|
HC LIPOPROTEIN A
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.90
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.32
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| Rate for Payer: Mclaren Medicare |
$14.32
|
| Rate for Payer: Meridian Medicaid |
$8.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$13.60
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$15.75
|
| Rate for Payer: PHP Medicaid |
$7.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$14.75
|
| Rate for Payer: VA VA |
$14.32
|
|
|
HC LIPOPROTEIN A
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
OP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$357.89 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: Aetna Medicare |
$74.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.25
|
| Rate for Payer: ASR ASR |
$347.15
|
| Rate for Payer: BCBS Complete |
$42.85
|
| Rate for Payer: BCBS MAPPO |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$277.47
|
| Rate for Payer: BCN Commercial |
$277.47
|
| Rate for Payer: BCN Medicare Advantage |
$74.60
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$336.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.60
|
| Rate for Payer: Healthscope Commercial |
$357.89
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$322.10
|
| Rate for Payer: Mclaren Medicaid |
$40.81
|
| Rate for Payer: Mclaren Medicare |
$74.60
|
| Rate for Payer: Meridian Medicaid |
$42.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PACE Medicare |
$70.87
|
| Rate for Payer: PACE SWMI |
$74.60
|
| Rate for Payer: PHP Commercial |
$82.06
|
| Rate for Payer: PHP Medicaid |
$40.81
|
| Rate for Payer: PHP Medicare Advantage |
$74.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.83
|
| Rate for Payer: Priority Health Medicare |
$74.60
|
| Rate for Payer: Priority Health Narrow Network |
$88.66
|
| Rate for Payer: Railroad Medicare Medicare |
$74.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.94
|
| Rate for Payer: UHC Medicare Advantage |
$76.84
|
| Rate for Payer: VA VA |
$74.60
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
IP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$250.52 |
| Max. Negotiated Rate |
$357.89 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: ASR ASR |
$347.15
|
| Rate for Payer: BCBS Trust/PPO |
$277.47
|
| Rate for Payer: BCN Commercial |
$277.47
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$336.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.31
|
| Rate for Payer: Healthscope Commercial |
$357.89
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$322.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.94
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| 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 |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| 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 |
$43.35
|
| 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 |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| 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 LITHIUM LEVEL
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: Aetna Medicare |
$6.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: ASR ASR |
$52.24
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$41.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$50.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.61
|
| Rate for Payer: Mclaren Commercial |
$48.47
|
| Rate for Payer: Mclaren Medicaid |
$3.62
|
| Rate for Payer: Mclaren Medicare |
$6.61
|
| Rate for Payer: Meridian Medicaid |
$3.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$7.27
|
| Rate for Payer: PHP Medicaid |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.63
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health Narrow Network |
$19.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.40
|
| Rate for Payer: UHC Medicare Advantage |
$6.81
|
| Rate for Payer: VA VA |
$6.61
|
|
|
HC LITHIUM LEVEL
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna Commercial |
$48.47
|
| Rate for Payer: ASR ASR |
$52.24
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$41.76
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$50.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Healthscope Whirlpool |
$52.24
|
| Rate for Payer: Mclaren Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.40
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,796.13
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,957.29 |
| Max. Negotiated Rate |
$2,796.13 |
| Rate for Payer: Aetna Commercial |
$2,516.52
|
| Rate for Payer: ASR ASR |
$2,712.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,167.84
|
| Rate for Payer: BCN Commercial |
$2,167.84
|
| Rate for Payer: Cash Price |
$2,236.90
|
| Rate for Payer: Cofinity Commercial |
$2,628.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,236.90
|
| Rate for Payer: Healthscope Commercial |
$2,796.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,712.25
|
| Rate for Payer: Mclaren Commercial |
$2,516.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,376.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,460.59
|
|
|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,796.13
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,118.45 |
| Max. Negotiated Rate |
$2,796.13 |
| Rate for Payer: Aetna Commercial |
$2,516.52
|
| Rate for Payer: ASR ASR |
$2,712.25
|
| Rate for Payer: BCBS Complete |
$1,118.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,167.84
|
| Rate for Payer: BCN Commercial |
$2,167.84
|
| Rate for Payer: Cash Price |
$2,236.90
|
| Rate for Payer: Cofinity Commercial |
$2,628.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,236.90
|
| Rate for Payer: Healthscope Commercial |
$2,796.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,712.25
|
| Rate for Payer: Mclaren Commercial |
$2,516.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,376.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,544.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,985.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,460.59
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,449.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,014.99 |
| Max. Negotiated Rate |
$1,449.99 |
| Rate for Payer: Aetna Commercial |
$1,304.99
|
| Rate for Payer: ASR ASR |
$1,406.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.18
|
| Rate for Payer: BCN Commercial |
$1,124.18
|
| Rate for Payer: Cash Price |
$1,159.99
|
| Rate for Payer: Cofinity Commercial |
$1,362.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.99
|
| Rate for Payer: Healthscope Commercial |
$1,449.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.49
|
| Rate for Payer: Mclaren Commercial |
$1,304.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.99
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,449.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.00 |
| Max. Negotiated Rate |
$1,449.99 |
| Rate for Payer: Aetna Commercial |
$1,304.99
|
| Rate for Payer: ASR ASR |
$1,406.49
|
| Rate for Payer: BCBS Complete |
$580.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.18
|
| Rate for Payer: BCN Commercial |
$1,124.18
|
| Rate for Payer: Cash Price |
$1,159.99
|
| Rate for Payer: Cofinity Commercial |
$1,362.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.99
|
| Rate for Payer: Healthscope Commercial |
$1,449.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.49
|
| Rate for Payer: Mclaren Commercial |
$1,304.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.99
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$55.49
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: ASR ASR |
$53.83
|
| Rate for Payer: BCBS Complete |
$8.36
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$43.02
|
| Rate for Payer: BCN Commercial |
$43.02
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$55.49
|
| Rate for Payer: Healthscope Whirlpool |
$53.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$49.94
|
| Rate for Payer: Mclaren Medicaid |
$7.96
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Medicaid |
$8.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.17
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$16.00
|
| Rate for Payer: PHP Medicaid |
$7.96
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$33.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.83
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$55.49
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: ASR ASR |
$53.83
|
| Rate for Payer: BCBS Trust/PPO |
$43.02
|
| Rate for Payer: BCN Commercial |
$43.02
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.39
|
| Rate for Payer: Healthscope Commercial |
$55.49
|
| Rate for Payer: Healthscope Whirlpool |
$53.83
|
| Rate for Payer: Mclaren Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.83
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
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 LOBSTER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
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 LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$94.48
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$94.48 |
| Rate for Payer: Aetna Commercial |
$85.03
|
| Rate for Payer: ASR ASR |
$91.65
|
| Rate for Payer: BCBS Trust/PPO |
$73.25
|
| Rate for Payer: BCN Commercial |
$73.25
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cofinity Commercial |
$88.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.58
|
| Rate for Payer: Healthscope Commercial |
$94.48
|
| Rate for Payer: Healthscope Whirlpool |
$91.65
|
| Rate for Payer: Mclaren Commercial |
$85.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.14
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$94.48
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$94.48 |
| Rate for Payer: Aetna Commercial |
$85.03
|
| Rate for Payer: ASR ASR |
$91.65
|
| Rate for Payer: BCBS Complete |
$37.79
|
| Rate for Payer: BCBS Trust/PPO |
$73.25
|
| Rate for Payer: BCN Commercial |
$73.25
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cofinity Commercial |
$88.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.58
|
| Rate for Payer: Healthscope Commercial |
$94.48
|
| Rate for Payer: Healthscope Whirlpool |
$91.65
|
| Rate for Payer: Mclaren Commercial |
$85.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.98
|
| Rate for Payer: Priority Health Narrow Network |
$67.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.14
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$342.78
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$137.11 |
| Max. Negotiated Rate |
$342.78 |
| Rate for Payer: Aetna Commercial |
$308.50
|
| Rate for Payer: ASR ASR |
$332.50
|
| Rate for Payer: BCBS Complete |
$137.11
|
| Rate for Payer: BCBS Trust/PPO |
$265.76
|
| Rate for Payer: BCN Commercial |
$265.76
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Commercial |
$322.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Healthscope Commercial |
$342.78
|
| Rate for Payer: Healthscope Whirlpool |
$332.50
|
| Rate for Payer: Mclaren Commercial |
$308.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.93
|
| Rate for Payer: Priority Health Narrow Network |
$243.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.65
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$342.78
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$239.95 |
| Max. Negotiated Rate |
$342.78 |
| Rate for Payer: Aetna Commercial |
$308.50
|
| Rate for Payer: ASR ASR |
$332.50
|
| Rate for Payer: BCBS Trust/PPO |
$265.76
|
| Rate for Payer: BCN Commercial |
$265.76
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Commercial |
$322.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Healthscope Commercial |
$342.78
|
| Rate for Payer: Healthscope Whirlpool |
$332.50
|
| Rate for Payer: Mclaren Commercial |
$308.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.65
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$202.77
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.94 |
| Max. Negotiated Rate |
$202.77 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: ASR ASR |
$196.69
|
| Rate for Payer: BCBS Trust/PPO |
$157.21
|
| Rate for Payer: BCN Commercial |
$157.21
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cofinity Commercial |
$190.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Healthscope Commercial |
$202.77
|
| Rate for Payer: Healthscope Whirlpool |
$196.69
|
| Rate for Payer: Mclaren Commercial |
$182.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.44
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$202.77
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$202.77 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: ASR ASR |
$196.69
|
| Rate for Payer: BCBS Complete |
$81.11
|
| Rate for Payer: BCBS Trust/PPO |
$157.21
|
| Rate for Payer: BCN Commercial |
$157.21
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cofinity Commercial |
$190.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Healthscope Commercial |
$202.77
|
| Rate for Payer: Healthscope Whirlpool |
$196.69
|
| Rate for Payer: Mclaren Commercial |
$182.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.52
|
| Rate for Payer: Priority Health Narrow Network |
$143.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.44
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: ASR ASR |
$139.68
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.64
|
| Rate for Payer: BCN Commercial |
$111.64
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$135.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Healthscope Whirlpool |
$139.68
|
| Rate for Payer: Mclaren Commercial |
$129.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.04
|
| Rate for Payer: Priority Health Narrow Network |
$102.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.72
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: ASR ASR |
$139.68
|
| Rate for Payer: BCBS Trust/PPO |
$111.64
|
| Rate for Payer: BCN Commercial |
$111.64
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$135.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Healthscope Whirlpool |
$139.68
|
| Rate for Payer: Mclaren Commercial |
$129.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.72
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$141.54
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$141.54 |
| Rate for Payer: Aetna Commercial |
$127.39
|
| Rate for Payer: ASR ASR |
$137.29
|
| Rate for Payer: BCBS Trust/PPO |
$109.74
|
| Rate for Payer: BCN Commercial |
$109.74
|
| Rate for Payer: Cash Price |
$113.23
|
| Rate for Payer: Cofinity Commercial |
$133.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.23
|
| Rate for Payer: Healthscope Commercial |
$141.54
|
| Rate for Payer: Healthscope Whirlpool |
$137.29
|
| Rate for Payer: Mclaren Commercial |
$127.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.56
|
|
