|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$264.14
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.10 |
| Max. Negotiated Rate |
$264.14 |
| Rate for Payer: Aetna Commercial |
$237.73
|
| Rate for Payer: ASR ASR |
$256.22
|
| Rate for Payer: BCBS Trust/PPO |
$216.91
|
| Rate for Payer: BCN Commercial |
$216.91
|
| 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: Healthscope Commercial |
$256.22
|
| Rate for Payer: Healthscope Whirlpool |
$264.14
|
| Rate for Payer: Mclaren Commercial |
$237.73
|
| 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: UHC All Payor (Choice/PPO) + Core |
$232.44
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$535.45
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.59 |
| Max. Negotiated Rate |
$535.45 |
| Rate for Payer: Aetna Commercial |
$481.90
|
| Rate for Payer: ASR ASR |
$519.39
|
| Rate for Payer: BCBS Trust/PPO |
$439.71
|
| Rate for Payer: BCN Commercial |
$439.71
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cofinity Commercial |
$503.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.36
|
| Rate for Payer: Healthscope Commercial |
$519.39
|
| Rate for Payer: Healthscope Whirlpool |
$535.45
|
| Rate for Payer: Mclaren Commercial |
$481.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.13
|
| Rate for Payer: Nomi Health Commercial |
$439.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.20
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$535.45
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$535.45 |
| Rate for Payer: Aetna Commercial |
$481.90
|
| Rate for Payer: Aetna Medicare |
$201.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: ASR ASR |
$519.39
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$441.48
|
| Rate for Payer: BCN Commercial |
$441.48
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cofinity Commercial |
$503.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$519.39
|
| Rate for Payer: Healthscope Whirlpool |
$535.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$201.44
|
| Rate for Payer: Mclaren Commercial |
$481.90
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$110.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.13
|
| Rate for Payer: Nomi Health Commercial |
$439.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.59
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$221.58
|
| Rate for Payer: PHP Medicaid |
$107.97
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$312.23
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP DNSP |
$201.44
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,813.46
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.98 |
| Max. Negotiated Rate |
$1,813.46 |
| Rate for Payer: Aetna Commercial |
$1,632.11
|
| Rate for Payer: Aetna Medicare |
$670.98
|
| Rate for Payer: ASR ASR |
$1,759.06
|
| Rate for Payer: BCBS Complete |
$725.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.20
|
| Rate for Payer: BCN Commercial |
$1,495.20
|
| Rate for Payer: Cash Price |
$1,450.77
|
| Rate for Payer: Cofinity Commercial |
$1,704.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,450.77
|
| Rate for Payer: Healthscope Commercial |
$1,759.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,813.46
|
| Rate for Payer: Mclaren Commercial |
$1,632.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,450.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,541.44
|
| Rate for Payer: Nomi Health Commercial |
$1,487.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,360.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,588.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,271.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,595.84
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,813.46
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,360.10 |
| Max. Negotiated Rate |
$1,813.46 |
| Rate for Payer: Aetna Commercial |
$1,632.11
|
| Rate for Payer: ASR ASR |
$1,759.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,489.21
|
| Rate for Payer: BCN Commercial |
$1,489.21
|
| Rate for Payer: Cash Price |
$1,450.77
|
| Rate for Payer: Cofinity Commercial |
$1,704.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,450.77
|
| Rate for Payer: Healthscope Commercial |
$1,759.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,813.46
|
| Rate for Payer: Mclaren Commercial |
$1,632.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,541.44
|
| Rate for Payer: Nomi Health Commercial |
$1,487.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,360.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,595.84
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
OP
|
$260.03
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$260.03 |
| Rate for Payer: Aetna Commercial |
$234.03
|
| Rate for Payer: Aetna Medicare |
$96.21
|
| Rate for Payer: ASR ASR |
$252.23
|
| Rate for Payer: BCBS Complete |
$104.01
|
| Rate for Payer: BCBS Trust/PPO |
$214.39
|
| Rate for Payer: BCN Commercial |
$214.39
|
| Rate for Payer: Cash Price |
$208.02
|
| Rate for Payer: Cofinity Commercial |
$244.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.02
|
| Rate for Payer: Healthscope Commercial |
$252.23
|
| Rate for Payer: Healthscope Whirlpool |
$260.03
|
| Rate for Payer: Mclaren Commercial |
$234.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.03
|
| Rate for Payer: Nomi Health Commercial |
$213.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.84
|
| Rate for Payer: Priority Health Narrow Network |
$182.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.83
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
IP
|
$260.03
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.02 |
| Max. Negotiated Rate |
$260.03 |
| Rate for Payer: Aetna Commercial |
$234.03
|
| Rate for Payer: ASR ASR |
$252.23
|
| Rate for Payer: BCBS Trust/PPO |
$213.54
|
| Rate for Payer: BCN Commercial |
$213.54
|
| Rate for Payer: Cash Price |
$208.02
|
| Rate for Payer: Cofinity Commercial |
$244.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.02
|
| Rate for Payer: Healthscope Commercial |
$252.23
|
| Rate for Payer: Healthscope Whirlpool |
$260.03
|
| Rate for Payer: Mclaren Commercial |
$234.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.03
|
| Rate for Payer: Nomi Health Commercial |
$213.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.83
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
OP
|
$760.43
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.36 |
| Max. Negotiated Rate |
$760.43 |
| Rate for Payer: Aetna Commercial |
$684.39
|
| Rate for Payer: Aetna Medicare |
$281.36
|
| Rate for Payer: ASR ASR |
$737.62
|
| Rate for Payer: BCBS Complete |
$304.17
|
| Rate for Payer: BCBS Trust/PPO |
$626.97
|
| Rate for Payer: BCN Commercial |
$626.97
|
| Rate for Payer: Cash Price |
$608.34
|
| Rate for Payer: Cofinity Commercial |
$714.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.34
|
| Rate for Payer: Healthscope Commercial |
$737.62
|
| Rate for Payer: Healthscope Whirlpool |
$760.43
|
| Rate for Payer: Mclaren Commercial |
$684.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$608.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.37
|
| Rate for Payer: Nomi Health Commercial |
$623.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$570.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$666.29
|
| Rate for Payer: Priority Health Narrow Network |
$533.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$669.18
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
IP
|
$760.43
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.32 |
| Max. Negotiated Rate |
$760.43 |
| Rate for Payer: Aetna Commercial |
$684.39
|
| Rate for Payer: ASR ASR |
$737.62
|
| Rate for Payer: BCBS Trust/PPO |
$624.47
|
| Rate for Payer: BCN Commercial |
$624.47
|
| Rate for Payer: Cash Price |
$608.34
|
| Rate for Payer: Cofinity Commercial |
$714.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.34
|
| Rate for Payer: Healthscope Commercial |
$737.62
|
| Rate for Payer: Healthscope Whirlpool |
$760.43
|
| Rate for Payer: Mclaren Commercial |
$684.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.37
|
| Rate for Payer: Nomi Health Commercial |
$623.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$570.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$669.18
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
IP
|
$64.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$64.85 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: ASR ASR |
$62.90
|
| Rate for Payer: BCBS Trust/PPO |
$53.25
|
| Rate for Payer: BCN Commercial |
$53.25
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cofinity Commercial |
$60.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.88
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Healthscope Whirlpool |
$64.85
|
| Rate for Payer: Mclaren Commercial |
$58.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.12
|
| Rate for Payer: Nomi Health Commercial |
$53.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.07
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
OP
|
$64.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna Medicare |
$23.99
|
| Rate for Payer: ASR ASR |
$62.90
|
| Rate for Payer: BCBS Complete |
$25.94
|
| Rate for Payer: BCBS Trust/PPO |
$53.47
|
| Rate for Payer: BCN Commercial |
$53.47
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cofinity Commercial |
$60.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.88
|
| Rate for Payer: Healthscope Commercial |
$62.90
|
| Rate for Payer: Healthscope Whirlpool |
$64.85
|
| Rate for Payer: Mclaren Commercial |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.12
|
| Rate for Payer: Nomi Health Commercial |
$53.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.07
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
OP
|
$223.09
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: Aetna Commercial |
$200.78
|
| Rate for Payer: Aetna Medicare |
$357.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: ASR ASR |
$216.40
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$183.94
|
| Rate for Payer: BCN Commercial |
$183.94
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$178.47
|
| Rate for Payer: Cash Price |
$178.47
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$216.40
|
| Rate for Payer: Healthscope Whirlpool |
$223.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.16
|
| Rate for Payer: Mclaren Commercial |
$200.78
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$196.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.63
|
| Rate for Payer: Nomi Health Commercial |
$182.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.32
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$392.88
|
| Rate for Payer: PHP Medicaid |
$191.44
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$553.60
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP DNSP |
$357.16
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
IP
|
$223.09
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$167.32 |
| Max. Negotiated Rate |
$223.09 |
| Rate for Payer: Aetna Commercial |
$200.78
|
| Rate for Payer: ASR ASR |
$216.40
|
| Rate for Payer: BCBS Trust/PPO |
$183.20
|
| Rate for Payer: BCN Commercial |
$183.20
|
| Rate for Payer: Cash Price |
$178.47
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.47
|
| Rate for Payer: Healthscope Commercial |
$216.40
|
| Rate for Payer: Healthscope Whirlpool |
$223.09
|
| Rate for Payer: Mclaren Commercial |
$200.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.63
|
| Rate for Payer: Nomi Health Commercial |
$182.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.32
|
|
|
HC FLUID CREATININE
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$16.98
|
| 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: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| 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: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC FLUID CREATININE
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| 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 FLUIDOTHERAPY
|
Facility
|
OP
|
$110.36
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$110.36 |
| Rate for Payer: Aetna Commercial |
$99.32
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: ASR ASR |
$107.05
|
| Rate for Payer: BCBS Complete |
$44.14
|
| Rate for Payer: BCBS Trust/PPO |
$90.99
|
| Rate for Payer: BCN Commercial |
$90.99
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$103.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$107.05
|
| Rate for Payer: Healthscope Whirlpool |
$110.36
|
| Rate for Payer: Mclaren Commercial |
$99.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: Nomi Health Commercial |
$90.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.69
|
| Rate for Payer: Priority Health Narrow Network |
$44.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.12
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
IP
|
$110.36
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.77 |
| Max. Negotiated Rate |
$110.36 |
| Rate for Payer: Aetna Commercial |
$99.32
|
| Rate for Payer: ASR ASR |
$107.05
|
| Rate for Payer: BCBS Trust/PPO |
$90.63
|
| Rate for Payer: BCN Commercial |
$90.63
|
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$103.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.29
|
| Rate for Payer: Healthscope Commercial |
$107.05
|
| Rate for Payer: Healthscope Whirlpool |
$110.36
|
| Rate for Payer: Mclaren Commercial |
$99.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.81
|
| Rate for Payer: Nomi Health Commercial |
$90.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.12
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
OP
|
$134.34
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$120.91
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$130.31
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$110.76
|
| Rate for Payer: BCN Commercial |
$110.76
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$107.47
|
| Rate for Payer: Cash Price |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$126.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$130.31
|
| Rate for Payer: Healthscope Whirlpool |
$134.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$120.91
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.19
|
| Rate for Payer: Nomi Health Commercial |
$110.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.75
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$117.71
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$94.17
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
IP
|
$134.34
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$120.91
|
| Rate for Payer: ASR ASR |
$130.31
|
| Rate for Payer: BCBS Trust/PPO |
$110.32
|
| Rate for Payer: BCN Commercial |
$110.32
|
| Rate for Payer: Cash Price |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$126.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.47
|
| Rate for Payer: Healthscope Commercial |
$130.31
|
| Rate for Payer: Healthscope Whirlpool |
$134.34
|
| Rate for Payer: Mclaren Commercial |
$120.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.19
|
| Rate for Payer: Nomi Health Commercial |
$110.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.22
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
IP
|
$114.19
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$85.64 |
| Max. Negotiated Rate |
$114.19 |
| Rate for Payer: Aetna Commercial |
$102.77
|
| Rate for Payer: ASR ASR |
$110.76
|
| Rate for Payer: BCBS Trust/PPO |
$93.77
|
| Rate for Payer: BCN Commercial |
$93.77
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$107.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$110.76
|
| Rate for Payer: Healthscope Whirlpool |
$114.19
|
| Rate for Payer: Mclaren Commercial |
$102.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Nomi Health Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.49
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
OP
|
$114.19
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$114.19 |
| Rate for Payer: Aetna Commercial |
$102.77
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$110.76
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$94.15
|
| Rate for Payer: BCN Commercial |
$94.15
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$107.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$110.76
|
| Rate for Payer: Healthscope Whirlpool |
$114.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$102.77
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Nomi Health Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$80.05
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC FLUTTER VALVE SUPPLY
|
Facility
|
OP
|
$121.06
|
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$121.06 |
| Rate for Payer: Aetna Commercial |
$108.95
|
| Rate for Payer: Aetna Medicare |
$44.79
|
| Rate for Payer: ASR ASR |
$117.43
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$99.81
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cofinity Commercial |
$113.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.85
|
| Rate for Payer: Healthscope Commercial |
$117.43
|
| Rate for Payer: Healthscope Whirlpool |
$121.06
|
| Rate for Payer: Mclaren Commercial |
$108.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.90
|
| Rate for Payer: Nomi Health Commercial |
$99.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.07
|
| Rate for Payer: Priority Health Narrow Network |
$84.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.53
|
|
|
HC FLUTTER VALVE SUPPLY
|
Facility
|
IP
|
$121.06
|
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$121.06 |
| Rate for Payer: Aetna Commercial |
$108.95
|
| Rate for Payer: ASR ASR |
$117.43
|
| Rate for Payer: BCBS Trust/PPO |
$99.41
|
| Rate for Payer: BCN Commercial |
$99.41
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cofinity Commercial |
$113.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.85
|
| Rate for Payer: Healthscope Commercial |
$117.43
|
| Rate for Payer: Healthscope Whirlpool |
$121.06
|
| Rate for Payer: Mclaren Commercial |
$108.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.90
|
| Rate for Payer: Nomi Health Commercial |
$99.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.53
|
|
|
HC FLU VAC,SPLIT VIRUS, PT 3 YRS OR OLDER, IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT Q2038
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC FLU VAC,SPLIT VIRUS, PT 3 YRS OR OLDER, IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT Q2038
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
