|
HC JC VIRUS, PCR, CSF
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: ASR ASR |
$102.82
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.80
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.82
|
| Rate for Payer: Mclaren Commercial |
$95.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.28
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$102.82
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$82.18
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$95.40
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.46
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$75.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.28
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$10.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$9.80
|
| Rate for Payer: ASR ASR |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.44
|
| Rate for Payer: BCN Commercial |
$8.44
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$10.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.71
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Whirlpool |
$10.56
|
| Rate for Payer: Mclaren Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.58
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$10.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$9.80
|
| Rate for Payer: ASR ASR |
$10.56
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$8.44
|
| Rate for Payer: BCN Commercial |
$8.44
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$10.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.71
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Whirlpool |
$10.56
|
| Rate for Payer: Mclaren Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.91
|
| Rate for Payer: Priority Health Narrow Network |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.58
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$208.70
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.09 |
| Max. Negotiated Rate |
$208.70 |
| Rate for Payer: Aetna Commercial |
$187.83
|
| Rate for Payer: ASR ASR |
$202.44
|
| Rate for Payer: BCBS Trust/PPO |
$161.81
|
| Rate for Payer: BCN Commercial |
$161.81
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cofinity Commercial |
$196.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.96
|
| Rate for Payer: Healthscope Commercial |
$208.70
|
| Rate for Payer: Healthscope Whirlpool |
$202.44
|
| Rate for Payer: Mclaren Commercial |
$187.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.66
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$208.70
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$208.70 |
| Rate for Payer: Aetna Commercial |
$187.83
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$202.44
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$161.81
|
| Rate for Payer: BCN Commercial |
$161.81
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cofinity Commercial |
$196.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$208.70
|
| Rate for Payer: Healthscope Whirlpool |
$202.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$187.83
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.40
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.92
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$148.18
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$75.90 |
| Rate for Payer: Aetna Commercial |
$68.31
|
| Rate for Payer: ASR ASR |
$73.62
|
| Rate for Payer: BCBS Trust/PPO |
$58.85
|
| Rate for Payer: BCN Commercial |
$58.85
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$71.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.72
|
| Rate for Payer: Healthscope Commercial |
$75.90
|
| Rate for Payer: Healthscope Whirlpool |
$73.62
|
| Rate for Payer: Mclaren Commercial |
$68.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.79
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$75.90 |
| Rate for Payer: Aetna Commercial |
$68.31
|
| 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 |
$73.62
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$58.85
|
| Rate for Payer: BCN Commercial |
$58.85
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$71.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$75.90
|
| Rate for Payer: Healthscope Whirlpool |
$73.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$68.31
|
| 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 |
$64.52
|
| 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 |
$53.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.07
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$53.89
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$36.10
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: ASR ASR |
$35.02
|
| Rate for Payer: BCBS Trust/PPO |
$27.99
|
| Rate for Payer: BCN Commercial |
$27.99
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$36.10
|
| Rate for Payer: Healthscope Whirlpool |
$35.02
|
| Rate for Payer: Mclaren Commercial |
$32.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.77
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$36.10
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: ASR ASR |
$35.02
|
| Rate for Payer: BCBS Complete |
$2.60
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$27.99
|
| Rate for Payer: BCN Commercial |
$27.99
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$36.10
|
| Rate for Payer: Healthscope Whirlpool |
$35.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.52
|
| Rate for Payer: Mclaren Commercial |
$32.49
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Medicaid |
$2.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.68
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$4.97
|
| Rate for Payer: PHP Medicaid |
$2.47
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.85
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$25.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.77
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: VA VA |
$4.52
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$5,852.76
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,515.86 |
| Max. Negotiated Rate |
$5,852.76 |
| Rate for Payer: Aetna Commercial |
$5,267.48
|
| Rate for Payer: Aetna Medicare |
$4,599.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: ASR ASR |
$5,677.18
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$4,537.64
|
| Rate for Payer: BCN Commercial |
$4,537.64
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Cash Price |
$4,682.21
|
| Rate for Payer: Cash Price |
$4,682.21
|
| Rate for Payer: Cofinity Commercial |
$5,501.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,682.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Healthscope Commercial |
$5,852.76
|
| Rate for Payer: Healthscope Whirlpool |
$5,677.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,599.37
|
| Rate for Payer: Mclaren Commercial |
$5,267.48
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,974.85
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Commercial |
$5,059.31
|
| Rate for Payer: PHP Medicaid |
$2,515.86
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,096.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,326.01
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,155.46
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,150.43
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$5,852.76
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,096.93 |
| Max. Negotiated Rate |
$5,852.76 |
| Rate for Payer: Aetna Commercial |
$5,267.48
|
| Rate for Payer: ASR ASR |
$5,677.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,537.64
|
| Rate for Payer: BCN Commercial |
$4,537.64
|
| Rate for Payer: Cash Price |
$4,682.21
|
| Rate for Payer: Cofinity Commercial |
$5,501.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,682.21
|
| Rate for Payer: Healthscope Commercial |
$5,852.76
|
| Rate for Payer: Healthscope Whirlpool |
$5,677.18
|
| Rate for Payer: Mclaren Commercial |
$5,267.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,974.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,096.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,150.43
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$135.72
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Aetna Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$131.65
|
| Rate for Payer: BCBS Trust/PPO |
$105.22
|
| Rate for Payer: BCN Commercial |
$105.22
|
| Rate for Payer: Cash Price |
$108.58
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.58
|
| Rate for Payer: Healthscope Commercial |
$135.72
|
| Rate for Payer: Healthscope Whirlpool |
$131.65
|
| Rate for Payer: Mclaren Commercial |
$122.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.43
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$135.72
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Aetna Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$131.65
|
| Rate for Payer: BCBS Complete |
$54.29
|
| Rate for Payer: BCBS Trust/PPO |
$105.22
|
| Rate for Payer: BCN Commercial |
$105.22
|
| Rate for Payer: Cash Price |
$108.58
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.58
|
| Rate for Payer: Healthscope Commercial |
$135.72
|
| Rate for Payer: Healthscope Whirlpool |
$131.65
|
| Rate for Payer: Mclaren Commercial |
$122.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.51
|
| Rate for Payer: Priority Health Narrow Network |
$96.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.43
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.50
|
| Rate for Payer: Priority Health Narrow Network |
$106.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC KIT ATS
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC KIT DILATOR VASC
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$472.50
|
| Rate for Payer: ASR ASR |
$509.25
|
| Rate for Payer: BCBS Trust/PPO |
$407.03
|
| Rate for Payer: BCN Commercial |
$407.03
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$493.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.00
|
| Rate for Payer: Healthscope Commercial |
$525.00
|
| Rate for Payer: Healthscope Whirlpool |
$509.25
|
| Rate for Payer: Mclaren Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.00
|
|
|
HC KIT DILATOR VASC
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$472.50
|
| Rate for Payer: ASR ASR |
$509.25
|
| Rate for Payer: BCBS Complete |
$210.00
|
| Rate for Payer: BCBS Trust/PPO |
$407.03
|
| Rate for Payer: BCN Commercial |
$407.03
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$493.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.00
|
| Rate for Payer: Healthscope Commercial |
$525.00
|
| Rate for Payer: Healthscope Whirlpool |
$509.25
|
| Rate for Payer: Mclaren Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.75
|
| Rate for Payer: Priority Health Narrow Network |
$372.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.00
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$120.80
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$120.80 |
| Rate for Payer: Aetna Commercial |
$108.72
|
| Rate for Payer: ASR ASR |
$117.18
|
| Rate for Payer: BCBS Trust/PPO |
$93.66
|
| Rate for Payer: BCN Commercial |
$93.66
|
| Rate for Payer: Cash Price |
$96.64
|
| Rate for Payer: Cofinity Commercial |
$113.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.64
|
| Rate for Payer: Healthscope Commercial |
$120.80
|
| Rate for Payer: Healthscope Whirlpool |
$117.18
|
| Rate for Payer: Mclaren Commercial |
$108.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.30
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$120.80
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$121.61 |
| Rate for Payer: Aetna Commercial |
$108.72
|
| Rate for Payer: Aetna Medicare |
$7.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.66
|
| Rate for Payer: ASR ASR |
$117.18
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$93.66
|
| Rate for Payer: BCN Commercial |
$93.66
|
| Rate for Payer: BCN Medicare Advantage |
$7.73
|
| Rate for Payer: Cash Price |
$96.64
|
| Rate for Payer: Cash Price |
$96.64
|
| Rate for Payer: Cofinity Commercial |
$113.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.73
|
| Rate for Payer: Healthscope Commercial |
$120.80
|
| Rate for Payer: Healthscope Whirlpool |
$117.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.73
|
| Rate for Payer: Mclaren Commercial |
$108.72
|
| Rate for Payer: Mclaren Medicaid |
$4.23
|
| Rate for Payer: Mclaren Medicare |
$7.73
|
| Rate for Payer: Meridian Medicaid |
$4.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.68
|
| Rate for Payer: PACE Medicare |
$7.34
|
| Rate for Payer: PACE SWMI |
$7.73
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicaid |
$4.23
|
| Rate for Payer: PHP Medicare Advantage |
$7.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.30
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: VA VA |
$7.73
|
|
|
HC KOH PREPARATION
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: ASR ASR |
$22.76
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Healthscope Whirlpool |
$22.76
|
| Rate for Payer: Mclaren Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.64
|
|
