|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: ASR ASR |
$213.71
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS Trust/PPO |
$170.81
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$207.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Healthscope Whirlpool |
$213.71
|
| Rate for Payer: Mclaren Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.49
|
| Rate for Payer: Priority Health Narrow Network |
$156.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.88
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: ASR ASR |
$213.71
|
| Rate for Payer: BCBS Trust/PPO |
$170.81
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$207.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Healthscope Whirlpool |
$213.71
|
| Rate for Payer: Mclaren Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.88
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: ASR ASR |
$213.71
|
| Rate for Payer: BCBS Trust/PPO |
$170.81
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$207.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Healthscope Whirlpool |
$213.71
|
| Rate for Payer: Mclaren Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.88
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: ASR ASR |
$213.71
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS Trust/PPO |
$170.81
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$207.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Healthscope Whirlpool |
$213.71
|
| Rate for Payer: Mclaren Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.49
|
| Rate for Payer: Priority Health Narrow Network |
$156.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.88
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$152.57
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$152.57 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: ASR ASR |
$147.99
|
| Rate for Payer: BCBS Trust/PPO |
$118.29
|
| Rate for Payer: BCN Commercial |
$118.29
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cofinity Commercial |
$143.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.06
|
| Rate for Payer: Healthscope Commercial |
$152.57
|
| Rate for Payer: Healthscope Whirlpool |
$147.99
|
| Rate for Payer: Mclaren Commercial |
$137.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.26
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$152.57
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$152.57 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: ASR ASR |
$147.99
|
| Rate for Payer: BCBS Complete |
$61.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.29
|
| Rate for Payer: BCN Commercial |
$118.29
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cofinity Commercial |
$143.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.06
|
| Rate for Payer: Healthscope Commercial |
$152.57
|
| Rate for Payer: Healthscope Whirlpool |
$147.99
|
| Rate for Payer: Mclaren Commercial |
$137.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.84
|
| Rate for Payer: Priority Health Narrow Network |
$108.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.26
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$174.42
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$156.98
|
| Rate for Payer: ASR ASR |
$169.19
|
| Rate for Payer: BCBS Trust/PPO |
$135.23
|
| Rate for Payer: BCN Commercial |
$135.23
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cofinity Commercial |
$163.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.54
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Healthscope Whirlpool |
$169.19
|
| Rate for Payer: Mclaren Commercial |
$156.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.49
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$174.42
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.77 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$156.98
|
| Rate for Payer: ASR ASR |
$169.19
|
| Rate for Payer: BCBS Complete |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$135.23
|
| Rate for Payer: BCN Commercial |
$135.23
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cofinity Commercial |
$163.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.54
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Healthscope Whirlpool |
$169.19
|
| Rate for Payer: Mclaren Commercial |
$156.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.72
|
| Rate for Payer: Priority Health Narrow Network |
$123.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.49
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$162.91
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$162.91 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$158.02
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$126.30
|
| Rate for Payer: BCN Commercial |
$126.30
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$153.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$162.91
|
| Rate for Payer: Healthscope Whirlpool |
$158.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$146.62
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.47
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.25
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$115.67
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.36
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$162.91
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$114.04 |
| Max. Negotiated Rate |
$162.91 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: ASR ASR |
$158.02
|
| Rate for Payer: BCBS Trust/PPO |
$126.30
|
| Rate for Payer: BCN Commercial |
$126.30
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$153.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.33
|
| Rate for Payer: Healthscope Commercial |
$162.91
|
| Rate for Payer: Healthscope Whirlpool |
$158.02
|
| Rate for Payer: Mclaren Commercial |
$146.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.36
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$323.05
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$226.14 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$290.74
|
| Rate for Payer: ASR ASR |
$313.36
|
| Rate for Payer: BCBS Trust/PPO |
$250.46
|
| Rate for Payer: BCN Commercial |
$250.46
|
| Rate for Payer: Cash Price |
$258.44
|
| Rate for Payer: Cofinity Commercial |
$303.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.44
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Healthscope Whirlpool |
$313.36
|
| Rate for Payer: Mclaren Commercial |
$290.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.28
|
|
|
HC PV JAK2V617F
|
Facility
|
OP
|
$323.05
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$290.74
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$313.36
|
| Rate for Payer: BCBS Complete |
$52.65
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$250.46
|
| Rate for Payer: BCN Commercial |
$250.46
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$258.44
|
| Rate for Payer: Cash Price |
$258.44
|
| Rate for Payer: Cofinity Commercial |
$303.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Healthscope Whirlpool |
$313.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$290.74
|
| Rate for Payer: Mclaren Medicaid |
$50.14
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Medicaid |
$52.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.59
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$50.14
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.88
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$44.70
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.28
|
| Rate for Payer: UHC Medicare Advantage |
$94.41
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$97.49 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: ASR ASR |
$90.21
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$72.10
|
| Rate for Payer: BCN Commercial |
$72.10
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$87.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$93.00
|
| Rate for Payer: Healthscope Whirlpool |
$90.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.44
|
| Rate for Payer: Mclaren Commercial |
$83.70
|
| Rate for Payer: Mclaren Medicaid |
$5.16
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Medicaid |
$5.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$10.38
|
| Rate for Payer: PHP Medicaid |
$5.16
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.49
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.84
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: ASR ASR |
$90.21
|
| Rate for Payer: BCBS Trust/PPO |
$72.10
|
| Rate for Payer: BCN Commercial |
$72.10
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$87.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$93.00
|
| Rate for Payer: Healthscope Whirlpool |
$90.21
|
| Rate for Payer: Mclaren Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.84
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$115.96 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.10
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.48
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.92
|
| Rate for Payer: Mclaren Medicare |
$14.48
|
| Rate for Payer: Meridian Medicaid |
$8.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$13.76
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Medicaid |
$7.92
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.96
|
| Rate for Payer: Priority Health Medicare |
$14.48
|
| Rate for Payer: Priority Health Narrow Network |
$92.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$14.91
|
| Rate for Payer: VA VA |
$14.48
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$334.42
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$334.42 |
| Rate for Payer: Aetna Commercial |
$300.98
|
| Rate for Payer: ASR ASR |
$324.39
|
| Rate for Payer: BCBS Trust/PPO |
$259.28
|
| Rate for Payer: BCN Commercial |
$259.28
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$314.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.54
|
| Rate for Payer: Healthscope Commercial |
$334.42
|
| Rate for Payer: Healthscope Whirlpool |
$324.39
|
| Rate for Payer: Mclaren Commercial |
$300.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.29
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$334.42
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$334.42 |
| Rate for Payer: Aetna Commercial |
$300.98
|
| Rate for Payer: ASR ASR |
$324.39
|
| Rate for Payer: BCBS Complete |
$133.77
|
| Rate for Payer: BCBS Trust/PPO |
$259.28
|
| Rate for Payer: BCN Commercial |
$259.28
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$314.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.54
|
| Rate for Payer: Healthscope Commercial |
$334.42
|
| Rate for Payer: Healthscope Whirlpool |
$324.39
|
| Rate for Payer: Mclaren Commercial |
$300.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.32
|
| Rate for Payer: Priority Health Narrow Network |
$237.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.29
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$340.51
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Aetna Commercial |
$306.46
|
| Rate for Payer: ASR ASR |
$330.29
|
| Rate for Payer: BCBS Complete |
$136.20
|
| Rate for Payer: BCBS Trust/PPO |
$264.00
|
| Rate for Payer: BCN Commercial |
$264.00
|
| Rate for Payer: Cash Price |
$272.41
|
| Rate for Payer: Cofinity Commercial |
$320.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.41
|
| Rate for Payer: Healthscope Commercial |
$340.51
|
| Rate for Payer: Healthscope Whirlpool |
$330.29
|
| Rate for Payer: Mclaren Commercial |
$306.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.86
|
| Rate for Payer: Priority Health Narrow Network |
$241.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.65
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$340.51
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.36 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Aetna Commercial |
$306.46
|
| Rate for Payer: ASR ASR |
$330.29
|
| Rate for Payer: BCBS Trust/PPO |
$264.00
|
| Rate for Payer: BCN Commercial |
$264.00
|
| Rate for Payer: Cash Price |
$272.41
|
| Rate for Payer: Cofinity Commercial |
$320.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.41
|
| Rate for Payer: Healthscope Commercial |
$340.51
|
| Rate for Payer: Healthscope Whirlpool |
$330.29
|
| Rate for Payer: Mclaren Commercial |
$306.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.65
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$213.84
|
| Rate for Payer: ASR ASR |
$230.47
|
| Rate for Payer: BCBS Trust/PPO |
$184.21
|
| Rate for Payer: BCN Commercial |
$184.21
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Healthscope Whirlpool |
$230.47
|
| Rate for Payer: Mclaren Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.09
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$213.84
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$230.47
|
| Rate for Payer: BCBS Complete |
$88.17
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$184.21
|
| Rate for Payer: BCN Commercial |
$184.21
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Healthscope Whirlpool |
$230.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$213.84
|
| Rate for Payer: Mclaren Medicaid |
$83.96
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Medicaid |
$88.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$83.96
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.09
|
| Rate for Payer: UHC Medicare Advantage |
$158.10
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$160.83
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$160.83 |
| Rate for Payer: Aetna Commercial |
$144.75
|
| Rate for Payer: ASR ASR |
$156.01
|
| Rate for Payer: BCBS Trust/PPO |
$124.69
|
| Rate for Payer: BCN Commercial |
$124.69
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cofinity Commercial |
$151.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.66
|
| Rate for Payer: Healthscope Commercial |
$160.83
|
| Rate for Payer: Healthscope Whirlpool |
$156.01
|
| Rate for Payer: Mclaren Commercial |
$144.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.53
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$160.83
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$160.83 |
| Rate for Payer: Aetna Commercial |
$144.75
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: ASR ASR |
$156.01
|
| Rate for Payer: BCBS Complete |
$57.44
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$124.69
|
| Rate for Payer: BCN Commercial |
$124.69
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cofinity Commercial |
$151.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$160.83
|
| Rate for Payer: Healthscope Whirlpool |
$156.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$100.00
|
| Rate for Payer: Mclaren Commercial |
$144.75
|
| Rate for Payer: Mclaren Medicaid |
$54.70
|
| Rate for Payer: Mclaren Medicare |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$57.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.71
|
| Rate for Payer: PACE Medicare |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$110.00
|
| Rate for Payer: PHP Medicaid |
$54.70
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.36
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health Narrow Network |
$114.19
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.53
|
| Rate for Payer: UHC Medicare Advantage |
$103.00
|
| Rate for Payer: VA VA |
$100.00
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$115.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$115.06 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$61.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.48
|
| Rate for Payer: ASR ASR |
$111.61
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$89.21
|
| Rate for Payer: BCN Commercial |
$89.21
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cofinity Commercial |
$108.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$115.06
|
| Rate for Payer: Healthscope Whirlpool |
$111.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$61.98
|
| Rate for Payer: Mclaren Commercial |
$103.55
|
| Rate for Payer: Mclaren Medicaid |
$33.90
|
| Rate for Payer: Mclaren Medicare |
$61.98
|
| Rate for Payer: Meridian Medicaid |
$35.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.80
|
| Rate for Payer: PACE Medicare |
$58.88
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Commercial |
$68.18
|
| Rate for Payer: PHP Medicaid |
$33.90
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.70
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health Narrow Network |
$81.69
|
| Rate for Payer: Railroad Medicare Medicare |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.25
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
| Rate for Payer: VA VA |
$61.98
|
|
