|
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 |
$67.39
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$53.91
|
| 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
|
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 |
$247.09
|
| 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 |
$254.71
|
| Rate for Payer: Priority Health Medicare |
$72.19
|
| Rate for Payer: Priority Health Narrow Network |
$203.78
|
| 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 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 |
$247.09
|
| 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 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 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 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
|
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 |
$3,433.01
|
| 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 |
$3,433.01
|
| 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 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 |
$3,433.01
|
| 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 |
$3,433.01
|
| 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 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
|
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 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 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
|
|
|
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 FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.66 |
| Max. Negotiated Rate |
$2,254.14 |
| Rate for Payer: Aetna Commercial |
$2,028.73
|
| Rate for Payer: Aetna Medicare |
$1,127.07
|
| Rate for Payer: ASR ASR |
$2,186.52
|
| Rate for Payer: ASR Commercial |
$2,186.52
|
| Rate for Payer: BCBS Complete |
$901.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.92
|
| Rate for Payer: BCN Commercial |
$1,747.63
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$2,118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,254.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.52
|
| Rate for Payer: Mclaren Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: Nomi Health Commercial |
$1,848.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,975.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.64
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,465.19 |
| Max. Negotiated Rate |
$2,254.14 |
| Rate for Payer: Aetna Commercial |
$2,028.73
|
| Rate for Payer: ASR ASR |
$2,186.52
|
| Rate for Payer: ASR Commercial |
$2,186.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.90
|
| Rate for Payer: BCN Commercial |
$1,747.63
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$2,118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,254.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.52
|
| Rate for Payer: Mclaren Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: Nomi Health Commercial |
$1,848.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.64
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.32 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: ASR Commercial |
$251.19
|
| Rate for Payer: BCBS Trust/PPO |
$211.03
|
| Rate for Payer: BCN Commercial |
$200.77
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$258.96
|
| Rate for Payer: Healthscope Whirlpool |
$251.19
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: ASR Commercial |
$251.19
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$212.06
|
| Rate for Payer: BCN Commercial |
$200.77
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$258.96
|
| Rate for Payer: Healthscope Whirlpool |
$251.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.90
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$181.53
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$472.45
|
| Rate for Payer: Aetna Medicare |
$196.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: ASR ASR |
$509.20
|
| Rate for Payer: ASR Commercial |
$509.20
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCBS Trust/PPO |
$429.88
|
| Rate for Payer: BCN Commercial |
$406.99
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$493.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Healthscope Whirlpool |
$509.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$196.20
|
| Rate for Payer: Mclaren Commercial |
$472.45
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: Nomi Health Commercial |
$430.46
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$215.82
|
| Rate for Payer: PHP Medicaid |
$105.16
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.96
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health Narrow Network |
$367.99
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$304.11
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP DNSP |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.22 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$472.45
|
| Rate for Payer: ASR ASR |
$509.20
|
| Rate for Payer: ASR Commercial |
$509.20
|
| Rate for Payer: BCBS Trust/PPO |
$427.78
|
| Rate for Payer: BCN Commercial |
$406.99
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$493.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Healthscope Whirlpool |
$509.20
|
| Rate for Payer: Mclaren Commercial |
$472.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: Nomi Health Commercial |
$430.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.96
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.16 |
| Max. Negotiated Rate |
$1,777.90 |
| Rate for Payer: Aetna Commercial |
$1,600.11
|
| Rate for Payer: Aetna Medicare |
$888.95
|
| Rate for Payer: ASR ASR |
$1,724.56
|
| Rate for Payer: ASR Commercial |
$1,724.56
|
| Rate for Payer: BCBS Complete |
$711.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.92
|
| Rate for Payer: BCN Commercial |
$1,378.41
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,671.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,777.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,724.56
|
| Rate for Payer: Mclaren Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.21
|
| Rate for Payer: Nomi Health Commercial |
$1,457.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,246.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,564.55
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,155.63 |
| Max. Negotiated Rate |
$1,777.90 |
| Rate for Payer: Aetna Commercial |
$1,600.11
|
| Rate for Payer: ASR ASR |
$1,724.56
|
| Rate for Payer: ASR Commercial |
$1,724.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,448.81
|
| Rate for Payer: BCN Commercial |
$1,378.41
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,671.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,777.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,724.56
|
| Rate for Payer: Mclaren Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.21
|
| Rate for Payer: Nomi Health Commercial |
$1,457.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,564.55
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
OP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$254.93 |
| Rate for Payer: Aetna Commercial |
$229.44
|
| Rate for Payer: Aetna Medicare |
$127.47
|
| Rate for Payer: ASR ASR |
$247.28
|
| Rate for Payer: ASR Commercial |
$247.28
|
| Rate for Payer: BCBS Complete |
$101.97
|
| Rate for Payer: BCBS Trust/PPO |
$208.76
|
| Rate for Payer: BCN Commercial |
$197.65
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$239.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$254.93
|
| Rate for Payer: Healthscope Whirlpool |
$247.28
|
| Rate for Payer: Mclaren Commercial |
$229.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: Nomi Health Commercial |
$209.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.37
|
| Rate for Payer: Priority Health Narrow Network |
$178.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.34
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
IP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.70 |
| Max. Negotiated Rate |
$254.93 |
| Rate for Payer: Aetna Commercial |
$229.44
|
| Rate for Payer: ASR ASR |
$247.28
|
| Rate for Payer: ASR Commercial |
$247.28
|
| Rate for Payer: BCBS Trust/PPO |
$207.74
|
| Rate for Payer: BCN Commercial |
$197.65
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$239.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$254.93
|
| Rate for Payer: Healthscope Whirlpool |
$247.28
|
| Rate for Payer: Mclaren Commercial |
$229.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: Nomi Health Commercial |
$209.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.34
|
|
