for Payer: Mclaren Commercial |
$266.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.93
|
|
|
HC FILSHIE CLIP
|
Facility
|
OP
|
$342.54
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$342.54 |
| Rate for Payer: Aetna Commercial |
$308.29
|
| Rate for Payer: Aetna Medicare |
$126.74
|
| Rate for Payer: ASR ASR |
$332.26
|
| Rate for Payer: BCBS Complete |
$137.02
|
| Rate for Payer: BCBS Trust/PPO |
$282.42
|
| Rate for Payer: BCN Commercial |
$282.42
|
| Rate for Payer: Cash Price |
$274.03
|
| Rate for Payer: Cofinity Commercial |
$321.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.03
|
| Rate for Payer: Healthscope Commercial |
$332.26
|
| Rate for Payer: Healthscope Whirlpool |
$342.54
|
| Rate for Payer: Mclaren Commercial |
$308.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.16
|
| Rate for Payer: Nomi Health Commercial |
$280.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$300.13
|
| Rate for Payer: Priority Health Narrow Network |
$240.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.44
|
|
|
HC FILSHIE CLIP
|
Facility
|
IP
|
$342.54
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$256.90 |
| Max. Negotiated Rate |
$342.54 |
| Rate for Payer: Aetna Commercial |
$308.29
|
| Rate for Payer: ASR ASR |
$332.26
|
| Rate for Payer: BCBS Trust/PPO |
$281.29
|
| Rate for Payer: BCN Commercial |
$281.29
|
| Rate for Payer: Cash Price |
$274.03
|
| Rate for Payer: Cofinity Commercial |
$321.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.03
|
| Rate for Payer: Healthscope Commercial |
$332.26
|
| Rate for Payer: Healthscope Whirlpool |
$342.54
|
| Rate for Payer: Mclaren Commercial |
$308.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.16
|
| Rate for Payer: Nomi Health Commercial |
$280.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.44
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
OP
|
$59.30
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Medicare |
$21.94
|
| Rate for Payer: ASR ASR |
$57.52
|
| Rate for Payer: BCBS Complete |
$23.72
|
| Rate for Payer: BCBS Trust/PPO |
$48.89
|
| Rate for Payer: BCN Commercial |
$48.89
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Commercial |
$55.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Healthscope Commercial |
$57.52
|
| Rate for Payer: Healthscope Whirlpool |
$59.30
|
| Rate for Payer: Mclaren Commercial |
$53.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.41
|
| Rate for Payer: Nomi Health Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.96
|
| Rate for Payer: Priority Health Narrow Network |
$41.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.18
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
IP
|
$59.30
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.48 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: ASR ASR |
$57.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.70
|
| Rate for Payer: BCN Commercial |
$48.70
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Commercial |
$55.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Healthscope Commercial |
$57.52
|
| Rate for Payer: Healthscope Whirlpool |
$59.30
|
| Rate for Payer: Mclaren Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.41
|
| Rate for Payer: Nomi Health Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.18
|
|
|
HC FILTERWIRE
|
Facility
|
OP
|
$3,890.74
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.57 |
| Max. Negotiated Rate |
$3,890.74 |
| Rate for Payer: Aetna Commercial |
$3,501.67
|
| Rate for Payer: Aetna Medicare |
$1,439.57
|
| Rate for Payer: ASR ASR |
$3,774.02
|
| Rate for Payer: BCBS Complete |
$1,556.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,207.92
|
| Rate for Payer: BCN Commercial |
$3,207.92
|
| Rate for Payer: Cash Price |
$3,112.59
|
| Rate for Payer: Cofinity Commercial |
$3,657.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,112.59
|
| Rate for Payer: Healthscope Commercial |
$3,774.02
|
| Rate for Payer: Healthscope Whirlpool |
$3,890.74
|
| Rate for Payer: Mclaren Commercial |
$3,501.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,112.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,307.13
|
| Rate for Payer: Nomi Health Commercial |
$3,190.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,918.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,409.07
|
| Rate for Payer: Priority Health Narrow Network |
$2,727.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,423.85
|
|
|
HC FILTERWIRE
|
Facility
|
IP
|
$3,890.74
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,918.05 |
| Max. Negotiated Rate |
$3,890.74 |
| Rate for Payer: Aetna Commercial |
$3,501.67
|
| Rate for Payer: ASR ASR |
$3,774.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,195.08
|
| Rate for Payer: BCN Commercial |
$3,195.08
|
| Rate for Payer: Cash Price |
$3,112.59
|
| Rate for Payer: Cofinity Commercial |
$3,657.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,112.59
|
| Rate for Payer: Healthscope Commercial |
$3,774.02
|
| Rate for Payer: Healthscope Whirlpool |
$3,890.74
|
| Rate for Payer: Mclaren Commercial |
$3,501.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,307.13
|
| Rate for Payer: Nomi Health Commercial |
$3,190.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,918.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,423.85
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
OP
|
$21.23
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.60
|
| Rate for Payer: Priority Health Narrow Network |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
IP
|
$21.23
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
IP
|
$171.91
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$154.72
|
| Rate for Payer: ASR ASR |
$166.75
|
| Rate for Payer: BCBS Trust/PPO |
$141.17
|
| Rate for Payer: BCN Commercial |
$141.17
|
| Rate for Payer: Cash Price |
$137.53
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.53
|
| Rate for Payer: Healthscope Commercial |
$166.75
|
| Rate for Payer: Healthscope Whirlpool |
$171.91
|
| Rate for Payer: Mclaren Commercial |
$154.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.12
|
| Rate for Payer: Nomi Health Commercial |
$140.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.28
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
OP
|
$171.91
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$154.72
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$166.75
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$141.74
|
| Rate for Payer: BCN Commercial |
$141.74
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$137.53
|
| Rate for Payer: Cash Price |
$137.53
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$166.75
|
| Rate for Payer: Healthscope Whirlpool |
$171.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$154.72
|
| Rate for Payer: Mclaren Medicaid |
$51.19
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.12
|
| Rate for Payer: Nomi Health Commercial |
$140.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.93
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.63
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$120.51
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicaid |
$26.77
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$26.77
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISH PROBES
|
Facility
|
IP
|
$79.43
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$79.43 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: ASR ASR |
$77.05
|
| Rate for Payer: BCBS Trust/PPO |
$65.23
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cofinity Commercial |
$74.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.54
|
| Rate for Payer: Healthscope Commercial |
$77.05
|
| Rate for Payer: Healthscope Whirlpool |
$79.43
|
| Rate for Payer: Mclaren Commercial |
$71.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.52
|
| Rate for Payer: Nomi Health Commercial |
$65.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.90
|
|
|
HC FISH PROBES
|
Facility
|
OP
|
$79.43
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$79.43 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$77.05
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$65.49
|
| Rate for Payer: BCN Commercial |
$65.49
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cofinity Commercial |
$74.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$77.05
|
| Rate for Payer: Healthscope Whirlpool |
$79.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$71.49
|
| Rate for Payer: Mclaren Medicaid |
$51.19
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.52
|
| Rate for Payer: Nomi Health Commercial |
$65.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.57
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$69.60
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$55.68
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicaid |
$26.77
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$26.77
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,299.22
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$850.71 |
| Max. Negotiated Rate |
$2,299.22 |
| Rate for Payer: Aetna Commercial |
$2,069.30
|
| Rate for Payer: Aetna Medicare |
$850.71
|
| Rate for Payer: ASR ASR |
$2,230.24
|
| Rate for Payer: BCBS Complete |
$919.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.71
|
| Rate for Payer: BCN Commercial |
$1,895.71
|
| Rate for Payer: Cash Price |
$1,839.38
|
| Rate for Payer: Cofinity Commercial |
$2,161.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,839.38
|
| Rate for Payer: Healthscope Commercial |
$2,230.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.22
|
| Rate for Payer: Mclaren Commercial |
$2,069.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,839.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,954.34
|
| Rate for Payer: Nomi Health Commercial |
$1,885.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,724.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,014.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,611.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,023.31
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,299.22
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,724.41 |
| Max. Negotiated Rate |
$2,299.22 |
| Rate for Payer: Aetna Commercial |
$2,069.30
|
| Rate for Payer: ASR ASR |
$2,230.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.12
|
| Rate for Payer: BCN Commercial |
$1,888.12
|
| Rate for Payer: Cash Price |
$1,839.38
|
| Rate for Payer: Cofinity Commercial |
$2,161.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,839.38
|
| Rate for Payer: Healthscope Commercial |
$2,230.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.22
|
| Rate for Payer: Mclaren Commercial |
$2,069.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,954.34
|
| Rate for Payer: Nomi Health Commercial |
$1,885.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,724.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,023.31
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$264.14
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$264.14 |
| Rate for Payer: Aetna Commercial |
$237.73
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$256.22
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$217.78
|
| Rate for Payer: BCN Commercial |
$217.78
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$211.31
|
| Rate for Payer: Cash Price |
$211.31
|
| Rate for Payer: Cofinity Commercial |
$248.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$256.22
|
| Rate for Payer: Healthscope Whirlpool |
$264.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$237.73
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.52
|
| Rate for Payer: Nomi Health Commercial |
$216.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.10
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.44
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$185.16
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
