|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.83
|
| Rate for Payer: Priority Health Narrow Network |
$57.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC PICC INTRODUCER
|
Facility
|
OP
|
$96.39
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$86.75
|
| Rate for Payer: ASR ASR |
$93.50
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS Trust/PPO |
$74.73
|
| Rate for Payer: BCN Commercial |
$74.73
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$90.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Healthscope Whirlpool |
$93.50
|
| Rate for Payer: Mclaren Commercial |
$86.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.71
|
| Rate for Payer: Priority Health Narrow Network |
$68.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.82
|
|
|
HC PICC INTRODUCER
|
Facility
|
IP
|
$96.39
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$86.75
|
| Rate for Payer: ASR ASR |
$93.50
|
| Rate for Payer: BCBS Trust/PPO |
$74.73
|
| Rate for Payer: BCN Commercial |
$74.73
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$90.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Healthscope Whirlpool |
$93.50
|
| Rate for Payer: Mclaren Commercial |
$86.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.82
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
IP
|
$110.38
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.27 |
| Max. Negotiated Rate |
$110.38 |
| Rate for Payer: Aetna Commercial |
$99.34
|
| Rate for Payer: ASR ASR |
$107.07
|
| Rate for Payer: BCBS Trust/PPO |
$85.58
|
| Rate for Payer: BCN Commercial |
$85.58
|
| Rate for Payer: Cash Price |
$88.30
|
| Rate for Payer: Cofinity Commercial |
$103.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.30
|
| Rate for Payer: Healthscope Commercial |
$110.38
|
| Rate for Payer: Healthscope Whirlpool |
$107.07
|
| Rate for Payer: Mclaren Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.13
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
OP
|
$110.38
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$44.15 |
| Max. Negotiated Rate |
$110.38 |
| Rate for Payer: Aetna Commercial |
$99.34
|
| Rate for Payer: ASR ASR |
$107.07
|
| Rate for Payer: BCBS Complete |
$44.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.58
|
| Rate for Payer: BCN Commercial |
$85.58
|
| Rate for Payer: Cash Price |
$88.30
|
| Rate for Payer: Cofinity Commercial |
$103.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.30
|
| Rate for Payer: Healthscope Commercial |
$110.38
|
| Rate for Payer: Healthscope Whirlpool |
$107.07
|
| Rate for Payer: Mclaren Commercial |
$99.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.45
|
| Rate for Payer: Priority Health Narrow Network |
$78.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.13
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$186.06 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: ASR ASR |
$180.48
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$186.06
|
| Rate for Payer: Healthscope Whirlpool |
$180.48
|
| Rate for Payer: Mclaren Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.73
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$186.06 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: ASR ASR |
$180.48
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$186.06
|
| Rate for Payer: Healthscope Whirlpool |
$180.48
|
| Rate for Payer: Mclaren Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.73
|
|
|
HC PICU OR PED CRITICAL CARE R&B
|
Facility
|
IP
|
$7,648.92
|
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,354.24 |
| Max. Negotiated Rate |
$7,648.92 |
| Rate for Payer: Aetna Commercial |
$6,884.03
|
| Rate for Payer: ASR ASR |
$7,419.45
|
| Rate for Payer: BCBS Trust/PPO |
$5,930.21
|
| Rate for Payer: BCN Commercial |
$5,930.21
|
| Rate for Payer: Cash Price |
$6,119.14
|
| Rate for Payer: Cofinity Commercial |
$7,189.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,119.14
|
| Rate for Payer: Healthscope Commercial |
$7,648.92
|
| Rate for Payer: Healthscope Whirlpool |
$7,419.45
|
| Rate for Payer: Mclaren Commercial |
$6,884.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,501.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,354.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,731.05
|
|
|
HC PICU OR PED INTERMEDIATE CARE R&B
|
Facility
|
IP
|
$6,382.60
|
|
| Hospital Charge Code |
20600002
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,467.82 |
| Max. Negotiated Rate |
$6,382.60 |
| Rate for Payer: Aetna Commercial |
$5,744.34
|
| Rate for Payer: ASR ASR |
$6,191.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,948.43
|
| Rate for Payer: BCN Commercial |
$4,948.43
|
| Rate for Payer: Cash Price |
$5,106.08
|
| Rate for Payer: Cofinity Commercial |
$5,999.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,106.08
|
| Rate for Payer: Healthscope Commercial |
$6,382.60
|
| Rate for Payer: Healthscope Whirlpool |
$6,191.12
|
| Rate for Payer: Mclaren Commercial |
$5,744.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,425.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,616.69
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
OP
|
$308.88
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$123.55 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: ASR ASR |
$299.61
|
| Rate for Payer: BCBS Complete |
$123.55
|
| Rate for Payer: BCBS Trust/PPO |
$239.47
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Whirlpool |
$299.61
|
| Rate for Payer: Mclaren Commercial |
$277.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.08
|
| Rate for Payer: Priority Health Narrow Network |
$219.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.81
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
IP
|
$308.88
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: ASR ASR |
$299.61
|
| Rate for Payer: BCBS Trust/PPO |
$239.47
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Whirlpool |
$299.61
|
| Rate for Payer: Mclaren Commercial |
$277.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.81
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$317.45 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,377.00
|
| Rate for Payer: Aetna Medicare |
$580.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$725.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$725.44
|
| Rate for Payer: ASR ASR |
$1,484.10
|
| Rate for Payer: BCBS Complete |
$333.35
|
| Rate for Payer: BCBS MAPPO |
$580.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.21
|
| Rate for Payer: BCN Commercial |
$1,186.21
|
| Rate for Payer: BCN Medicare Advantage |
$580.35
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,438.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.35
|
| Rate for Payer: Healthscope Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$580.35
|
| Rate for Payer: Mclaren Commercial |
$1,377.00
|
| Rate for Payer: Mclaren Medicaid |
$317.45
|
| Rate for Payer: Mclaren Medicare |
$580.35
|
| Rate for Payer: Meridian Medicaid |
$333.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$609.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$667.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.50
|
| Rate for Payer: PACE Medicare |
$551.33
|
| Rate for Payer: PACE SWMI |
$580.35
|
| Rate for Payer: PHP Commercial |
$638.39
|
| Rate for Payer: PHP Medicaid |
$317.45
|
| Rate for Payer: PHP Medicare Advantage |
$580.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,392.30
|
| Rate for Payer: Priority Health Medicare |
$580.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,086.30
|
| Rate for Payer: Railroad Medicare Medicare |
$580.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.40
|
| Rate for Payer: UHC Medicare Advantage |
$597.76
|
| Rate for Payer: VA VA |
$580.35
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,377.00
|
| Rate for Payer: ASR ASR |
$1,484.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.21
|
| Rate for Payer: BCN Commercial |
$1,186.21
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,438.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.10
|
| Rate for Payer: Mclaren Commercial |
$1,377.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.40
|
|
|
HC PIGWEED IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC PIGWEED IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| 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 |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PI LINKED ANTIGEN
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Aetna Commercial |
$150.69
|
| Rate for Payer: ASR ASR |
$162.41
|
| Rate for Payer: BCBS Trust/PPO |
$129.81
|
| Rate for Payer: BCN Commercial |
$129.81
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.94
|
| Rate for Payer: Healthscope Commercial |
$167.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.41
|
| Rate for Payer: Mclaren Commercial |
$150.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.34
|
|
|
HC PI LINKED ANTIGEN
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$150.69
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$162.41
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$129.81
|
| Rate for Payer: BCN Commercial |
$129.81
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$167.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$150.69
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.34
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC PI LINKED ANTIGEN CMPT
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$150.69
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$162.41
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$129.81
|
| Rate for Payer: BCN Commercial |
$129.81
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$167.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$150.69
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.34
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC PI LINKED ANTIGEN CMPT
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Aetna Commercial |
$150.69
|
| Rate for Payer: ASR ASR |
$162.41
|
| Rate for Payer: BCBS Trust/PPO |
$129.81
|
| Rate for Payer: BCN Commercial |
$129.81
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$157.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.94
|
| Rate for Payer: Healthscope Commercial |
$167.43
|
| Rate for Payer: Healthscope Whirlpool |
$162.41
|
| Rate for Payer: Mclaren Commercial |
$150.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.34
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC PINWORM EXAM
|
Facility
|
IP
|
$54.40
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Aetna Commercial |
$48.96
|
| Rate for Payer: ASR ASR |
$52.77
|
| Rate for Payer: BCBS Trust/PPO |
$42.18
|
| Rate for Payer: BCN Commercial |
$42.18
|
| Rate for Payer: Cash Price |
$43.52
|
| Rate for Payer: Cofinity Commercial |
$51.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.52
|
| Rate for Payer: Healthscope Commercial |
$54.40
|
| Rate for Payer: Healthscope Whirlpool |
$52.77
|
| Rate for Payer: Mclaren Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.87
|
|
|
HC PINWORM EXAM
|
Facility
|
OP
|
$54.40
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Aetna Commercial |
$48.96
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$52.77
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$42.18
|
| Rate for Payer: BCN Commercial |
$42.18
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$43.52
|
| Rate for Payer: Cash Price |
$43.52
|
| Rate for Payer: Cofinity Commercial |
$51.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$54.40
|
| Rate for Payer: Healthscope Whirlpool |
$52.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.24
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.15
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$20.12
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.87
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
IP
|
$9,134.11
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,393.88 |
| Max. Negotiated Rate |
$9,134.11 |
| Rate for Payer: Aetna Commercial |
$8,220.70
|
| Rate for Payer: ASR ASR |
$8,860.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,081.68
|
| Rate for Payer: BCN Commercial |
$7,081.68
|
| Rate for Payer: Cash Price |
$7,307.29
|
| Rate for Payer: Cofinity Commercial |
$8,586.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,307.29
|
| Rate for Payer: Healthscope Commercial |
$9,134.11
|
| Rate for Payer: Healthscope Whirlpool |
$8,860.09
|
| Rate for Payer: Mclaren Commercial |
$8,220.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,763.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,393.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,038.02
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
OP
|
$9,134.11
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,653.64 |
| Max. Negotiated Rate |
$9,134.11 |
| Rate for Payer: Aetna Commercial |
$8,220.70
|
| Rate for Payer: ASR ASR |
$8,860.09
|
| Rate for Payer: BCBS Complete |
$3,653.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,081.68
|
| Rate for Payer: BCN Commercial |
$7,081.68
|
| Rate for Payer: Cash Price |
$7,307.29
|
| Rate for Payer: Cofinity Commercial |
$8,586.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,307.29
|
| Rate for Payer: Healthscope Commercial |
$9,134.11
|
| Rate for Payer: Healthscope Whirlpool |
$8,860.09
|
| Rate for Payer: Mclaren Commercial |
$8,220.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,763.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,393.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,312.04
|
| Rate for Payer: Priority Health Narrow Network |
$6,485.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,038.02
|
|
