|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.35 |
| Max. Negotiated Rate |
$485.16 |
| Rate for Payer: Aetna Commercial |
$436.64
|
| Rate for Payer: ASR ASR |
$470.61
|
| Rate for Payer: ASR Commercial |
$470.61
|
| Rate for Payer: BCBS Trust/PPO |
$395.36
|
| Rate for Payer: BCN Commercial |
$376.14
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$456.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$485.16
|
| Rate for Payer: Healthscope Whirlpool |
$470.61
|
| Rate for Payer: Mclaren Commercial |
$436.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Nomi Health Commercial |
$397.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.94
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$155.91 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$13.57
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$13.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$26.52
|
| Rate for Payer: PHP Medicaid |
$12.92
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.91
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$124.73
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP DNSP |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$12.92
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,436.63
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,533.81 |
| Max. Negotiated Rate |
$5,436.63 |
| Rate for Payer: Aetna Commercial |
$4,892.97
|
| Rate for Payer: ASR ASR |
$5,273.53
|
| Rate for Payer: ASR Commercial |
$5,273.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,430.31
|
| Rate for Payer: BCN Commercial |
$4,215.02
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cofinity Commercial |
$5,110.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,349.30
|
| Rate for Payer: Healthscope Commercial |
$5,436.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,273.53
|
| Rate for Payer: Mclaren Commercial |
$4,892.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,621.14
|
| Rate for Payer: Nomi Health Commercial |
$4,458.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,533.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,784.23
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,436.63
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$743.98 |
| Max. Negotiated Rate |
$5,436.63 |
| Rate for Payer: Aetna Commercial |
$4,892.97
|
| Rate for Payer: Aetna Medicare |
$1,388.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,735.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,735.02
|
| Rate for Payer: ASR ASR |
$5,273.53
|
| Rate for Payer: ASR Commercial |
$5,273.53
|
| Rate for Payer: BCBS Complete |
$781.18
|
| Rate for Payer: BCBS MAPPO |
$1,388.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,452.06
|
| Rate for Payer: BCN Commercial |
$4,215.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,388.02
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cofinity Commercial |
$5,110.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,349.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,388.02
|
| Rate for Payer: Healthscope Commercial |
$5,436.63
|
| Rate for Payer: Healthscope Whirlpool |
$5,273.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,388.02
|
| Rate for Payer: Mclaren Commercial |
$4,892.97
|
| Rate for Payer: Mclaren Medicaid |
$743.98
|
| Rate for Payer: Mclaren Medicare |
$1,388.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.42
|
| Rate for Payer: Meridian Medicaid |
$781.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,596.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,621.14
|
| Rate for Payer: Nomi Health Commercial |
$4,458.04
|
| Rate for Payer: PACE Medicare |
$1,318.62
|
| Rate for Payer: PACE SWMI |
$1,388.02
|
| Rate for Payer: PHP Commercial |
$1,526.82
|
| Rate for Payer: PHP Medicaid |
$743.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,388.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$743.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,533.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,517.36
|
| Rate for Payer: Priority Health Medicare |
$1,388.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,013.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,388.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,784.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,388.02
|
| Rate for Payer: UHC Exchange |
$2,151.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,388.02
|
| Rate for Payer: UHCCP DNSP |
$1,388.02
|
| Rate for Payer: UHCCP Medicaid |
$743.98
|
| Rate for Payer: VA VA |
$1,388.02
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,297.89
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$843.63 |
| Max. Negotiated Rate |
$1,297.89 |
| Rate for Payer: Aetna Commercial |
$1,168.10
|
| Rate for Payer: ASR ASR |
$1,258.95
|
| Rate for Payer: ASR Commercial |
$1,258.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,057.65
|
| Rate for Payer: BCN Commercial |
$1,006.25
|
| Rate for Payer: Cash Price |
$1,038.31
|
| Rate for Payer: Cofinity Commercial |
$1,220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.31
|
| Rate for Payer: Healthscope Commercial |
$1,297.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.95
|
| Rate for Payer: Mclaren Commercial |
$1,168.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.21
|
| Rate for Payer: Nomi Health Commercial |
$1,064.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,142.14
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,297.89
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$519.16 |
| Max. Negotiated Rate |
$1,297.89 |
| Rate for Payer: Aetna Commercial |
$1,168.10
|
| Rate for Payer: Aetna Medicare |
$648.94
|
| Rate for Payer: ASR ASR |
$1,258.95
|
| Rate for Payer: ASR Commercial |
$1,258.95
|
| Rate for Payer: BCBS Complete |
$519.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.84
|
| Rate for Payer: BCN Commercial |
$1,006.25
|
| Rate for Payer: Cash Price |
$1,038.31
|
| Rate for Payer: Cofinity Commercial |
$1,220.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.31
|
| Rate for Payer: Healthscope Commercial |
$1,297.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.95
|
| Rate for Payer: Mclaren Commercial |
$1,168.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.21
|
| Rate for Payer: Nomi Health Commercial |
$1,064.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.21
|
| Rate for Payer: Priority Health Narrow Network |
$909.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,142.14
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$187.07
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$187.07 |
| Rate for Payer: Aetna Commercial |
$168.36
|
| Rate for Payer: ASR ASR |
$181.46
|
| Rate for Payer: ASR Commercial |
$181.46
|
| Rate for Payer: BCBS Trust/PPO |
$152.44
|
| Rate for Payer: BCN Commercial |
$145.04
|
| Rate for Payer: Cash Price |
$149.66
|
| Rate for Payer: Cofinity Commercial |
$175.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.66
|
| Rate for Payer: Healthscope Commercial |
$187.07
|
| Rate for Payer: Healthscope Whirlpool |
$181.46
|
| Rate for Payer: Mclaren Commercial |
$168.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.01
|
| Rate for Payer: Nomi Health Commercial |
$153.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.62
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$187.07
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$187.07 |
| Rate for Payer: Aetna Commercial |
$168.36
|
| Rate for Payer: Aetna Medicare |
$93.54
|
| Rate for Payer: ASR ASR |
$181.46
|
| Rate for Payer: ASR Commercial |
$181.46
|
| Rate for Payer: BCBS Complete |
$74.83
|
| Rate for Payer: BCBS Trust/PPO |
$153.19
|
| Rate for Payer: BCN Commercial |
$145.04
|
| Rate for Payer: Cash Price |
$149.66
|
| Rate for Payer: Cash Price |
$149.66
|
| Rate for Payer: Cofinity Commercial |
$175.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.66
|
| Rate for Payer: Healthscope Commercial |
$187.07
|
| Rate for Payer: Healthscope Whirlpool |
$181.46
|
| Rate for Payer: Mclaren Commercial |
$168.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.01
|
| Rate for Payer: Nomi Health Commercial |
$153.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.62
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$357.38
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.95 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna Medicare |
$178.69
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Complete |
$142.95
|
| Rate for Payer: BCBS Trust/PPO |
$292.66
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.14
|
| Rate for Payer: Priority Health Narrow Network |
$250.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$357.38
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.23
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.36
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: ASR ASR |
$14.90
|
| Rate for Payer: ASR Commercial |
$14.90
|
| Rate for Payer: BCBS Complete |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Commercial |
$11.91
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$14.90
|
| Rate for Payer: Mclaren Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.46
|
| Rate for Payer: Priority Health Narrow Network |
$10.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.52
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.36
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: ASR ASR |
$14.90
|
| Rate for Payer: ASR Commercial |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.52
|
| Rate for Payer: BCN Commercial |
$11.91
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$14.90
|
| Rate for Payer: Mclaren Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.52
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Medicare |
$13.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.10
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$88.04
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.68
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$7.33
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: Meridian Medicaid |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PACE Medicare |
$13.00
|
| Rate for Payer: PACE SWMI |
$13.68
|
| Rate for Payer: PHP Commercial |
$15.05
|
| Rate for Payer: PHP Medicaid |
$7.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.41
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$39.53
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.68
|
| Rate for Payer: UHC Exchange |
$21.20
|
| Rate for Payer: UHC Medicare Advantage |
$13.68
|
| Rate for Payer: UHCCP DNSP |
$13.68
|
| Rate for Payer: UHCCP Medicaid |
$7.33
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$86.48
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$86.90
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.99
|
| Rate for Payer: Priority Health Narrow Network |
$44.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.04
|
| Rate for Payer: Priority Health Narrow Network |
$679.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$789.64
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$1,062.63 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$685.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$856.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$856.96
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Complete |
$385.84
|
| Rate for Payer: BCBS MAPPO |
$685.57
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: BCN Medicare Advantage |
$685.57
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.57
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$685.57
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$367.47
|
| Rate for Payer: Mclaren Medicare |
$685.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.85
|
| Rate for Payer: Meridian Medicaid |
$385.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$788.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PACE Medicare |
$651.29
|
| Rate for Payer: PACE SWMI |
$685.57
|
| Rate for Payer: PHP Commercial |
$754.13
|
| Rate for Payer: PHP Medicaid |
$367.47
|
| Rate for Payer: PHP Medicare Advantage |
$685.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.04
|
| Rate for Payer: Priority Health Medicare |
$685.57
|
| Rate for Payer: Priority Health Narrow Network |
$679.27
|
| Rate for Payer: Railroad Medicare Medicare |
$685.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.57
|
| Rate for Payer: UHC Exchange |
$1,062.63
|
| Rate for Payer: UHC Medicare Advantage |
$685.57
|
| Rate for Payer: UHCCP DNSP |
$685.57
|
| Rate for Payer: UHCCP Medicaid |
$367.47
|
| Rate for Payer: VA VA |
$685.57
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$789.64
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
OP
|
$138.64
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$124.78
|
| Rate for Payer: Aetna Medicare |
$199.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: ASR ASR |
$134.48
|
| Rate for Payer: ASR Commercial |
$134.48
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$113.53
|
| Rate for Payer: BCN Commercial |
$107.49
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$110.91
|
| Rate for Payer: Cash Price |
$110.91
|
| Rate for Payer: Cofinity Commercial |
$130.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Healthscope Whirlpool |
$134.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.28
|
| Rate for Payer: Mclaren Commercial |
$124.78
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.84
|
| Rate for Payer: Nomi Health Commercial |
$113.68
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$219.21
|
| Rate for Payer: PHP Medicaid |
$106.81
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.29
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$92.23
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP DNSP |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
IP
|
$138.64
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna Commercial |
$124.78
|
| Rate for Payer: ASR ASR |
$134.48
|
| Rate for Payer: ASR Commercial |
$134.48
|
| Rate for Payer: BCBS Trust/PPO |
$112.98
|
| Rate for Payer: BCN Commercial |
$107.49
|
| Rate for Payer: Cash Price |
$110.91
|
| Rate for Payer: Cofinity Commercial |
$130.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.91
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Healthscope Whirlpool |
$134.48
|
| Rate for Payer: Mclaren Commercial |
$124.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.84
|
| Rate for Payer: Nomi Health Commercial |
$113.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.00
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.16
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
