|
HC GLUCOSE BODY FLUID NOT BLOOD
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
30100222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
|
|
HC GLUCOSE LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$16.65
|
| 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: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.93
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: Meridian Medicaid |
$2.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$4.32
|
| Rate for Payer: PHP Medicaid |
$2.11
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.81
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health Narrow Network |
$20.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$6.09
|
| Rate for Payer: UHC Medicare Advantage |
$3.93
|
| Rate for Payer: UHCCP DNSP |
$3.93
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC GLUCOSE LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100223
|
|
Hospital Revenue Code
|
301
|
| 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 GLUCOSE POST DOSE
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
30100224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$46.31 |
| Rate for Payer: Aetna Commercial |
$41.68
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: ASR ASR |
$44.92
|
| Rate for Payer: ASR Commercial |
$44.92
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$37.92
|
| Rate for Payer: BCN Commercial |
$35.90
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$43.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$46.31
|
| Rate for Payer: Healthscope Whirlpool |
$44.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$41.68
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.22
|
| Rate for Payer: PHP Medicaid |
$2.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.84
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$25.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHCCP DNSP |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC GLUCOSE POST DOSE
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
30100224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$46.31 |
| Rate for Payer: Aetna Commercial |
$41.68
|
| Rate for Payer: ASR ASR |
$44.92
|
| Rate for Payer: ASR Commercial |
$44.92
|
| Rate for Payer: BCBS Trust/PPO |
$37.74
|
| Rate for Payer: BCN Commercial |
$35.90
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$43.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$46.31
|
| Rate for Payer: Healthscope Whirlpool |
$44.92
|
| Rate for Payer: Mclaren Commercial |
$41.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.75
|
|
|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$16.65
|
| 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: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.93
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: Meridian Medicaid |
$2.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$4.32
|
| Rate for Payer: PHP Medicaid |
$2.11
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.81
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health Narrow Network |
$20.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$6.09
|
| Rate for Payer: UHC Medicare Advantage |
$3.93
|
| Rate for Payer: UHCCP DNSP |
$3.93
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| 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 GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: ASR ASR |
$9.28
|
| Rate for Payer: ASR Commercial |
$9.28
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Healthscope Whirlpool |
$9.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$8.61
|
| Rate for Payer: Mclaren Medicaid |
$1.76
|
| Rate for Payer: Mclaren Medicare |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: Meridian Medicaid |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: PACE Medicare |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: PHP Medicaid |
$1.76
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
| Rate for Payer: UHCCP DNSP |
$3.28
|
| Rate for Payer: UHCCP Medicaid |
$1.76
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
IP
|
$9.57
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: ASR ASR |
$9.28
|
| Rate for Payer: ASR Commercial |
$9.28
|
| Rate for Payer: BCBS Trust/PPO |
$7.80
|
| Rate for Payer: BCN Commercial |
$7.42
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Healthscope Whirlpool |
$9.28
|
| Rate for Payer: Mclaren Commercial |
$8.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.42
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: ASR Commercial |
$91.23
|
| Rate for Payer: BCBS Trust/PPO |
$76.64
|
| Rate for Payer: BCN Commercial |
$72.92
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.23
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: ASR Commercial |
$91.23
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$77.02
|
| Rate for Payer: BCN Commercial |
$72.92
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$59.85
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: ASR Commercial |
$71.24
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$60.14
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$51.48
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.63
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$71.37 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.71
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$5.20
|
| Rate for Payer: Mclaren Medicare |
$9.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Medicaid |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: PHP Medicaid |
$5.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.37
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health Narrow Network |
$57.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Exchange |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$9.71
|
| Rate for Payer: UHCCP DNSP |
$9.71
|
| Rate for Payer: UHCCP Medicaid |
$5.20
|
| Rate for Payer: VA VA |
$9.71
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC GOLDENROD IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
IP
|
$612.44
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$398.09 |
| Max. Negotiated Rate |
$612.44 |
| Rate for Payer: Aetna Commercial |
$551.20
|
| Rate for Payer: ASR ASR |
$594.07
|
| Rate for Payer: ASR Commercial |
$594.07
|
| Rate for Payer: BCBS Trust/PPO |
$499.08
|
| Rate for Payer: BCN Commercial |
$474.82
|
| Rate for Payer: Cash Price |
$489.95
|
| Rate for Payer: Cofinity Commercial |
$575.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.95
|
| Rate for Payer: Healthscope Commercial |
$612.44
|
| Rate for Payer: Healthscope Whirlpool |
$594.07
|
| Rate for Payer: Mclaren Commercial |
$551.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.57
|
| Rate for Payer: Nomi Health Commercial |
$502.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.95
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
OP
|
$612.44
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.98 |
| Max. Negotiated Rate |
$612.44 |
| Rate for Payer: Aetna Commercial |
$551.20
|
| Rate for Payer: Aetna Medicare |
$306.22
|
| Rate for Payer: ASR ASR |
$594.07
|
| Rate for Payer: ASR Commercial |
$594.07
|
| Rate for Payer: BCBS Complete |
$244.98
|
| Rate for Payer: BCBS Trust/PPO |
$501.53
|
| Rate for Payer: BCN Commercial |
$474.82
|
| Rate for Payer: Cash Price |
$489.95
|
| Rate for Payer: Cofinity Commercial |
$575.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.95
|
| Rate for Payer: Healthscope Commercial |
$612.44
|
| Rate for Payer: Healthscope Whirlpool |
$594.07
|
| Rate for Payer: Mclaren Commercial |
$551.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.57
|
| Rate for Payer: Nomi Health Commercial |
$502.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.62
|
| Rate for Payer: Priority Health Narrow Network |
$429.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.95
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$762.97
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$762.97 |
| Rate for Payer: Aetna Commercial |
$686.67
|
| Rate for Payer: Aetna Medicare |
$381.48
|
| Rate for Payer: ASR ASR |
$740.08
|
| Rate for Payer: ASR Commercial |
$740.08
|
| Rate for Payer: BCBS Complete |
$305.19
|
| Rate for Payer: BCBS Trust/PPO |
$624.80
|
| Rate for Payer: BCN Commercial |
$591.53
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cofinity Commercial |
$717.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.38
|
| Rate for Payer: Healthscope Commercial |
$762.97
|
| Rate for Payer: Healthscope Whirlpool |
$740.08
|
| Rate for Payer: Mclaren Commercial |
$686.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.52
|
| Rate for Payer: Nomi Health Commercial |
$625.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.25
|
| Rate for Payer: Priority Health Narrow Network |
$100.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.41
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$762.97
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$495.93 |
| Max. Negotiated Rate |
$762.97 |
| Rate for Payer: Aetna Commercial |
$686.67
|
| Rate for Payer: ASR ASR |
$740.08
|
| Rate for Payer: ASR Commercial |
$740.08
|
| Rate for Payer: BCBS Trust/PPO |
$621.74
|
| Rate for Payer: BCN Commercial |
$591.53
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cofinity Commercial |
$717.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.38
|
| Rate for Payer: Healthscope Commercial |
$762.97
|
| Rate for Payer: Healthscope Whirlpool |
$740.08
|
| Rate for Payer: Mclaren Commercial |
$686.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.52
|
| Rate for Payer: Nomi Health Commercial |
$625.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.41
|
|
