|
HC POC IONIZED CALCIUM
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.78 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: ASR ASR |
$102.24
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$105.40
|
| Rate for Payer: Healthscope Whirlpool |
$102.24
|
| Rate for Payer: Mclaren Commercial |
$94.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.75
|
|
|
HC POC IONIZED CALCIUM
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| 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 |
$102.24
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$105.40
|
| Rate for Payer: Healthscope Whirlpool |
$102.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.68
|
| Rate for Payer: Mclaren Commercial |
$94.86
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| 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 |
$7.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.18
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$36.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.75
|
| Rate for Payer: UHC Medicare Advantage |
$14.09
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC POC LACTIC ACID
|
Facility
|
IP
|
$53.59
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100697
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$48.23
|
| Rate for Payer: ASR ASR |
$51.98
|
| Rate for Payer: BCBS Trust/PPO |
$41.55
|
| Rate for Payer: BCN Commercial |
$41.55
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.87
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Healthscope Whirlpool |
$51.98
|
| Rate for Payer: Mclaren Commercial |
$48.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.16
|
|
|
HC POC LACTIC ACID
|
Facility
|
OP
|
$53.59
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100697
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$64.65 |
| Rate for Payer: Aetna Commercial |
$48.23
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: ASR ASR |
$51.98
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$41.55
|
| Rate for Payer: BCN Commercial |
$41.55
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$50.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Healthscope Whirlpool |
$51.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.57
|
| Rate for Payer: Mclaren Commercial |
$48.23
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.55
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicaid |
$6.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.65
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow Network |
$51.72
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC POC POTASSIUM
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Aetna Commercial |
$28.44
|
| Rate for Payer: ASR ASR |
$30.65
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$29.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.28
|
| Rate for Payer: Healthscope Commercial |
$31.60
|
| Rate for Payer: Healthscope Whirlpool |
$30.65
|
| Rate for Payer: Mclaren Commercial |
$28.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.81
|
|
|
HC POC POTASSIUM
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: Aetna Commercial |
$28.44
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: ASR ASR |
$30.65
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$29.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$31.60
|
| Rate for Payer: Healthscope Whirlpool |
$30.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.76
|
| Rate for Payer: Mclaren Commercial |
$28.44
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.86
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.24
|
| Rate for Payer: PHP Medicaid |
$2.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.93
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow Network |
$13.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.81
|
| Rate for Payer: UHC Medicare Advantage |
$4.90
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POC SODIUM
|
Facility
|
IP
|
$32.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$32.23 |
| Rate for Payer: Aetna Commercial |
$29.01
|
| Rate for Payer: ASR ASR |
$31.26
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCN Commercial |
$24.99
|
| Rate for Payer: Cash Price |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$30.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.78
|
| Rate for Payer: Healthscope Commercial |
$32.23
|
| Rate for Payer: Healthscope Whirlpool |
$31.26
|
| Rate for Payer: Mclaren Commercial |
$29.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.36
|
|
|
HC POC SODIUM
|
Facility
|
OP
|
$32.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$32.23 |
| Rate for Payer: Aetna Commercial |
$29.01
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: ASR ASR |
$31.26
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCN Commercial |
$24.99
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$25.78
|
| Rate for Payer: Cash Price |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$30.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$32.23
|
| Rate for Payer: Healthscope Whirlpool |
$31.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.81
|
| Rate for Payer: Mclaren Commercial |
$29.01
|
| Rate for Payer: Mclaren Medicaid |
$2.63
|
| Rate for Payer: Mclaren Medicare |
$4.81
|
| Rate for Payer: Meridian Medicaid |
$2.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.40
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$5.29
|
| Rate for Payer: PHP Medicaid |
$2.63
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health Narrow Network |
$12.73
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: VA VA |
$4.81
|
|
|
HC POC TOTAL CO2
|
Facility
|
OP
|
$17.82
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$23.09 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.82
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Whirlpool |
$17.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.88
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: Mclaren Medicaid |
$2.67
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Medicaid |
$2.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$5.37
|
| Rate for Payer: PHP Medicaid |
$2.67
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.09
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$18.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC POC TOTAL CO2
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: ASR ASR |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.82
|
| Rate for Payer: BCN Commercial |
$13.82
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Healthscope Whirlpool |
$17.29
|
| Rate for Payer: Mclaren Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.68
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: ASR ASR |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.99
|
| Rate for Payer: BCN Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.37
|
| Rate for Payer: Healthscope Commercial |
$15.46
|
| Rate for Payer: Healthscope Whirlpool |
$15.00
|
| Rate for Payer: Mclaren Commercial |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.60
|
|
|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: ASR ASR |
$15.00
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$11.99
|
| Rate for Payer: BCN Commercial |
$11.99
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$15.46
|
| Rate for Payer: Healthscope Whirlpool |
$15.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.95
|
| Rate for Payer: Mclaren Commercial |
$13.91
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.14
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicaid |
$2.16
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.95
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$14.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.07
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC POLARCATH
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,856.39 |
| Max. Negotiated Rate |
$6,937.70 |
| Rate for Payer: Aetna Commercial |
$6,243.93
|
| Rate for Payer: ASR ASR |
$6,729.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.80
|
| Rate for Payer: BCN Commercial |
$5,378.80
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$6,521.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,937.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,729.57
|
| Rate for Payer: Mclaren Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,856.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,105.18
|
|
|
HC POLARCATH
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$6,937.70 |
| Rate for Payer: Aetna Commercial |
$6,243.93
|
| Rate for Payer: ASR ASR |
$6,729.57
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.80
|
| Rate for Payer: BCN Commercial |
$5,378.80
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$6,521.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,937.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,729.57
|
| Rate for Payer: Mclaren Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,856.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,313.31
|
| Rate for Payer: Priority Health Narrow Network |
$4,925.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,105.18
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$268.79
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$268.79 |
| Rate for Payer: Aetna Commercial |
$241.91
|
| Rate for Payer: ASR ASR |
$260.73
|
| Rate for Payer: BCBS Complete |
$107.52
|
| Rate for Payer: BCBS Trust/PPO |
$208.39
|
| Rate for Payer: BCN Commercial |
$208.39
|
| Rate for Payer: Cash Price |
$215.03
|
| Rate for Payer: Cofinity Commercial |
$252.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.03
|
| Rate for Payer: Healthscope Commercial |
$268.79
|
| Rate for Payer: Healthscope Whirlpool |
$260.73
|
| Rate for Payer: Mclaren Commercial |
$241.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.60
|
| Rate for Payer: Priority Health Narrow Network |
$190.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.54
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$268.79
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.15 |
| Max. Negotiated Rate |
$268.79 |
| Rate for Payer: Aetna Commercial |
$241.91
|
| Rate for Payer: ASR ASR |
$260.73
|
| Rate for Payer: BCBS Trust/PPO |
$208.39
|
| Rate for Payer: BCN Commercial |
$208.39
|
| Rate for Payer: Cash Price |
$215.03
|
| Rate for Payer: Cofinity Commercial |
$252.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.03
|
| Rate for Payer: Healthscope Commercial |
$268.79
|
| Rate for Payer: Healthscope Whirlpool |
$260.73
|
| Rate for Payer: Mclaren Commercial |
$241.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.54
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$42.64
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$42.64 |
| Rate for Payer: Aetna Commercial |
$38.38
|
| Rate for Payer: ASR ASR |
$41.36
|
| Rate for Payer: BCBS Trust/PPO |
$33.06
|
| Rate for Payer: BCN Commercial |
$33.06
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Cofinity Commercial |
$40.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.11
|
| Rate for Payer: Healthscope Commercial |
$42.64
|
| Rate for Payer: Healthscope Whirlpool |
$41.36
|
| Rate for Payer: Mclaren Commercial |
$38.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.52
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$42.64
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$42.64 |
| Rate for Payer: Aetna Commercial |
$38.38
|
| Rate for Payer: ASR ASR |
$41.36
|
| Rate for Payer: BCBS Complete |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$33.06
|
| Rate for Payer: BCN Commercial |
$33.06
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Cofinity Commercial |
$40.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.11
|
| Rate for Payer: Healthscope Commercial |
$42.64
|
| Rate for Payer: Healthscope Whirlpool |
$41.36
|
| Rate for Payer: Mclaren Commercial |
$38.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.80
|
| Rate for Payer: Priority Health Narrow Network |
$30.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.52
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$482.14
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.86 |
| Max. Negotiated Rate |
$482.14 |
| Rate for Payer: Aetna Commercial |
$433.93
|
| Rate for Payer: ASR ASR |
$467.68
|
| Rate for Payer: BCBS Complete |
$192.86
|
| Rate for Payer: BCBS Trust/PPO |
$373.80
|
| Rate for Payer: BCN Commercial |
$373.80
|
| Rate for Payer: Cash Price |
$385.71
|
| Rate for Payer: Cofinity Commercial |
$453.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.71
|
| Rate for Payer: Healthscope Commercial |
$482.14
|
| Rate for Payer: Healthscope Whirlpool |
$467.68
|
| Rate for Payer: Mclaren Commercial |
$433.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.75
|
| Rate for Payer: Priority Health Narrow Network |
$342.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.28
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$482.14
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$482.14 |
| Rate for Payer: Aetna Commercial |
$433.93
|
| Rate for Payer: ASR ASR |
$467.68
|
| Rate for Payer: BCBS Trust/PPO |
$373.80
|
| Rate for Payer: BCN Commercial |
$373.80
|
| Rate for Payer: Cash Price |
$385.71
|
| Rate for Payer: Cofinity Commercial |
$453.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.71
|
| Rate for Payer: Healthscope Commercial |
$482.14
|
| Rate for Payer: Healthscope Whirlpool |
$467.68
|
| Rate for Payer: Mclaren Commercial |
$433.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.28
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$179.15
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Aetna Commercial |
$161.24
|
| Rate for Payer: ASR ASR |
$173.78
|
| Rate for Payer: BCBS Trust/PPO |
$138.89
|
| Rate for Payer: BCN Commercial |
$138.89
|
| Rate for Payer: Cash Price |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$168.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.32
|
| Rate for Payer: Healthscope Commercial |
$179.15
|
| Rate for Payer: Healthscope Whirlpool |
$173.78
|
| Rate for Payer: Mclaren Commercial |
$161.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.65
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$179.15
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Aetna Commercial |
$161.24
|
| Rate for Payer: ASR ASR |
$173.78
|
| Rate for Payer: BCBS Complete |
$71.66
|
| Rate for Payer: BCBS Trust/PPO |
$138.89
|
| Rate for Payer: BCN Commercial |
$138.89
|
| Rate for Payer: Cash Price |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$168.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.32
|
| Rate for Payer: Healthscope Commercial |
$179.15
|
| Rate for Payer: Healthscope Whirlpool |
$173.78
|
| Rate for Payer: Mclaren Commercial |
$161.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.03
|
| Rate for Payer: Priority Health Narrow Network |
$127.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.65
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$181.63 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Complete |
$8.45
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.71
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Mclaren Medicaid |
$8.05
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Medicaid |
$8.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Medicaid |
$8.05
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.63
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow Network |
$145.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
| Rate for Payer: UHC Medicare Advantage |
$15.15
|
| Rate for Payer: VA VA |
$14.71
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$105.69 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: ASR ASR |
$30.07
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$31.00
|
| Rate for Payer: Healthscope Whirlpool |
$30.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.44
|
| Rate for Payer: Mclaren Commercial |
$27.90
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: PHP Medicaid |
$4.62
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.69
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Narrow Network |
$84.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.69
|
| Rate for Payer: VA VA |
$8.44
|
|
