|
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
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Commercial |
$235.93
|
| Rate for Payer: ASR ASR |
$205.64
|
| Rate for Payer: ASR ASR |
$254.28
|
| Rate for Payer: BCBS Trust/PPO |
$164.36
|
| Rate for Payer: BCBS Trust/PPO |
$203.24
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: BCN Commercial |
$203.24
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$246.41
|
| Rate for Payer: Cofinity Commercial |
$199.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.71
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Healthscope Commercial |
$262.14
|
| Rate for Payer: Healthscope Whirlpool |
$205.64
|
| Rate for Payer: Healthscope Whirlpool |
$254.28
|
| Rate for Payer: Mclaren Commercial |
$235.93
|
| Rate for Payer: Mclaren Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.56
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Commercial |
$235.93
|
| Rate for Payer: ASR ASR |
$254.28
|
| Rate for Payer: ASR ASR |
$205.64
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Complete |
$104.86
|
| Rate for Payer: BCBS Trust/PPO |
$203.24
|
| Rate for Payer: BCBS Trust/PPO |
$164.36
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: BCN Commercial |
$203.24
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cofinity Commercial |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$246.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Healthscope Commercial |
$262.14
|
| Rate for Payer: Healthscope Whirlpool |
$205.64
|
| Rate for Payer: Healthscope Whirlpool |
$254.28
|
| Rate for Payer: Mclaren Commercial |
$235.93
|
| Rate for Payer: Mclaren Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.55
|
| Rate for Payer: Priority Health Narrow Network |
$150.52
|
| Rate for Payer: Priority Health Narrow Network |
$186.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.68
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$542.64
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$379.85 |
| Max. Negotiated Rate |
$542.64 |
| Rate for Payer: Aetna Commercial |
$488.38
|
| Rate for Payer: Aetna Commercial |
$474.30
|
| Rate for Payer: ASR ASR |
$526.36
|
| Rate for Payer: ASR ASR |
$511.19
|
| Rate for Payer: BCBS Trust/PPO |
$408.58
|
| Rate for Payer: BCBS Trust/PPO |
$420.71
|
| Rate for Payer: BCN Commercial |
$420.71
|
| Rate for Payer: BCN Commercial |
$408.58
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$495.38
|
| Rate for Payer: Cofinity Commercial |
$510.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Healthscope Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$527.00
|
| Rate for Payer: Healthscope Whirlpool |
$526.36
|
| Rate for Payer: Healthscope Whirlpool |
$511.19
|
| Rate for Payer: Mclaren Commercial |
$488.38
|
| Rate for Payer: Mclaren Commercial |
$474.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.76
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$542.64
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$542.64 |
| Rate for Payer: Aetna Commercial |
$488.38
|
| Rate for Payer: Aetna Commercial |
$474.30
|
| Rate for Payer: Aetna Medicare |
$328.43
|
| Rate for Payer: Aetna Medicare |
$328.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: ASR ASR |
$511.19
|
| Rate for Payer: ASR ASR |
$526.36
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS Trust/PPO |
$408.58
|
| Rate for Payer: BCBS Trust/PPO |
$420.71
|
| Rate for Payer: BCN Commercial |
$408.58
|
| Rate for Payer: BCN Commercial |
$420.71
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$510.08
|
| Rate for Payer: Cofinity Commercial |
$495.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Healthscope Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$527.00
|
| Rate for Payer: Healthscope Whirlpool |
$511.19
|
| Rate for Payer: Healthscope Whirlpool |
$526.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$328.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$328.43
|
| Rate for Payer: Mclaren Commercial |
$488.38
|
| Rate for Payer: Mclaren Commercial |
$474.30
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.24
|
| Rate for Payer: PACE Medicare |
$312.01
|
| Rate for Payer: PACE Medicare |
$312.01
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PHP Commercial |
$361.27
|
| Rate for Payer: PHP Commercial |
$361.27
|
| Rate for Payer: PHP Medicaid |
$179.65
|
| Rate for Payer: PHP Medicaid |
$179.65
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$493.80
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Narrow Network |
$385.27
|
| Rate for Payer: Priority Health Narrow Network |
$374.17
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.76
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: VA VA |
$328.43
|
| Rate for Payer: VA VA |
$328.43
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.88
|
| Rate for Payer: Priority Health Narrow Network |
$48.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: ASR ASR |
$77.60
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.02
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$75.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$80.00
|
| Rate for Payer: Healthscope Whirlpool |
$77.60
|
| Rate for Payer: Mclaren Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.80
|
| Rate for Payer: Priority Health Narrow Network |
$56.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.40
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: ASR ASR |
$77.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.02
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$75.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$80.00
|
| Rate for Payer: Healthscope Whirlpool |
$77.60
|
| Rate for Payer: Mclaren Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.40
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: ASR ASR |
$209.52
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$167.46
|
| Rate for Payer: BCN Commercial |
$167.46
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$203.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.80
|
| Rate for Payer: Healthscope Commercial |
$216.00
|
| Rate for Payer: Healthscope Whirlpool |
$209.52
|
| Rate for Payer: Mclaren Commercial |
$194.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.56
|
| Rate for Payer: Priority Health Narrow Network |
$153.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.08
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: ASR ASR |
$209.52
|
| Rate for Payer: BCBS Trust/PPO |
$167.46
|
| Rate for Payer: BCN Commercial |
$167.46
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$203.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.80
|
| Rate for Payer: Healthscope Commercial |
$216.00
|
| Rate for Payer: Healthscope Whirlpool |
$209.52
|
| Rate for Payer: Mclaren Commercial |
$194.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.08
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$238.62
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$190.72
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$231.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$246.00
|
| Rate for Payer: Healthscope Whirlpool |
$238.62
|
| Rate for Payer: Mclaren Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.86
|
| Rate for Payer: Priority Health Narrow Network |
$174.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.48
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$238.62
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$190.72
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$231.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$246.00
|
| Rate for Payer: Healthscope Whirlpool |
$238.62
|
| Rate for Payer: Mclaren Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.48
|
|
|
HC POST-OP
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$15.95
|
| Rate for Payer: ASR ASR |
$17.19
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.19
|
| Rate for Payer: Mclaren Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.13
|
| Rate for Payer: Priority Health Narrow Network |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.59
|
|
|
HC POST-OP
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$15.95
|
| Rate for Payer: ASR ASR |
$17.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.19
|
| Rate for Payer: Mclaren Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.59
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.05 |
| Max. Negotiated Rate |
$378.64 |
| Rate for Payer: Aetna Commercial |
$340.78
|
| Rate for Payer: ASR ASR |
$367.28
|
| Rate for Payer: BCBS Trust/PPO |
$293.56
|
| Rate for Payer: BCN Commercial |
$293.56
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$355.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Healthscope Commercial |
$378.64
|
| Rate for Payer: Healthscope Whirlpool |
$367.28
|
| Rate for Payer: Mclaren Commercial |
$340.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.20
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$378.64 |
| Rate for Payer: Aetna Commercial |
$340.78
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$367.28
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$293.56
|
| Rate for Payer: BCN Commercial |
$293.56
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$355.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$378.64
|
| Rate for Payer: Healthscope Whirlpool |
$367.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$340.78
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.56
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$268.83
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.20
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| 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 |
$19.79
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.76
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| 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 |
$17.34
|
| 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 |
$14.28
|
| 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 |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.90
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: ASR ASR |
$20.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$20.80
|
| Rate for Payer: Healthscope Whirlpool |
$20.18
|
| Rate for Payer: Mclaren Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.30
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: ASR ASR |
$20.18
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$20.80
|
| Rate for Payer: Healthscope Whirlpool |
$20.18
|
| Rate for Payer: Mclaren Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.30
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$36.20
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$36.20 |
| Rate for Payer: Aetna Commercial |
$32.58
|
| Rate for Payer: ASR ASR |
$35.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.07
|
| Rate for Payer: BCN Commercial |
$28.07
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.96
|
| Rate for Payer: Healthscope Commercial |
$36.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.11
|
| Rate for Payer: Mclaren Commercial |
$32.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.86
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$36.20
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$36.20 |
| Rate for Payer: Aetna Commercial |
$32.58
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.91
|
| Rate for Payer: ASR ASR |
$35.11
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$28.07
|
| Rate for Payer: BCN Commercial |
$28.07
|
| Rate for Payer: BCN Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$36.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.73
|
| Rate for Payer: Mclaren Commercial |
$32.58
|
| Rate for Payer: Mclaren Medicaid |
$2.59
|
| Rate for Payer: Mclaren Medicare |
$4.73
|
| Rate for Payer: Meridian Medicaid |
$2.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.77
|
| Rate for Payer: PACE Medicare |
$4.49
|
| Rate for Payer: PACE SWMI |
$4.73
|
| Rate for Payer: PHP Commercial |
$5.20
|
| Rate for Payer: PHP Medicaid |
$2.59
|
| Rate for Payer: PHP Medicare Advantage |
$4.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.76
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$23.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.87
|
| Rate for Payer: VA VA |
$4.73
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: ASR ASR |
$9.70
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Healthscope Whirlpool |
$9.70
|
| Rate for Payer: Mclaren Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.10
|
| Rate for Payer: Priority Health Narrow Network |
$7.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.80
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: ASR ASR |
$9.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Healthscope Whirlpool |
$9.70
|
| Rate for Payer: Mclaren Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.80
|
|
