|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$75.28
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$75.28 |
| Rate for Payer: Aetna Commercial |
$67.75
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$73.02
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$58.36
|
| Rate for Payer: BCN Commercial |
$58.36
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$70.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$75.28
|
| Rate for Payer: Healthscope Whirlpool |
$73.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$67.75
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.99
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.58
|
| Rate for Payer: PHP Medicaid |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.36
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$15.49
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,771.29
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,639.90 |
| Max. Negotiated Rate |
$3,771.29 |
| Rate for Payer: Aetna Commercial |
$3,394.16
|
| Rate for Payer: ASR ASR |
$3,658.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,923.88
|
| Rate for Payer: BCN Commercial |
$2,923.88
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cofinity Commercial |
$3,545.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,017.03
|
| Rate for Payer: Healthscope Commercial |
$3,771.29
|
| Rate for Payer: Healthscope Whirlpool |
$3,658.15
|
| Rate for Payer: Mclaren Commercial |
$3,394.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,205.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,639.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,318.74
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,771.29
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,508.52 |
| Max. Negotiated Rate |
$3,771.29 |
| Rate for Payer: Aetna Commercial |
$3,394.16
|
| Rate for Payer: ASR ASR |
$3,658.15
|
| Rate for Payer: BCBS Complete |
$1,508.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,923.88
|
| Rate for Payer: BCN Commercial |
$2,923.88
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cofinity Commercial |
$3,545.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,017.03
|
| Rate for Payer: Healthscope Commercial |
$3,771.29
|
| Rate for Payer: Healthscope Whirlpool |
$3,658.15
|
| Rate for Payer: Mclaren Commercial |
$3,394.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,205.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,639.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,431.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,677.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,318.74
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$121.61 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$10.13
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$19.08
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$10.13
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
| Rate for Payer: UHC Medicare Advantage |
$19.08
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: ASR ASR |
$75.19
|
| Rate for Payer: BCBS Trust/PPO |
$60.10
|
| Rate for Payer: BCN Commercial |
$60.10
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$72.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$77.52
|
| Rate for Payer: Healthscope Whirlpool |
$75.19
|
| Rate for Payer: Mclaren Commercial |
$69.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.22
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$121.61 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$75.19
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$60.10
|
| Rate for Payer: BCN Commercial |
$60.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$72.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$77.52
|
| Rate for Payer: Healthscope Whirlpool |
$75.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$69.77
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$10.13
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.22
|
| Rate for Payer: UHC Medicare Advantage |
$19.08
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.69
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Mclaren Medicare |
$14.69
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicaid |
$8.04
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health Narrow Network |
$46.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
| Rate for Payer: UHC Medicare Advantage |
$15.13
|
| Rate for Payer: VA VA |
$14.69
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
OP
|
$368.40
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$147.36 |
| Max. Negotiated Rate |
$368.40 |
| Rate for Payer: Aetna Commercial |
$331.56
|
| Rate for Payer: ASR ASR |
$357.35
|
| Rate for Payer: BCBS Complete |
$147.36
|
| Rate for Payer: BCBS Trust/PPO |
$285.62
|
| Rate for Payer: BCN Commercial |
$285.62
|
| Rate for Payer: Cash Price |
$294.72
|
| Rate for Payer: Cofinity Commercial |
$346.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.72
|
| Rate for Payer: Healthscope Commercial |
$368.40
|
| Rate for Payer: Healthscope Whirlpool |
$357.35
|
| Rate for Payer: Mclaren Commercial |
$331.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.24
|
| Rate for Payer: Priority Health Narrow Network |
$261.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.19
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
IP
|
$368.40
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$257.88 |
| Max. Negotiated Rate |
$368.40 |
| Rate for Payer: Aetna Commercial |
$331.56
|
| Rate for Payer: ASR ASR |
$357.35
|
| Rate for Payer: BCBS Trust/PPO |
$285.62
|
| Rate for Payer: BCN Commercial |
$285.62
|
| Rate for Payer: Cash Price |
$294.72
|
| Rate for Payer: Cofinity Commercial |
$346.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.72
|
| Rate for Payer: Healthscope Commercial |
$368.40
|
| Rate for Payer: Healthscope Whirlpool |
$357.35
|
| Rate for Payer: Mclaren Commercial |
$331.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.19
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$123.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: ASR ASR |
$120.04
|
| Rate for Payer: BCBS Complete |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$95.94
|
| Rate for Payer: BCN Commercial |
$95.94
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.00
|
| Rate for Payer: Healthscope Commercial |
$123.75
|
| Rate for Payer: Healthscope Whirlpool |
$120.04
|
| Rate for Payer: Mclaren Commercial |
$111.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.61
|
| Rate for Payer: Priority Health Narrow Network |
$87.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.90
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$123.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: ASR ASR |
$120.04
|
| Rate for Payer: BCBS Trust/PPO |
$95.94
|
| Rate for Payer: BCN Commercial |
$95.94
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.00
|
| Rate for Payer: Healthscope Commercial |
$123.75
|
| Rate for Payer: Healthscope Whirlpool |
$120.04
|
| Rate for Payer: Mclaren Commercial |
$111.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.90
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.90
|
| Rate for Payer: Priority Health Narrow Network |
$63.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
|
|
HC LINE VACUUM
|
Facility
|
OP
|
$13.50
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$13.10
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.47
|
| Rate for Payer: BCN Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.28
|
| Rate for Payer: Priority Health Narrow Network |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.88
|
|
|
HC LINE VACUUM
|
Facility
|
IP
|
$13.50
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$10.47
|
| Rate for Payer: BCN Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.88
|
|
|
HC LIPASE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$6.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.89
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Mclaren Medicare |
$6.89
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$7.58
|
| Rate for Payer: PHP Medicaid |
$3.77
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health Narrow Network |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPASE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC LIPASE BF
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: BCBS Trust/PPO |
$43.56
|
| Rate for Payer: BCN Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Healthscope Whirlpool |
$54.49
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
|
|
HC LIPASE BF
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: Aetna Medicare |
$6.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$43.56
|
| Rate for Payer: BCN Commercial |
$43.56
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Healthscope Whirlpool |
$54.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.89
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Mclaren Medicare |
$6.89
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.75
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$7.58
|
| Rate for Payer: PHP Medicaid |
$3.77
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.05
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health Narrow Network |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPID PANEL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC LIPID PANEL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$98.51 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$13.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.74
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$7.69
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.39
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.32
|
| Rate for Payer: Mclaren Medicare |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$7.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$12.72
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$14.73
|
| Rate for Payer: PHP Medicaid |
$7.32
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.51
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health Narrow Network |
$78.81
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$13.79
|
| Rate for Payer: VA VA |
$13.39
|
|
