|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$367.09 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$255.60
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.48
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$218.80
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,362.72 |
| Max. Negotiated Rate |
$2,096.50 |
| Rate for Payer: Aetna Commercial |
$1,886.85
|
| Rate for Payer: ASR ASR |
$2,033.60
|
| Rate for Payer: ASR Commercial |
$2,033.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.44
|
| Rate for Payer: BCN Commercial |
$1,625.42
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,970.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$2,096.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,033.60
|
| Rate for Payer: Mclaren Commercial |
$1,886.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.02
|
| Rate for Payer: Nomi Health Commercial |
$1,719.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,844.92
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.60 |
| Max. Negotiated Rate |
$2,096.50 |
| Rate for Payer: Aetna Commercial |
$1,886.85
|
| Rate for Payer: Aetna Medicare |
$1,048.25
|
| Rate for Payer: ASR ASR |
$2,033.60
|
| Rate for Payer: ASR Commercial |
$2,033.60
|
| Rate for Payer: BCBS Complete |
$838.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.82
|
| Rate for Payer: BCN Commercial |
$1,625.42
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,970.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$2,096.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,033.60
|
| Rate for Payer: Mclaren Commercial |
$1,886.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.02
|
| Rate for Payer: Nomi Health Commercial |
$1,719.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,836.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,469.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,844.92
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,521.07 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,160.65
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,551.43 |
| Max. Negotiated Rate |
$3,878.57 |
| Rate for Payer: Aetna Commercial |
$3,490.71
|
| Rate for Payer: Aetna Medicare |
$1,939.28
|
| Rate for Payer: ASR ASR |
$3,762.21
|
| Rate for Payer: ASR Commercial |
$3,762.21
|
| Rate for Payer: BCBS Complete |
$1,551.43
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.16
|
| Rate for Payer: BCN Commercial |
$3,007.06
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,645.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,878.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.21
|
| Rate for Payer: Mclaren Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,398.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,718.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,413.14
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$336.22 |
| Max. Negotiated Rate |
$840.56 |
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: ASR ASR |
$815.34
|
| Rate for Payer: ASR Commercial |
$815.34
|
| Rate for Payer: BCBS Complete |
$336.22
|
| Rate for Payer: BCBS Trust/PPO |
$688.33
|
| Rate for Payer: BCN Commercial |
$651.69
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$790.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$840.56
|
| Rate for Payer: Healthscope Whirlpool |
$815.34
|
| Rate for Payer: Mclaren Commercial |
$756.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: Nomi Health Commercial |
$689.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.50
|
| Rate for Payer: Priority Health Narrow Network |
$589.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.69
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$840.56 |
| Rate for Payer: Aetna Commercial |
$756.50
|
| Rate for Payer: ASR ASR |
$815.34
|
| Rate for Payer: ASR Commercial |
$815.34
|
| Rate for Payer: BCBS Trust/PPO |
$684.97
|
| Rate for Payer: BCN Commercial |
$651.69
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$790.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$840.56
|
| Rate for Payer: Healthscope Whirlpool |
$815.34
|
| Rate for Payer: Mclaren Commercial |
$756.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: Nomi Health Commercial |
$689.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.69
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,070.57 |
| Max. Negotiated Rate |
$2,676.43 |
| Rate for Payer: Aetna Commercial |
$2,408.79
|
| Rate for Payer: Aetna Medicare |
$1,338.22
|
| Rate for Payer: ASR ASR |
$2,596.14
|
| Rate for Payer: ASR Commercial |
$2,596.14
|
| Rate for Payer: BCBS Complete |
$1,070.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,191.73
|
| Rate for Payer: BCN Commercial |
$2,075.04
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$2,515.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,676.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,596.14
|
| Rate for Payer: Mclaren Commercial |
$2,408.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: Nomi Health Commercial |
$2,194.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,345.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,876.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,355.26
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,739.68 |
| Max. Negotiated Rate |
$2,676.43 |
| Rate for Payer: Aetna Commercial |
$2,408.79
|
| Rate for Payer: ASR ASR |
$2,596.14
|
| Rate for Payer: ASR Commercial |
$2,596.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.02
|
| Rate for Payer: BCN Commercial |
$2,075.04
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$2,515.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,676.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,596.14
|
| Rate for Payer: Mclaren Commercial |
$2,408.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: Nomi Health Commercial |
$2,194.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,355.26
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.67
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$62.98
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.72
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$5.21
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$10.69
|
| Rate for Payer: PHP Medicaid |
$5.21
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.47
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$57.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$15.07
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP DNSP |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$5.21
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.96 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: ASR Commercial |
$281.98
|
| Rate for Payer: BCBS Trust/PPO |
$236.89
|
| Rate for Payer: BCN Commercial |
$225.38
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$273.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.98
|
| Rate for Payer: Mclaren Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: Nomi Health Commercial |
$238.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.24
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: ASR Commercial |
$281.98
|
| Rate for Payer: BCBS Complete |
$40.63
|
| Rate for Payer: BCBS MAPPO |
$72.19
|
| Rate for Payer: BCBS Trust/PPO |
$238.05
|
| Rate for Payer: BCN Commercial |
$225.38
|
| Rate for Payer: BCN Medicare Advantage |
$72.19
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$273.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$72.19
|
| Rate for Payer: Mclaren Commercial |
$261.63
|
| Rate for Payer: Mclaren Medicaid |
$38.69
|
| Rate for Payer: Mclaren Medicare |
$72.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.80
|
| Rate for Payer: Meridian Medicaid |
$40.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: Nomi Health Commercial |
$238.37
|
| Rate for Payer: PACE Medicare |
$68.58
|
| Rate for Payer: PACE SWMI |
$72.19
|
| Rate for Payer: PHP Commercial |
$79.41
|
| Rate for Payer: PHP Medicaid |
$38.69
|
| Rate for Payer: PHP Medicare Advantage |
$72.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Medicare |
$72.19
|
| Rate for Payer: Priority Health Narrow Network |
$66.12
|
| Rate for Payer: Railroad Medicare Medicare |
$72.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.19
|
| Rate for Payer: UHC Exchange |
$111.89
|
| Rate for Payer: UHC Medicare Advantage |
$72.19
|
| Rate for Payer: UHCCP DNSP |
$72.19
|
| Rate for Payer: UHCCP Medicaid |
$38.69
|
| Rate for Payer: VA VA |
$72.19
|
|
|
HC FILSHIE CLIP
|
Facility
|
OP
|
$335.82
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$335.82 |
| Rate for Payer: Aetna Commercial |
$302.24
|
| Rate for Payer: Aetna Medicare |
$167.91
|
| Rate for Payer: ASR ASR |
$325.75
|
| Rate for Payer: ASR Commercial |
$325.75
|
| Rate for Payer: BCBS Complete |
$134.33
|
| Rate for Payer: BCBS Trust/PPO |
$275.00
|
| Rate for Payer: BCN Commercial |
$260.36
|
| Rate for Payer: Cash Price |
$268.66
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.66
|
| Rate for Payer: Healthscope Commercial |
$335.82
|
| Rate for Payer: Healthscope Whirlpool |
$325.75
|
| Rate for Payer: Mclaren Commercial |
$302.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.45
|
| Rate for Payer: Nomi Health Commercial |
$275.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.25
|
| Rate for Payer: Priority Health Narrow Network |
$235.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.52
|
|
|
HC FILSHIE CLIP
|
Facility
|
IP
|
$335.82
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$335.82 |
| Rate for Payer: Aetna Commercial |
$302.24
|
| Rate for Payer: ASR ASR |
$325.75
|
| Rate for Payer: ASR Commercial |
$325.75
|
| Rate for Payer: BCBS Trust/PPO |
$273.66
|
| Rate for Payer: BCN Commercial |
$260.36
|
| Rate for Payer: Cash Price |
$268.66
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.66
|
| Rate for Payer: Healthscope Commercial |
$335.82
|
| Rate for Payer: Healthscope Whirlpool |
$325.75
|
| Rate for Payer: Mclaren Commercial |
$302.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.45
|
| Rate for Payer: Nomi Health Commercial |
$275.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.52
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
OP
|
$58.14
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Medicare |
$29.07
|
| Rate for Payer: ASR ASR |
$56.40
|
| Rate for Payer: ASR Commercial |
$56.40
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS Trust/PPO |
$47.61
|
| Rate for Payer: BCN Commercial |
$45.08
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$54.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$58.14
|
| Rate for Payer: Healthscope Whirlpool |
$56.40
|
| Rate for Payer: Mclaren Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$47.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.94
|
| Rate for Payer: Priority Health Narrow Network |
$40.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.16
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
IP
|
$58.14
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: ASR ASR |
$56.40
|
| Rate for Payer: ASR Commercial |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$47.38
|
| Rate for Payer: BCN Commercial |
$45.08
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$54.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$58.14
|
| Rate for Payer: Healthscope Whirlpool |
$56.40
|
| Rate for Payer: Mclaren Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$47.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.16
|
|
|
HC FILTERWIRE
|
Facility
|
IP
|
$3,814.45
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,479.39 |
| Max. Negotiated Rate |
$3,814.45 |
| Rate for Payer: Aetna Commercial |
$3,433.00
|
| Rate for Payer: ASR ASR |
$3,700.02
|
| Rate for Payer: ASR Commercial |
$3,700.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,108.40
|
| Rate for Payer: BCN Commercial |
$2,957.34
|
| Rate for Payer: Cash Price |
$3,051.56
|
| Rate for Payer: Cofinity Commercial |
$3,585.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.56
|
| Rate for Payer: Healthscope Commercial |
$3,814.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,700.02
|
| Rate for Payer: Mclaren Commercial |
$3,433.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,242.28
|
| Rate for Payer: Nomi Health Commercial |
$3,127.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,479.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,356.72
|
|
|
HC FILTERWIRE
|
Facility
|
OP
|
$3,814.45
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.78 |
| Max. Negotiated Rate |
$3,814.45 |
| Rate for Payer: Aetna Commercial |
$3,433.00
|
| Rate for Payer: Aetna Medicare |
$1,907.22
|
| Rate for Payer: ASR ASR |
$3,700.02
|
| Rate for Payer: ASR Commercial |
$3,700.02
|
| Rate for Payer: BCBS Complete |
$1,525.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,123.65
|
| Rate for Payer: BCN Commercial |
$2,957.34
|
| Rate for Payer: Cash Price |
$3,051.56
|
| Rate for Payer: Cofinity Commercial |
$3,585.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.56
|
| Rate for Payer: Healthscope Commercial |
$3,814.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,700.02
|
| Rate for Payer: Mclaren Commercial |
$3,433.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,242.28
|
| Rate for Payer: Nomi Health Commercial |
$3,127.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,479.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,342.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,673.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,356.72
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
OP
|
$20.81
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
IP
|
$20.81
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: ASR ASR |
$163.48
|
| Rate for Payer: ASR Commercial |
$163.48
|
| Rate for Payer: BCBS Trust/PPO |
$137.34
|
| Rate for Payer: BCN Commercial |
$130.67
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$158.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Healthscope Whirlpool |
$163.48
|
| Rate for Payer: Mclaren Commercial |
$151.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$138.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.32
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$163.48
|
| Rate for Payer: ASR Commercial |
$163.48
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$138.02
|
| Rate for Payer: BCN Commercial |
$130.67
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$158.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Healthscope Whirlpool |
$163.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$151.69
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$138.20
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.67
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$118.15
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISH PROBES
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$77.87 |
| Rate for Payer: Aetna Commercial |
$70.08
|
| Rate for Payer: ASR ASR |
$75.53
|
| Rate for Payer: ASR Commercial |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$63.46
|
| Rate for Payer: BCN Commercial |
$60.37
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$73.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$77.87
|
| Rate for Payer: Healthscope Whirlpool |
$75.53
|
| Rate for Payer: Mclaren Commercial |
$70.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$63.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.53
|
|
|
HC FISH PROBES
|
Facility
|
OP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$70.08
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$75.53
|
| Rate for Payer: ASR Commercial |
$75.53
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.77
|
| Rate for Payer: BCN Commercial |
$60.37
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$73.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$77.87
|
| Rate for Payer: Healthscope Whirlpool |
$75.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$70.08
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$63.85
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.23
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$54.59
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
