|
HC IR Z ABSCESS PERIANAL
|
Facility
|
IP
|
$1,208.35
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.43 |
| Max. Negotiated Rate |
$1,208.35 |
| Rate for Payer: Aetna Commercial |
$1,087.52
|
| Rate for Payer: ASR ASR |
$1,172.10
|
| Rate for Payer: ASR Commercial |
$1,172.10
|
| Rate for Payer: BCBS Trust/PPO |
$984.68
|
| Rate for Payer: BCN Commercial |
$936.83
|
| Rate for Payer: Cash Price |
$966.68
|
| Rate for Payer: Cofinity Commercial |
$1,135.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.68
|
| Rate for Payer: Healthscope Commercial |
$1,208.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.10
|
| Rate for Payer: Mclaren Commercial |
$1,087.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.10
|
| Rate for Payer: Nomi Health Commercial |
$990.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.35
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
OP
|
$1,208.35
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$1,378.21 |
| Rate for Payer: Aetna Commercial |
$1,087.52
|
| Rate for Payer: Aetna Medicare |
$889.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: ASR ASR |
$1,172.10
|
| Rate for Payer: ASR Commercial |
$1,172.10
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCBS Trust/PPO |
$989.52
|
| Rate for Payer: BCN Commercial |
$936.83
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$966.68
|
| Rate for Payer: Cash Price |
$966.68
|
| Rate for Payer: Cofinity Commercial |
$1,135.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$1,208.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$889.17
|
| Rate for Payer: Mclaren Commercial |
$1,087.52
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.10
|
| Rate for Payer: Nomi Health Commercial |
$990.85
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$978.09
|
| Rate for Payer: PHP Medicaid |
$476.60
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,058.76
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health Narrow Network |
$847.05
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,378.21
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP DNSP |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
IP
|
$161.36
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.88 |
| Max. Negotiated Rate |
$161.36 |
| Rate for Payer: Aetna Commercial |
$145.22
|
| Rate for Payer: ASR ASR |
$156.52
|
| Rate for Payer: ASR Commercial |
$156.52
|
| Rate for Payer: BCBS Trust/PPO |
$131.49
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Cofinity Commercial |
$151.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.09
|
| Rate for Payer: Healthscope Commercial |
$161.36
|
| Rate for Payer: Healthscope Whirlpool |
$156.52
|
| Rate for Payer: Mclaren Commercial |
$145.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.16
|
| Rate for Payer: Nomi Health Commercial |
$132.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.00
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
OP
|
$161.36
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$161.36 |
| Rate for Payer: Aetna Commercial |
$145.22
|
| Rate for Payer: Aetna Medicare |
$33.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.42
|
| Rate for Payer: ASR ASR |
$156.52
|
| Rate for Payer: ASR Commercial |
$156.52
|
| Rate for Payer: BCBS Complete |
$19.10
|
| Rate for Payer: BCBS MAPPO |
$33.94
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: BCN Medicare Advantage |
$33.94
|
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Cofinity Commercial |
$151.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.94
|
| Rate for Payer: Healthscope Commercial |
$161.36
|
| Rate for Payer: Healthscope Whirlpool |
$156.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.94
|
| Rate for Payer: Mclaren Commercial |
$145.22
|
| Rate for Payer: Mclaren Medicaid |
$18.19
|
| Rate for Payer: Mclaren Medicare |
$33.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.64
|
| Rate for Payer: Meridian Medicaid |
$19.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.16
|
| Rate for Payer: Nomi Health Commercial |
$132.32
|
| Rate for Payer: PACE Medicare |
$32.24
|
| Rate for Payer: PACE SWMI |
$33.94
|
| Rate for Payer: PHP Commercial |
$37.33
|
| Rate for Payer: PHP Medicaid |
$18.19
|
| Rate for Payer: PHP Medicare Advantage |
$33.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.38
|
| Rate for Payer: Priority Health Medicare |
$33.94
|
| Rate for Payer: Priority Health Narrow Network |
$113.11
|
| Rate for Payer: Railroad Medicare Medicare |
$33.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.94
|
| Rate for Payer: UHC Exchange |
$52.61
|
| Rate for Payer: UHC Medicare Advantage |
$33.94
|
| Rate for Payer: UHCCP DNSP |
$33.94
|
| Rate for Payer: UHCCP Medicaid |
$18.19
|
| Rate for Payer: VA VA |
$33.94
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$55.14 |
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: ASR ASR |
$53.49
|
| Rate for Payer: ASR Commercial |
$53.49
|
| Rate for Payer: BCBS Trust/PPO |
$44.93
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$55.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Mclaren Commercial |
$49.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.52
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$55.14 |
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$53.49
|
| Rate for Payer: ASR Commercial |
$53.49
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$45.15
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$55.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$49.63
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.31
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$38.65
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.63
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$89.46
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$76.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$89.46
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$76.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.43 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: ASR ASR |
$154.35
|
| Rate for Payer: ASR Commercial |
$154.35
|
| Rate for Payer: BCBS Trust/PPO |
$129.67
|
| Rate for Payer: BCN Commercial |
$123.37
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$159.12
|
| Rate for Payer: Healthscope Whirlpool |
$154.35
|
| Rate for Payer: Mclaren Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.25
|
| Rate for Payer: Nomi Health Commercial |
$130.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.03
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: ASR ASR |
$154.35
|
| Rate for Payer: ASR Commercial |
$154.35
|
| Rate for Payer: BCBS Complete |
$63.65
|
| Rate for Payer: BCBS Trust/PPO |
$130.30
|
| Rate for Payer: BCN Commercial |
$123.37
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$159.12
|
| Rate for Payer: Healthscope Whirlpool |
$154.35
|
| Rate for Payer: Mclaren Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.25
|
| Rate for Payer: Nomi Health Commercial |
$130.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.42
|
| Rate for Payer: Priority Health Narrow Network |
$111.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.03
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: ASR ASR |
$2.33
|
| Rate for Payer: ASR Commercial |
$2.33
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$2.40
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.10
|
| Rate for Payer: Priority Health Narrow Network |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.11
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: ASR ASR |
$2.33
|
| Rate for Payer: ASR Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$1.96
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$2.40
|
| Rate for Payer: Healthscope Whirlpool |
$2.33
|
| Rate for Payer: Mclaren Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.11
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: ASR ASR |
$4.33
|
| Rate for Payer: ASR Commercial |
$4.33
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Whirlpool |
$4.33
|
| Rate for Payer: Mclaren Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: ASR ASR |
$4.33
|
| Rate for Payer: ASR Commercial |
$4.33
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Whirlpool |
$4.33
|
| Rate for Payer: Mclaren Commercial |
$4.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.91
|
| Rate for Payer: Priority Health Narrow Network |
$3.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: ASR ASR |
$1.88
|
| Rate for Payer: ASR Commercial |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Healthscope Whirlpool |
$1.88
|
| Rate for Payer: Mclaren Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Nomi Health Commercial |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.71
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: ASR ASR |
$1.88
|
| Rate for Payer: ASR Commercial |
$1.88
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Healthscope Whirlpool |
$1.88
|
| Rate for Payer: Mclaren Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Nomi Health Commercial |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.70
|
| Rate for Payer: Priority Health Narrow Network |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.71
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: ASR ASR |
$1.62
|
| Rate for Payer: ASR Commercial |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Healthscope Whirlpool |
$1.62
|
| Rate for Payer: Mclaren Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.42
|
| Rate for Payer: Nomi Health Commercial |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.47
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: ASR ASR |
$1.62
|
| Rate for Payer: ASR Commercial |
$1.62
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Healthscope Whirlpool |
$1.62
|
| Rate for Payer: Mclaren Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.42
|
| Rate for Payer: Nomi Health Commercial |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.47
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: ASR ASR |
$1.84
|
| Rate for Payer: ASR Commercial |
$1.84
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.56
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Whirlpool |
$1.84
|
| Rate for Payer: Mclaren Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.66
|
| Rate for Payer: Priority Health Narrow Network |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.67
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: ASR ASR |
$1.84
|
| Rate for Payer: ASR Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Whirlpool |
$1.84
|
| Rate for Payer: Mclaren Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.67
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$321.69 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: ASR ASR |
$312.04
|
| Rate for Payer: ASR Commercial |
$312.04
|
| Rate for Payer: BCBS Trust/PPO |
$262.15
|
| Rate for Payer: BCN Commercial |
$249.41
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$302.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Healthscope Commercial |
$321.69
|
| Rate for Payer: Healthscope Whirlpool |
$312.04
|
| Rate for Payer: Mclaren Commercial |
$289.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$263.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.09
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$459.84 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Aetna Medicare |
$296.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: ASR ASR |
$312.04
|
| Rate for Payer: ASR Commercial |
$312.04
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCBS Trust/PPO |
$263.43
|
| Rate for Payer: BCN Commercial |
$249.41
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$302.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$321.69
|
| Rate for Payer: Healthscope Whirlpool |
$312.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$296.67
|
| Rate for Payer: Mclaren Commercial |
$289.52
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$263.79
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$326.34
|
| Rate for Payer: PHP Medicaid |
$159.02
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.86
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health Narrow Network |
$225.50
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Exchange |
$459.84
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP DNSP |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$159.02
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$119.72 |
| Rate for Payer: Aetna Commercial |
$107.75
|
| Rate for Payer: Aetna Medicare |
$59.86
|
| Rate for Payer: ASR ASR |
$116.13
|
| Rate for Payer: ASR Commercial |
$116.13
|
| Rate for Payer: BCBS Complete |
$47.89
|
| Rate for Payer: BCBS Trust/PPO |
$98.04
|
| Rate for Payer: BCN Commercial |
$92.82
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$112.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Healthscope Commercial |
$119.72
|
| Rate for Payer: Healthscope Whirlpool |
$116.13
|
| Rate for Payer: Mclaren Commercial |
$107.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: Nomi Health Commercial |
$98.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.90
|
| Rate for Payer: Priority Health Narrow Network |
$83.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.35
|
|
