|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: ASR ASR |
$494.70
|
| Rate for Payer: ASR Commercial |
$494.70
|
| Rate for Payer: BCBS Trust/PPO |
$415.60
|
| Rate for Payer: BCN Commercial |
$395.40
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$479.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$510.00
|
| Rate for Payer: Healthscope Whirlpool |
$494.70
|
| Rate for Payer: Mclaren Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$418.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.80
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.78
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$82.23
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Medicare |
$21.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$40.04
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.67
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Medicaid |
$11.62
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.85
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow Network |
$34.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.67
|
| Rate for Payer: UHC Exchange |
$33.59
|
| Rate for Payer: UHC Medicare Advantage |
$21.67
|
| Rate for Payer: UHCCP DNSP |
$21.67
|
| Rate for Payer: UHCCP Medicaid |
$11.62
|
| Rate for Payer: VA VA |
$21.67
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.85
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: ASR Commercial |
$2.10
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.77
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.16
|
| Rate for Payer: Healthscope Whirlpool |
$2.10
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.89
|
| Rate for Payer: Priority Health Narrow Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: ASR ASR |
$2.10
|
| Rate for Payer: ASR Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.16
|
| Rate for Payer: Healthscope Whirlpool |
$2.10
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: ASR Commercial |
$63.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.20
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.11 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: Aetna Medicare |
$32.64
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: ASR Commercial |
$63.32
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.20
|
| Rate for Payer: Priority Health Narrow Network |
$45.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: ASR Commercial |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$76.68
|
| Rate for Payer: BCN Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: ASR Commercial |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.31
|
| Rate for Payer: BCN Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$141.92
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$56.77 |
| Max. Negotiated Rate |
$141.92 |
| Rate for Payer: Aetna Commercial |
$127.73
|
| Rate for Payer: Aetna Medicare |
$70.96
|
| Rate for Payer: ASR ASR |
$137.66
|
| Rate for Payer: ASR Commercial |
$137.66
|
| Rate for Payer: BCBS Complete |
$56.77
|
| Rate for Payer: BCBS Trust/PPO |
$116.22
|
| Rate for Payer: BCN Commercial |
$110.03
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$133.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$141.92
|
| Rate for Payer: Healthscope Whirlpool |
$137.66
|
| Rate for Payer: Mclaren Commercial |
$127.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.63
|
| Rate for Payer: Nomi Health Commercial |
$116.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.35
|
| Rate for Payer: Priority Health Narrow Network |
$99.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.89
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$141.92
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$141.92 |
| Rate for Payer: Aetna Commercial |
$127.73
|
| Rate for Payer: ASR ASR |
$137.66
|
| Rate for Payer: ASR Commercial |
$137.66
|
| Rate for Payer: BCBS Trust/PPO |
$115.65
|
| Rate for Payer: BCN Commercial |
$110.03
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$133.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$141.92
|
| Rate for Payer: Healthscope Whirlpool |
$137.66
|
| Rate for Payer: Mclaren Commercial |
$127.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.63
|
| Rate for Payer: Nomi Health Commercial |
$116.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.89
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$239.75 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: ASR ASR |
$232.56
|
| Rate for Payer: ASR Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$195.37
|
| Rate for Payer: BCN Commercial |
$185.88
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$225.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Healthscope Commercial |
$239.75
|
| Rate for Payer: Healthscope Whirlpool |
$232.56
|
| Rate for Payer: Mclaren Commercial |
$215.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$196.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.98
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$239.75 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$232.56
|
| Rate for Payer: ASR Commercial |
$232.56
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$196.33
|
| Rate for Payer: BCN Commercial |
$185.88
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$225.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$239.75
|
| Rate for Payer: Healthscope Whirlpool |
$232.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$215.78
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$196.59
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.07
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$168.06
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.11 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$318.62
|
| Rate for Payer: ASR ASR |
$343.40
|
| Rate for Payer: ASR Commercial |
$343.40
|
| Rate for Payer: BCBS Trust/PPO |
$288.49
|
| Rate for Payer: BCN Commercial |
$274.47
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$332.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Healthscope Commercial |
$354.02
|
| Rate for Payer: Healthscope Whirlpool |
$343.40
|
| Rate for Payer: Mclaren Commercial |
$318.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$290.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.54
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$470.74 |
| Rate for Payer: Aetna Commercial |
$318.62
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$343.40
|
| Rate for Payer: ASR Commercial |
$343.40
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$289.91
|
| Rate for Payer: BCN Commercial |
$274.47
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$332.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$354.02
|
| Rate for Payer: Healthscope Whirlpool |
$343.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$318.62
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$290.30
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.19
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$248.17
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$390.42 |
| Rate for Payer: Aetna Commercial |
$351.38
|
| Rate for Payer: Aetna Medicare |
$195.21
|
| Rate for Payer: ASR ASR |
$378.71
|
| Rate for Payer: ASR Commercial |
$378.71
|
| Rate for Payer: BCBS Complete |
$156.17
|
| Rate for Payer: BCBS Trust/PPO |
$319.71
|
| Rate for Payer: BCN Commercial |
$302.69
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$366.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$390.42
|
| Rate for Payer: Healthscope Whirlpool |
$378.71
|
| Rate for Payer: Mclaren Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: Nomi Health Commercial |
$320.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.09
|
| Rate for Payer: Priority Health Narrow Network |
$273.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.57
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.77 |
| Max. Negotiated Rate |
$390.42 |
| Rate for Payer: Aetna Commercial |
$351.38
|
| Rate for Payer: ASR ASR |
$378.71
|
| Rate for Payer: ASR Commercial |
$378.71
|
| Rate for Payer: BCBS Trust/PPO |
$318.15
|
| Rate for Payer: BCN Commercial |
$302.69
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$366.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$390.42
|
| Rate for Payer: Healthscope Whirlpool |
$378.71
|
| Rate for Payer: Mclaren Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: Nomi Health Commercial |
$320.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.57
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$939.43 |
| Max. Negotiated Rate |
$1,445.27 |
| Rate for Payer: Aetna Commercial |
$1,300.74
|
| Rate for Payer: ASR ASR |
$1,401.91
|
| Rate for Payer: ASR Commercial |
$1,401.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,177.75
|
| Rate for Payer: BCN Commercial |
$1,120.52
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,358.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Healthscope Commercial |
$1,445.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,401.91
|
| Rate for Payer: Mclaren Commercial |
$1,300.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,185.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,271.84
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,445.27 |
| Rate for Payer: Aetna Commercial |
$1,300.74
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$1,401.91
|
| Rate for Payer: ASR Commercial |
$1,401.91
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.53
|
| Rate for Payer: BCN Commercial |
$1,120.52
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,358.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,445.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,401.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$1,300.74
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,185.12
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,266.35
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.13
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,271.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$978.58 |
| Max. Negotiated Rate |
$1,505.50 |
| Rate for Payer: Aetna Commercial |
$1,354.95
|
| Rate for Payer: ASR ASR |
$1,460.34
|
| Rate for Payer: ASR Commercial |
$1,460.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.83
|
| Rate for Payer: BCN Commercial |
$1,167.21
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Commercial |
$1,505.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,460.34
|
| Rate for Payer: Mclaren Commercial |
$1,354.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.67
|
| Rate for Payer: Nomi Health Commercial |
$1,234.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,324.84
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,505.50 |
| Rate for Payer: Aetna Commercial |
$1,354.95
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,460.34
|
| Rate for Payer: ASR Commercial |
$1,460.34
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.85
|
| Rate for Payer: BCN Commercial |
$1,167.21
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,505.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,460.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,354.95
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.67
|
| Rate for Payer: Nomi Health Commercial |
$1,234.51
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.12
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,055.36
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,324.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
