|
HC HAI PORTA CATH ACCESS
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$110.31
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.56 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$109.78
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$115.29 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Medicare |
$15.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: ASR ASR |
$102.90
|
| Rate for Payer: ASR Commercial |
$102.90
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$86.87
|
| Rate for Payer: BCN Commercial |
$82.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$99.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$106.08
|
| Rate for Payer: Healthscope Whirlpool |
$102.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.78
|
| Rate for Payer: Mclaren Commercial |
$95.47
|
| Rate for Payer: Mclaren Medicaid |
$8.46
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: Meridian Medicaid |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$17.36
|
| Rate for Payer: PHP Medicaid |
$8.46
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.29
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Narrow Network |
$92.23
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Exchange |
$24.46
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: UHCCP DNSP |
$15.78
|
| Rate for Payer: UHCCP Medicaid |
$8.46
|
| Rate for Payer: VA VA |
$15.78
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: ASR ASR |
$102.90
|
| Rate for Payer: ASR Commercial |
$102.90
|
| Rate for Payer: BCBS Trust/PPO |
$86.44
|
| Rate for Payer: BCN Commercial |
$82.24
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$99.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$106.08
|
| Rate for Payer: Healthscope Whirlpool |
$102.90
|
| Rate for Payer: Mclaren Commercial |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.35
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,631.49 |
| Max. Negotiated Rate |
$2,509.98 |
| Rate for Payer: Aetna Commercial |
$2,258.98
|
| Rate for Payer: ASR ASR |
$2,434.68
|
| Rate for Payer: ASR Commercial |
$2,434.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.38
|
| Rate for Payer: BCN Commercial |
$1,945.99
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$2,359.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,509.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,434.68
|
| Rate for Payer: Mclaren Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: Nomi Health Commercial |
$2,058.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,208.78
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,003.99 |
| Max. Negotiated Rate |
$2,509.98 |
| Rate for Payer: Aetna Commercial |
$2,258.98
|
| Rate for Payer: Aetna Medicare |
$1,254.99
|
| Rate for Payer: ASR ASR |
$2,434.68
|
| Rate for Payer: ASR Commercial |
$2,434.68
|
| Rate for Payer: BCBS Complete |
$1,003.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,055.42
|
| Rate for Payer: BCN Commercial |
$1,945.99
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$2,359.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,509.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,434.68
|
| Rate for Payer: Mclaren Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: Nomi Health Commercial |
$2,058.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,199.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,208.78
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,514.13 |
| Max. Negotiated Rate |
$6,285.33 |
| Rate for Payer: Aetna Commercial |
$5,656.80
|
| Rate for Payer: Aetna Medicare |
$3,142.66
|
| Rate for Payer: ASR ASR |
$6,096.77
|
| Rate for Payer: ASR Commercial |
$6,096.77
|
| Rate for Payer: BCBS Complete |
$2,514.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,147.06
|
| Rate for Payer: BCN Commercial |
$4,873.02
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$5,908.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$6,285.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,096.77
|
| Rate for Payer: Mclaren Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: Nomi Health Commercial |
$5,153.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,507.21
|
| Rate for Payer: Priority Health Narrow Network |
$4,406.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,531.09
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$6,285.33 |
| Rate for Payer: Aetna Commercial |
$5,656.80
|
| Rate for Payer: ASR ASR |
$6,096.77
|
| Rate for Payer: ASR Commercial |
$6,096.77
|
| Rate for Payer: BCBS Trust/PPO |
$5,121.92
|
| Rate for Payer: BCN Commercial |
$4,873.02
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$5,908.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$6,285.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,096.77
|
| Rate for Payer: Mclaren Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: Nomi Health Commercial |
$5,153.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,531.09
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
OP
|
$5,766.18
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,306.47 |
| Max. Negotiated Rate |
$5,766.18 |
| Rate for Payer: Aetna Commercial |
$5,189.56
|
| Rate for Payer: Aetna Medicare |
$2,883.09
|
| Rate for Payer: ASR ASR |
$5,593.19
|
| Rate for Payer: ASR Commercial |
$5,593.19
|
| Rate for Payer: BCBS Complete |
$2,306.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,721.92
|
| Rate for Payer: BCN Commercial |
$4,470.52
|
| Rate for Payer: Cash Price |
$4,612.94
|
| Rate for Payer: Cofinity Commercial |
$5,420.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,612.94
|
| Rate for Payer: Healthscope Commercial |
$5,766.18
|
| Rate for Payer: Healthscope Whirlpool |
$5,593.19
|
| Rate for Payer: Mclaren Commercial |
$5,189.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,901.25
|
| Rate for Payer: Nomi Health Commercial |
$4,728.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,748.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,052.33
|
| Rate for Payer: Priority Health Narrow Network |
$4,042.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,074.24
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
IP
|
$5,766.18
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,748.02 |
| Max. Negotiated Rate |
$5,766.18 |
| Rate for Payer: Aetna Commercial |
$5,189.56
|
| Rate for Payer: ASR ASR |
$5,593.19
|
| Rate for Payer: ASR Commercial |
$5,593.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,698.86
|
| Rate for Payer: BCN Commercial |
$4,470.52
|
| Rate for Payer: Cash Price |
$4,612.94
|
| Rate for Payer: Cofinity Commercial |
$5,420.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,612.94
|
| Rate for Payer: Healthscope Commercial |
$5,766.18
|
| Rate for Payer: Healthscope Whirlpool |
$5,593.19
|
| Rate for Payer: Mclaren Commercial |
$5,189.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,901.25
|
| Rate for Payer: Nomi Health Commercial |
$4,728.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,748.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,074.24
|
|
|
HC HAPTOGLOGIN
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: ASR ASR |
$82.12
|
| Rate for Payer: ASR Commercial |
$82.12
|
| Rate for Payer: BCBS Trust/PPO |
$68.99
|
| Rate for Payer: BCN Commercial |
$65.64
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$79.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$84.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Mclaren Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.50
|
|
|
HC HAPTOGLOGIN
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare |
$12.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: ASR ASR |
$82.12
|
| Rate for Payer: ASR Commercial |
$82.12
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$69.33
|
| Rate for Payer: BCN Commercial |
$65.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$79.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$84.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.58
|
| Rate for Payer: Mclaren Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PACE Medicare |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Medicaid |
$6.74
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.92
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health Narrow Network |
$35.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.58
|
| Rate for Payer: UHC Exchange |
$19.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.58
|
| Rate for Payer: UHCCP DNSP |
$12.58
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.58
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
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 HAZELNUT FILBERT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
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 HBO PER 30 MINUTES
|
Facility
|
IP
|
$654.23
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$654.23 |
| Rate for Payer: Aetna Commercial |
$588.81
|
| Rate for Payer: ASR ASR |
$634.60
|
| Rate for Payer: ASR Commercial |
$634.60
|
| Rate for Payer: BCBS Trust/PPO |
$533.13
|
| Rate for Payer: BCN Commercial |
$507.22
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cofinity Commercial |
$614.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.38
|
| Rate for Payer: Healthscope Commercial |
$654.23
|
| Rate for Payer: Healthscope Whirlpool |
$634.60
|
| Rate for Payer: Mclaren Commercial |
$588.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: Nomi Health Commercial |
$536.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$575.72
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
OP
|
$654.23
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$654.23 |
| Rate for Payer: Aetna Commercial |
$588.81
|
| Rate for Payer: Aetna Medicare |
$135.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.89
|
| Rate for Payer: ASR ASR |
$634.60
|
| Rate for Payer: ASR Commercial |
$634.60
|
| Rate for Payer: BCBS Complete |
$76.04
|
| Rate for Payer: BCBS MAPPO |
$135.11
|
| Rate for Payer: BCBS Trust/PPO |
$535.75
|
| Rate for Payer: BCN Commercial |
$507.22
|
| Rate for Payer: BCN Medicare Advantage |
$135.11
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cofinity Commercial |
$614.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.11
|
| Rate for Payer: Healthscope Commercial |
$654.23
|
| Rate for Payer: Healthscope Whirlpool |
$634.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$135.11
|
| Rate for Payer: Mclaren Commercial |
$588.81
|
| Rate for Payer: Mclaren Medicaid |
$72.42
|
| Rate for Payer: Mclaren Medicare |
$135.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$76.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: Nomi Health Commercial |
$536.47
|
| Rate for Payer: PACE Medicare |
$128.35
|
| Rate for Payer: PACE SWMI |
$135.11
|
| Rate for Payer: PHP Commercial |
$148.62
|
| Rate for Payer: PHP Medicaid |
$72.42
|
| Rate for Payer: PHP Medicare Advantage |
$135.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$573.24
|
| Rate for Payer: Priority Health Medicare |
$135.11
|
| Rate for Payer: Priority Health Narrow Network |
$458.62
|
| Rate for Payer: Railroad Medicare Medicare |
$135.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$575.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.11
|
| Rate for Payer: UHC Exchange |
$209.42
|
| Rate for Payer: UHC Medicare Advantage |
$135.11
|
| Rate for Payer: UHCCP DNSP |
$135.11
|
| Rate for Payer: UHCCP Medicaid |
$72.42
|
| Rate for Payer: VA VA |
$135.11
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
IP
|
$835.42
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$543.02 |
| Max. Negotiated Rate |
$835.42 |
| Rate for Payer: Aetna Commercial |
$751.88
|
| Rate for Payer: ASR ASR |
$810.36
|
| Rate for Payer: ASR Commercial |
$810.36
|
| Rate for Payer: BCBS Trust/PPO |
$680.78
|
| Rate for Payer: BCN Commercial |
$647.70
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$785.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.34
|
| Rate for Payer: Healthscope Commercial |
$835.42
|
| Rate for Payer: Healthscope Whirlpool |
$810.36
|
| Rate for Payer: Mclaren Commercial |
$751.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.11
|
| Rate for Payer: Nomi Health Commercial |
$685.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$735.17
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
OP
|
$835.42
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$835.42 |
| Rate for Payer: Aetna Commercial |
$751.88
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$810.36
|
| Rate for Payer: ASR Commercial |
$810.36
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$684.13
|
| Rate for Payer: BCN Commercial |
$647.70
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$785.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$835.42
|
| Rate for Payer: Healthscope Whirlpool |
$810.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$751.88
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.11
|
| Rate for Payer: Nomi Health Commercial |
$685.04
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.88
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$187.10
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$735.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
OP
|
$535.76
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$535.76 |
| Rate for Payer: Aetna Commercial |
$482.18
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$519.69
|
| Rate for Payer: ASR Commercial |
$519.69
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$438.73
|
| Rate for Payer: BCN Commercial |
$415.37
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cofinity Commercial |
$503.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$535.76
|
| Rate for Payer: Healthscope Whirlpool |
$519.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$482.18
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: Nomi Health Commercial |
$439.32
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.53
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$166.02
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
IP
|
$535.76
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$348.24 |
| Max. Negotiated Rate |
$535.76 |
| Rate for Payer: Aetna Commercial |
$482.18
|
| Rate for Payer: ASR ASR |
$519.69
|
| Rate for Payer: ASR Commercial |
$519.69
|
| Rate for Payer: BCBS Trust/PPO |
$436.59
|
| Rate for Payer: BCN Commercial |
$415.37
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cofinity Commercial |
$503.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.61
|
| Rate for Payer: Healthscope Commercial |
$535.76
|
| Rate for Payer: Healthscope Whirlpool |
$519.69
|
| Rate for Payer: Mclaren Commercial |
$482.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: Nomi Health Commercial |
$439.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.47
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
IP
|
$6,486.08
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,215.95 |
| Max. Negotiated Rate |
$6,486.08 |
| Rate for Payer: Aetna Commercial |
$5,837.47
|
| Rate for Payer: ASR ASR |
$6,291.50
|
| Rate for Payer: ASR Commercial |
$6,291.50
|
| Rate for Payer: BCBS Trust/PPO |
$5,285.51
|
| Rate for Payer: BCN Commercial |
$5,028.66
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cofinity Commercial |
$6,096.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,188.86
|
| Rate for Payer: Healthscope Commercial |
$6,486.08
|
| Rate for Payer: Healthscope Whirlpool |
$6,291.50
|
| Rate for Payer: Mclaren Commercial |
$5,837.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,513.17
|
| Rate for Payer: Nomi Health Commercial |
$5,318.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,215.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,707.75
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
OP
|
$6,486.08
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.13 |
| Max. Negotiated Rate |
$6,486.08 |
| Rate for Payer: Aetna Commercial |
$5,837.47
|
| Rate for Payer: Aetna Medicare |
$3,151.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,939.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,939.21
|
| Rate for Payer: ASR ASR |
$6,291.50
|
| Rate for Payer: ASR Commercial |
$6,291.50
|
| Rate for Payer: BCBS Complete |
$1,773.59
|
| Rate for Payer: BCBS MAPPO |
$3,151.37
|
| Rate for Payer: BCBS Trust/PPO |
$5,311.45
|
| Rate for Payer: BCN Commercial |
$5,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,151.37
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cofinity Commercial |
$6,096.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,151.37
|
| Rate for Payer: Healthscope Commercial |
$6,486.08
|
| Rate for Payer: Healthscope Whirlpool |
$6,291.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,151.37
|
| Rate for Payer: Mclaren Commercial |
$5,837.47
|
| Rate for Payer: Mclaren Medicaid |
$1,689.13
|
| Rate for Payer: Mclaren Medicare |
$3,151.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,308.94
|
| Rate for Payer: Meridian Medicaid |
$1,773.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,624.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,513.17
|
| Rate for Payer: Nomi Health Commercial |
$5,318.59
|
| Rate for Payer: PACE Medicare |
$2,993.80
|
| Rate for Payer: PACE SWMI |
$3,151.37
|
| Rate for Payer: PHP Commercial |
$3,466.51
|
| Rate for Payer: PHP Medicaid |
$1,689.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,151.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,215.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,683.10
|
| Rate for Payer: Priority Health Medicare |
$3,151.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,546.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,151.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,707.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,151.37
|
| Rate for Payer: UHC Exchange |
$4,884.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,151.37
|
| Rate for Payer: UHCCP DNSP |
$3,151.37
|
| Rate for Payer: UHCCP Medicaid |
$1,689.13
|
| Rate for Payer: VA VA |
$3,151.37
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$429.33 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.33
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$343.46
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: ASR Commercial |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Healthscope Whirlpool |
$61.56
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$403.49
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$403.49 |
| Rate for Payer: Aetna Commercial |
$363.14
|
| Rate for Payer: ASR ASR |
$391.39
|
| Rate for Payer: ASR Commercial |
$391.39
|
| Rate for Payer: BCBS Trust/PPO |
$328.80
|
| Rate for Payer: BCN Commercial |
$312.83
|
| Rate for Payer: Cash Price |
$322.79
|
| Rate for Payer: Cofinity Commercial |
$379.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.79
|
| Rate for Payer: Healthscope Commercial |
$403.49
|
| Rate for Payer: Healthscope Whirlpool |
$391.39
|
| Rate for Payer: Mclaren Commercial |
$363.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.97
|
| Rate for Payer: Nomi Health Commercial |
$330.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.07
|
|
