|
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 |
$74.18
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health Narrow Network |
$59.35
|
| 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 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 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 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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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 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 |
$72.09 |
| Max. Negotiated Rate |
$654.23 |
| Rate for Payer: Aetna Commercial |
$588.81
|
| Rate for Payer: Aetna Medicare |
$134.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.11
|
| Rate for Payer: ASR ASR |
$634.60
|
| Rate for Payer: ASR Commercial |
$634.60
|
| Rate for Payer: BCBS Complete |
$75.69
|
| Rate for Payer: BCBS MAPPO |
$134.49
|
| Rate for Payer: BCBS Trust/PPO |
$535.75
|
| Rate for Payer: BCN Commercial |
$507.22
|
| Rate for Payer: BCN Medicare Advantage |
$134.49
|
| 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 |
$134.49
|
| Rate for Payer: Healthscope Commercial |
$654.23
|
| Rate for Payer: Healthscope Whirlpool |
$634.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$134.49
|
| Rate for Payer: Mclaren Commercial |
$588.81
|
| Rate for Payer: Mclaren Medicaid |
$72.09
|
| Rate for Payer: Mclaren Medicare |
$134.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.21
|
| Rate for Payer: Meridian Medicaid |
$75.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: Nomi Health Commercial |
$536.47
|
| Rate for Payer: PACE Medicare |
$127.77
|
| Rate for Payer: PACE SWMI |
$134.49
|
| Rate for Payer: PHP Commercial |
$147.94
|
| Rate for Payer: PHP Medicaid |
$72.09
|
| Rate for Payer: PHP Medicare Advantage |
$134.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.09
|
| 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 |
$134.49
|
| Rate for Payer: Priority Health Narrow Network |
$458.62
|
| Rate for Payer: Railroad Medicare Medicare |
$134.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$575.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.49
|
| Rate for Payer: UHC Exchange |
$208.46
|
| Rate for Payer: UHC Medicare Advantage |
$134.49
|
| Rate for Payer: UHCCP DNSP |
$134.49
|
| Rate for Payer: UHCCP Medicaid |
$72.09
|
| Rate for Payer: VA VA |
$134.49
|
|
|
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 |
$81.79 |
| Max. Negotiated Rate |
$835.42 |
| Rate for Payer: Aetna Commercial |
$751.88
|
| 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 |
$810.36
|
| Rate for Payer: ASR Commercial |
$810.36
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$684.13
|
| Rate for Payer: BCN Commercial |
$647.70
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| 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 |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$835.42
|
| Rate for Payer: Healthscope Whirlpool |
$810.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$751.88
|
| 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 |
$710.11
|
| Rate for Payer: Nomi Health Commercial |
$685.04
|
| 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 |
$543.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.00
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$585.63
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$735.17
|
| 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 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 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 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 |
$67.38 |
| Max. Negotiated Rate |
$535.76 |
| Rate for Payer: Aetna Commercial |
$482.18
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$519.69
|
| Rate for Payer: ASR Commercial |
$519.69
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$438.73
|
| Rate for Payer: BCN Commercial |
$415.37
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| 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 |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$535.76
|
| Rate for Payer: Healthscope Whirlpool |
$519.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$482.18
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: Nomi Health Commercial |
$439.32
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.43
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$375.57
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
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 |
$1,681.38 |
| Max. Negotiated Rate |
$6,486.08 |
| Rate for Payer: Aetna Commercial |
$5,837.47
|
| Rate for Payer: Aetna Medicare |
$3,136.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: ASR ASR |
$6,291.50
|
| Rate for Payer: ASR Commercial |
$6,291.50
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCBS Trust/PPO |
$5,311.45
|
| Rate for Payer: BCN Commercial |
$5,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| 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 |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$6,486.08
|
| Rate for Payer: Healthscope Whirlpool |
$6,291.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,136.90
|
| Rate for Payer: Mclaren Commercial |
$5,837.47
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| 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 |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$3,450.59
|
| Rate for Payer: PHP Medicaid |
$1,681.38
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| 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 |
$3,136.90
|
| Rate for Payer: Priority Health Narrow Network |
$4,546.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,707.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Exchange |
$4,862.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP DNSP |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,681.38
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
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 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 |
$63.46 |
| 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 |
$16.55
|
| 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 |
$55.60
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| 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 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
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$403.49
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$403.49 |
| Rate for Payer: Aetna Commercial |
$363.14
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: ASR ASR |
$391.39
|
| Rate for Payer: ASR Commercial |
$391.39
|
| Rate for Payer: BCBS Complete |
$144.89
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$330.42
|
| Rate for Payer: BCN Commercial |
$312.83
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$322.79
|
| 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: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$403.49
|
| Rate for Payer: Healthscope Whirlpool |
$391.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$363.14
|
| Rate for Payer: Mclaren Medicaid |
$137.99
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$144.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.97
|
| Rate for Payer: Nomi Health Commercial |
$330.86
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.19
|
| Rate for Payer: PHP Medicaid |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.54
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$282.85
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Exchange |
$399.05
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$137.99
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.35
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$21.88
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$4.39
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| 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 |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$4.39
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
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 HDR 1 CHANNEL
|
Facility
|
IP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,293.28 |
| Max. Negotiated Rate |
$1,989.66 |
| Rate for Payer: Aetna Commercial |
$1,790.69
|
| Rate for Payer: ASR ASR |
$1,929.97
|
| Rate for Payer: ASR Commercial |
$1,929.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.37
|
| Rate for Payer: BCN Commercial |
$1,542.58
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,870.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Healthscope Commercial |
$1,989.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,929.97
|
| Rate for Payer: Mclaren Commercial |
$1,790.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,750.90
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.69 |
| Max. Negotiated Rate |
$1,989.66 |
| Rate for Payer: Aetna Commercial |
$1,790.69
|
| Rate for Payer: Aetna Medicare |
$676.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$845.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$845.83
|
| Rate for Payer: ASR ASR |
$1,929.97
|
| Rate for Payer: ASR Commercial |
$1,929.97
|
| Rate for Payer: BCBS Complete |
$380.82
|
| Rate for Payer: BCBS MAPPO |
$676.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.33
|
| Rate for Payer: BCN Commercial |
$1,542.58
|
| Rate for Payer: BCN Medicare Advantage |
$676.66
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,870.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.66
|
| Rate for Payer: Healthscope Commercial |
$1,989.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,929.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$676.66
|
| Rate for Payer: Mclaren Commercial |
$1,790.69
|
| Rate for Payer: Mclaren Medicaid |
$362.69
|
| Rate for Payer: Mclaren Medicare |
$676.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.49
|
| Rate for Payer: Meridian Medicaid |
$380.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$778.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: PACE Medicare |
$642.83
|
| Rate for Payer: PACE SWMI |
$676.66
|
| Rate for Payer: PHP Commercial |
$744.33
|
| Rate for Payer: PHP Medicaid |
$362.69
|
| Rate for Payer: PHP Medicare Advantage |
$676.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,743.34
|
| Rate for Payer: Priority Health Medicare |
$676.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,394.75
|
| Rate for Payer: Railroad Medicare Medicare |
$676.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,750.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.66
|
| Rate for Payer: UHC Exchange |
$1,048.82
|
| Rate for Payer: UHC Medicare Advantage |
$676.66
|
| Rate for Payer: UHCCP DNSP |
$676.66
|
| Rate for Payer: UHCCP Medicaid |
$362.69
|
| Rate for Payer: VA VA |
$676.66
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.69 |
| Max. Negotiated Rate |
$2,210.05 |
| Rate for Payer: Aetna Commercial |
$1,989.05
|
| Rate for Payer: Aetna Medicare |
$676.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$845.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$845.83
|
| Rate for Payer: ASR ASR |
$2,143.75
|
| Rate for Payer: ASR Commercial |
$2,143.75
|
| Rate for Payer: BCBS Complete |
$380.82
|
| Rate for Payer: BCBS MAPPO |
$676.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,809.81
|
| Rate for Payer: BCN Commercial |
$1,713.45
|
| Rate for Payer: BCN Medicare Advantage |
$676.66
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$2,077.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.66
|
| Rate for Payer: Healthscope Commercial |
$2,210.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$676.66
|
| Rate for Payer: Mclaren Commercial |
$1,989.05
|
| Rate for Payer: Mclaren Medicaid |
$362.69
|
| Rate for Payer: Mclaren Medicare |
$676.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.49
|
| Rate for Payer: Meridian Medicaid |
$380.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$778.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: PACE Medicare |
$642.83
|
| Rate for Payer: PACE SWMI |
$676.66
|
| Rate for Payer: PHP Commercial |
$744.33
|
| Rate for Payer: PHP Medicaid |
$362.69
|
| Rate for Payer: PHP Medicare Advantage |
$676.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,936.45
|
| Rate for Payer: Priority Health Medicare |
$676.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,549.25
|
| Rate for Payer: Railroad Medicare Medicare |
$676.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.66
|
| Rate for Payer: UHC Exchange |
$1,048.82
|
| Rate for Payer: UHC Medicare Advantage |
$676.66
|
| Rate for Payer: UHCCP DNSP |
$676.66
|
| Rate for Payer: UHCCP Medicaid |
$362.69
|
| Rate for Payer: VA VA |
$676.66
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,436.53 |
| Max. Negotiated Rate |
$2,210.05 |
| Rate for Payer: Aetna Commercial |
$1,989.05
|
| Rate for Payer: ASR ASR |
$2,143.75
|
| Rate for Payer: ASR Commercial |
$2,143.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,800.97
|
| Rate for Payer: BCN Commercial |
$1,713.45
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$2,077.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Healthscope Commercial |
$2,210.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.75
|
| Rate for Payer: Mclaren Commercial |
$1,989.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.84
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.57 |
| Max. Negotiated Rate |
$562.41 |
| Rate for Payer: Aetna Commercial |
$506.17
|
| Rate for Payer: ASR ASR |
$545.54
|
| Rate for Payer: ASR Commercial |
$545.54
|
| Rate for Payer: BCBS Trust/PPO |
$458.31
|
| Rate for Payer: BCN Commercial |
$436.04
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$528.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Healthscope Commercial |
$562.41
|
| Rate for Payer: Healthscope Whirlpool |
$545.54
|
| Rate for Payer: Mclaren Commercial |
$506.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.92
|
|
