|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$268.65
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.06 |
| Max. Negotiated Rate |
$268.65 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: ASR ASR |
$260.59
|
| Rate for Payer: BCBS Trust/PPO |
$208.28
|
| Rate for Payer: BCN Commercial |
$208.28
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cofinity Commercial |
$252.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.92
|
| Rate for Payer: Healthscope Commercial |
$268.65
|
| Rate for Payer: Healthscope Whirlpool |
$260.59
|
| Rate for Payer: Mclaren Commercial |
$241.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.41
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,425.06
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$1,425.06 |
| Rate for Payer: Aetna Commercial |
$1,282.55
|
| Rate for Payer: ASR ASR |
$1,382.31
|
| Rate for Payer: BCBS Complete |
$570.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.85
|
| Rate for Payer: BCN Commercial |
$1,104.85
|
| Rate for Payer: Cash Price |
$1,140.05
|
| Rate for Payer: Cofinity Commercial |
$1,339.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,140.05
|
| Rate for Payer: Healthscope Commercial |
$1,425.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,382.31
|
| Rate for Payer: Mclaren Commercial |
$1,282.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,296.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,011.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,254.05
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,425.06
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$997.54 |
| Max. Negotiated Rate |
$1,425.06 |
| Rate for Payer: Aetna Commercial |
$1,282.55
|
| Rate for Payer: ASR ASR |
$1,382.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.85
|
| Rate for Payer: BCN Commercial |
$1,104.85
|
| Rate for Payer: Cash Price |
$1,140.05
|
| Rate for Payer: Cofinity Commercial |
$1,339.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,140.05
|
| Rate for Payer: Healthscope Commercial |
$1,425.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,382.31
|
| Rate for Payer: Mclaren Commercial |
$1,282.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,254.05
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$252.72
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$252.72 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: ASR ASR |
$245.14
|
| Rate for Payer: BCBS Trust/PPO |
$195.93
|
| Rate for Payer: BCN Commercial |
$195.93
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Cofinity Commercial |
$237.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.18
|
| Rate for Payer: Healthscope Commercial |
$252.72
|
| Rate for Payer: Healthscope Whirlpool |
$245.14
|
| Rate for Payer: Mclaren Commercial |
$227.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.39
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$252.72
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.09 |
| Max. Negotiated Rate |
$252.72 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: ASR ASR |
$245.14
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS Trust/PPO |
$195.93
|
| Rate for Payer: BCN Commercial |
$195.93
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Cofinity Commercial |
$237.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.18
|
| Rate for Payer: Healthscope Commercial |
$252.72
|
| Rate for Payer: Healthscope Whirlpool |
$245.14
|
| Rate for Payer: Mclaren Commercial |
$227.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.98
|
| Rate for Payer: Priority Health Narrow Network |
$179.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.39
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,661.40
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,262.98 |
| Max. Negotiated Rate |
$4,661.40 |
| Rate for Payer: Aetna Commercial |
$4,195.26
|
| Rate for Payer: ASR ASR |
$4,521.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,613.98
|
| Rate for Payer: BCN Commercial |
$3,613.98
|
| Rate for Payer: Cash Price |
$3,729.12
|
| Rate for Payer: Cofinity Commercial |
$4,381.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,729.12
|
| Rate for Payer: Healthscope Commercial |
$4,661.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,521.56
|
| Rate for Payer: Mclaren Commercial |
$4,195.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,962.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,102.03
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,661.40
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,864.56 |
| Max. Negotiated Rate |
$4,661.40 |
| Rate for Payer: Aetna Commercial |
$4,195.26
|
| Rate for Payer: ASR ASR |
$4,521.56
|
| Rate for Payer: BCBS Complete |
$1,864.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,613.98
|
| Rate for Payer: BCN Commercial |
$3,613.98
|
| Rate for Payer: Cash Price |
$3,729.12
|
| Rate for Payer: Cofinity Commercial |
$4,381.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,729.12
|
| Rate for Payer: Healthscope Commercial |
$4,661.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,521.56
|
| Rate for Payer: Mclaren Commercial |
$4,195.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,962.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,241.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,309.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,102.03
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$30.10
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$27.09
|
| Rate for Payer: ASR ASR |
$29.20
|
| Rate for Payer: BCBS Trust/PPO |
$23.34
|
| Rate for Payer: BCN Commercial |
$23.34
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.08
|
| Rate for Payer: Healthscope Commercial |
$30.10
|
| Rate for Payer: Healthscope Whirlpool |
$29.20
|
| Rate for Payer: Mclaren Commercial |
$27.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.49
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$30.10
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$27.09
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.65
|
| Rate for Payer: ASR ASR |
$29.20
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS MAPPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$23.34
|
| Rate for Payer: BCN Commercial |
$23.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.32
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$30.10
|
| Rate for Payer: Healthscope Whirlpool |
$29.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.32
|
| Rate for Payer: Mclaren Commercial |
$27.09
|
| Rate for Payer: Mclaren Medicaid |
$2.91
|
| Rate for Payer: Mclaren Medicare |
$5.32
|
| Rate for Payer: Meridian Medicaid |
$3.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.58
|
| Rate for Payer: PACE Medicare |
$5.05
|
| Rate for Payer: PACE SWMI |
$5.32
|
| Rate for Payer: PHP Commercial |
$5.85
|
| Rate for Payer: PHP Medicaid |
$2.91
|
| Rate for Payer: PHP Medicare Advantage |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.04
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health Narrow Network |
$16.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.49
|
| Rate for Payer: UHC Medicare Advantage |
$5.48
|
| Rate for Payer: VA VA |
$5.32
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,529.70
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,770.79 |
| Max. Negotiated Rate |
$2,529.70 |
| Rate for Payer: Aetna Commercial |
$2,276.73
|
| Rate for Payer: ASR ASR |
$2,453.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,961.28
|
| Rate for Payer: BCN Commercial |
$1,961.28
|
| Rate for Payer: Cash Price |
$2,023.76
|
| Rate for Payer: Cofinity Commercial |
$2,377.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,023.76
|
| Rate for Payer: Healthscope Commercial |
$2,529.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,453.81
|
| Rate for Payer: Mclaren Commercial |
$2,276.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,770.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.14
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,529.70
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,011.88 |
| Max. Negotiated Rate |
$2,529.70 |
| Rate for Payer: Aetna Commercial |
$2,276.73
|
| Rate for Payer: ASR ASR |
$2,453.81
|
| Rate for Payer: BCBS Complete |
$1,011.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,961.28
|
| Rate for Payer: BCN Commercial |
$1,961.28
|
| Rate for Payer: Cash Price |
$2,023.76
|
| Rate for Payer: Cofinity Commercial |
$2,377.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,023.76
|
| Rate for Payer: Healthscope Commercial |
$2,529.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,453.81
|
| Rate for Payer: Mclaren Commercial |
$2,276.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,770.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,302.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,796.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.14
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: ASR ASR |
$43.65
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Healthscope Whirlpool |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.95
|
| Rate for Payer: Priority Health Narrow Network |
$31.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: ASR ASR |
$43.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Healthscope Whirlpool |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$42.04 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$40.78
|
| Rate for Payer: BCBS Complete |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$32.59
|
| Rate for Payer: BCN Commercial |
$32.59
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$39.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$42.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$37.84
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Medicaid |
$15.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.26
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$29.85
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.43 |
| Max. Negotiated Rate |
$42.04 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: ASR ASR |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$32.59
|
| Rate for Payer: BCN Commercial |
$32.59
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$39.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Healthscope Commercial |
$42.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.78
|
| Rate for Payer: Mclaren Commercial |
$37.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.00
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$42.04 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$40.78
|
| Rate for Payer: BCBS Complete |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$32.59
|
| Rate for Payer: BCN Commercial |
$32.59
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$39.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$42.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$37.84
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Medicaid |
$15.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.26
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$29.85
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.43 |
| Max. Negotiated Rate |
$42.04 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: ASR ASR |
$40.78
|
| Rate for Payer: BCBS Trust/PPO |
$32.59
|
| Rate for Payer: BCN Commercial |
$32.59
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$39.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Healthscope Commercial |
$42.04
|
| Rate for Payer: Healthscope Whirlpool |
$40.78
|
| Rate for Payer: Mclaren Commercial |
$37.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.00
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$377.19 |
| Rate for Payer: Aetna Commercial |
$339.47
|
| Rate for Payer: Aetna Medicare |
$301.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: ASR ASR |
$365.87
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$292.44
|
| Rate for Payer: BCN Commercial |
$292.44
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$354.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$377.19
|
| Rate for Payer: Healthscope Whirlpool |
$365.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$301.03
|
| Rate for Payer: Mclaren Commercial |
$339.47
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$331.13
|
| Rate for Payer: PHP Medicaid |
$164.66
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.24
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$267.80
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.93
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: VA VA |
$301.03
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$264.03 |
| Max. Negotiated Rate |
$377.19 |
| Rate for Payer: Aetna Commercial |
$339.47
|
| Rate for Payer: ASR ASR |
$365.87
|
| Rate for Payer: BCBS Trust/PPO |
$292.44
|
| Rate for Payer: BCN Commercial |
$292.44
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$354.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.75
|
| Rate for Payer: Healthscope Commercial |
$377.19
|
| Rate for Payer: Healthscope Whirlpool |
$365.87
|
| Rate for Payer: Mclaren Commercial |
$339.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.93
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.59
|
| Rate for Payer: ASR ASR |
$1.72
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.77
|
| Rate for Payer: Healthscope Whirlpool |
$1.72
|
| Rate for Payer: Mclaren Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.05
|
| Rate for Payer: Priority Health Narrow Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.56
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna Commercial |
$1.59
|
| Rate for Payer: ASR ASR |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.77
|
| Rate for Payer: Healthscope Whirlpool |
$1.72
|
| Rate for Payer: Mclaren Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.56
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$647.84 |
| Max. Negotiated Rate |
$925.49 |
| Rate for Payer: Aetna Commercial |
$832.94
|
| Rate for Payer: ASR ASR |
$897.73
|
| Rate for Payer: BCBS Trust/PPO |
$717.53
|
| Rate for Payer: BCN Commercial |
$717.53
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$869.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.39
|
| Rate for Payer: Healthscope Commercial |
$925.49
|
| Rate for Payer: Healthscope Whirlpool |
$897.73
|
| Rate for Payer: Mclaren Commercial |
$832.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$814.43
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$925.49 |
| Rate for Payer: Aetna Commercial |
$832.94
|
| Rate for Payer: ASR ASR |
$897.73
|
| Rate for Payer: BCBS Complete |
$370.20
|
| Rate for Payer: BCBS Trust/PPO |
$717.53
|
| Rate for Payer: BCN Commercial |
$717.53
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$869.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.39
|
| Rate for Payer: Healthscope Commercial |
$925.49
|
| Rate for Payer: Healthscope Whirlpool |
$897.73
|
| Rate for Payer: Mclaren Commercial |
$832.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$842.20
|
| Rate for Payer: Priority Health Narrow Network |
$657.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$814.43
|
|
