|
HC SCALLOP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC SCALP ELECTRODE
|
Facility
|
IP
|
$131.15
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$131.15 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: ASR ASR |
$127.22
|
| Rate for Payer: BCBS Trust/PPO |
$101.68
|
| Rate for Payer: BCN Commercial |
$101.68
|
| Rate for Payer: Cash Price |
$104.92
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.92
|
| Rate for Payer: Healthscope Commercial |
$131.15
|
| Rate for Payer: Healthscope Whirlpool |
$127.22
|
| Rate for Payer: Mclaren Commercial |
$118.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.41
|
|
|
HC SCALP ELECTRODE
|
Facility
|
OP
|
$131.15
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$52.46 |
| Max. Negotiated Rate |
$131.15 |
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: ASR ASR |
$127.22
|
| Rate for Payer: BCBS Complete |
$52.46
|
| Rate for Payer: BCBS Trust/PPO |
$101.68
|
| Rate for Payer: BCN Commercial |
$101.68
|
| Rate for Payer: Cash Price |
$104.92
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.92
|
| Rate for Payer: Healthscope Commercial |
$131.15
|
| Rate for Payer: Healthscope Whirlpool |
$127.22
|
| Rate for Payer: Mclaren Commercial |
$118.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.35
|
| Rate for Payer: Priority Health Narrow Network |
$93.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.41
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$97.80
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.46 |
| Max. Negotiated Rate |
$97.80 |
| Rate for Payer: Aetna Commercial |
$88.02
|
| Rate for Payer: ASR ASR |
$94.87
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.24
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$94.87
|
| Rate for Payer: Mclaren Commercial |
$88.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.06
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$97.80
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$97.80 |
| Rate for Payer: Aetna Commercial |
$88.02
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: ASR ASR |
$94.87
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$94.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.01
|
| Rate for Payer: Mclaren Commercial |
$88.02
|
| Rate for Payer: Mclaren Medicaid |
$7.12
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.13
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Medicaid |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.00
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health Narrow Network |
$69.44
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.06
|
| Rate for Payer: UHC Medicare Advantage |
$13.40
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC SCISSORS
|
Facility
|
OP
|
$17.32
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$13.43
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.76
|
| Rate for Payer: Priority Health Narrow Network |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
HC SCISSORS
|
Facility
|
IP
|
$17.32
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: ASR ASR |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.43
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.86
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Whirlpool |
$16.80
|
| Rate for Payer: Mclaren Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.24
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$33.45
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$26.73
|
| Rate for Payer: BCN Commercial |
$26.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$32.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Healthscope Whirlpool |
$33.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.67
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$114.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
IP
|
$2,125.40
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,487.78 |
| Max. Negotiated Rate |
$2,125.40 |
| Rate for Payer: Aetna Commercial |
$1,912.86
|
| Rate for Payer: ASR ASR |
$2,061.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.82
|
| Rate for Payer: BCN Commercial |
$1,647.82
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cofinity Commercial |
$1,997.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,700.32
|
| Rate for Payer: Healthscope Commercial |
$2,125.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,061.64
|
| Rate for Payer: Mclaren Commercial |
$1,912.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,806.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,870.35
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
OP
|
$2,125.40
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.30 |
| Max. Negotiated Rate |
$2,125.40 |
| Rate for Payer: Aetna Commercial |
$1,912.86
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$2,061.64
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.82
|
| Rate for Payer: BCN Commercial |
$1,647.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cofinity Commercial |
$1,997.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,700.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$2,125.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,061.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$1,912.86
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,806.59
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,934.11
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,509.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,870.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
IP
|
$77.05
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$77.05 |
| Rate for Payer: Aetna Commercial |
$69.34
|
| Rate for Payer: ASR ASR |
$74.74
|
| Rate for Payer: BCBS Trust/PPO |
$59.74
|
| Rate for Payer: BCN Commercial |
$59.74
|
| Rate for Payer: Cash Price |
$61.64
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.64
|
| Rate for Payer: Healthscope Commercial |
$77.05
|
| Rate for Payer: Healthscope Whirlpool |
$74.74
|
| Rate for Payer: Mclaren Commercial |
$69.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.80
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
OP
|
$77.05
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$77.05 |
| Rate for Payer: Aetna Commercial |
$69.34
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: ASR ASR |
$74.74
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$59.74
|
| Rate for Payer: BCCCP Commercial |
$15.88
|
| Rate for Payer: BCN Commercial |
$59.74
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$61.64
|
| Rate for Payer: Cash Price |
$61.64
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$77.05
|
| Rate for Payer: Healthscope Whirlpool |
$74.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$69.34
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.49
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$29.12
|
| Rate for Payer: PHP Medicaid |
$14.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.12
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$54.71
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.80
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
OP
|
$101.19
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$101.19 |
| Rate for Payer: Aetna Commercial |
$91.07
|
| Rate for Payer: ASR ASR |
$98.15
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$78.45
|
| Rate for Payer: BCCCP Commercial |
$54.20
|
| Rate for Payer: BCN Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.95
|
| Rate for Payer: Healthscope Commercial |
$101.19
|
| Rate for Payer: Healthscope Whirlpool |
$98.15
|
| Rate for Payer: Mclaren Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.08
|
| Rate for Payer: Priority Health Narrow Network |
$71.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.05
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
IP
|
$101.19
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$101.19 |
| Rate for Payer: Aetna Commercial |
$91.07
|
| Rate for Payer: ASR ASR |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$78.45
|
| Rate for Payer: BCN Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.95
|
| Rate for Payer: Healthscope Commercial |
$101.19
|
| Rate for Payer: Healthscope Whirlpool |
$98.15
|
| Rate for Payer: Mclaren Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.05
|
|
|
HC SDL MSLT/MWT
|
Facility
|
OP
|
$2,521.75
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$2,521.75 |
| Rate for Payer: Aetna Commercial |
$2,269.58
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$2,446.10
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,955.11
|
| Rate for Payer: BCN Commercial |
$1,955.11
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cofinity Commercial |
$2,370.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,017.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$2,521.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,446.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$2,269.58
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,143.49
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,765.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,411.52
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,929.22
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,219.14
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC SDL MSLT/MWT
|
Facility
|
IP
|
$2,521.75
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,765.22 |
| Max. Negotiated Rate |
$2,521.75 |
| Rate for Payer: Aetna Commercial |
$2,269.58
|
| Rate for Payer: ASR ASR |
$2,446.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,955.11
|
| Rate for Payer: BCN Commercial |
$1,955.11
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cofinity Commercial |
$2,370.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,017.40
|
| Rate for Payer: Healthscope Commercial |
$2,521.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,446.10
|
| Rate for Payer: Mclaren Commercial |
$2,269.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,143.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,765.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,219.14
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
OP
|
$3,490.58
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$508.36 |
| Max. Negotiated Rate |
$3,490.58 |
| Rate for Payer: Aetna Commercial |
$3,141.52
|
| Rate for Payer: Aetna Medicare |
$929.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,161.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,161.70
|
| Rate for Payer: ASR ASR |
$3,385.86
|
| Rate for Payer: BCBS Complete |
$533.82
|
| Rate for Payer: BCBS MAPPO |
$929.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,706.25
|
| Rate for Payer: BCN Commercial |
$2,706.25
|
| Rate for Payer: BCN Medicare Advantage |
$929.36
|
| Rate for Payer: Cash Price |
$2,792.46
|
| Rate for Payer: Cash Price |
$2,792.46
|
| Rate for Payer: Cofinity Commercial |
$3,281.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.36
|
| Rate for Payer: Healthscope Commercial |
$3,490.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,385.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$929.36
|
| Rate for Payer: Mclaren Commercial |
$3,141.52
|
| Rate for Payer: Mclaren Medicaid |
$508.36
|
| Rate for Payer: Mclaren Medicare |
$929.36
|
| Rate for Payer: Meridian Medicaid |
$533.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$975.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,966.99
|
| Rate for Payer: PACE Medicare |
$882.89
|
| Rate for Payer: PACE SWMI |
$929.36
|
| Rate for Payer: PHP Commercial |
$1,022.30
|
| Rate for Payer: PHP Medicaid |
$508.36
|
| Rate for Payer: PHP Medicare Advantage |
$929.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,773.76
|
| Rate for Payer: Priority Health Medicare |
$929.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,219.01
|
| Rate for Payer: Railroad Medicare Medicare |
$929.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,071.71
|
| Rate for Payer: UHC Medicare Advantage |
$957.24
|
| Rate for Payer: VA VA |
$929.36
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
IP
|
$3,490.58
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,443.41 |
| Max. Negotiated Rate |
$3,490.58 |
| Rate for Payer: Aetna Commercial |
$3,141.52
|
| Rate for Payer: ASR ASR |
$3,385.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,706.25
|
| Rate for Payer: BCN Commercial |
$2,706.25
|
| Rate for Payer: Cash Price |
$2,792.46
|
| Rate for Payer: Cofinity Commercial |
$3,281.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.46
|
| Rate for Payer: Healthscope Commercial |
$3,490.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,385.86
|
| Rate for Payer: Mclaren Commercial |
$3,141.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,966.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,071.71
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
OP
|
$3,859.04
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$508.36 |
| Max. Negotiated Rate |
$3,859.04 |
| Rate for Payer: Aetna Commercial |
$3,473.14
|
| Rate for Payer: Aetna Medicare |
$929.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,161.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,161.70
|
| Rate for Payer: ASR ASR |
$3,743.27
|
| Rate for Payer: BCBS Complete |
$533.82
|
| Rate for Payer: BCBS MAPPO |
$929.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,991.91
|
| Rate for Payer: BCN Commercial |
$2,991.91
|
| Rate for Payer: BCN Medicare Advantage |
$929.36
|
| Rate for Payer: Cash Price |
$3,087.23
|
| Rate for Payer: Cash Price |
$3,087.23
|
| Rate for Payer: Cofinity Commercial |
$3,627.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,087.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.36
|
| Rate for Payer: Healthscope Commercial |
$3,859.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,743.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$929.36
|
| Rate for Payer: Mclaren Commercial |
$3,473.14
|
| Rate for Payer: Mclaren Medicaid |
$508.36
|
| Rate for Payer: Mclaren Medicare |
$929.36
|
| Rate for Payer: Meridian Medicaid |
$533.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$975.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,280.18
|
| Rate for Payer: PACE Medicare |
$882.89
|
| Rate for Payer: PACE SWMI |
$929.36
|
| Rate for Payer: PHP Commercial |
$1,022.30
|
| Rate for Payer: PHP Medicaid |
$508.36
|
| Rate for Payer: PHP Medicare Advantage |
$929.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,701.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,773.76
|
| Rate for Payer: Priority Health Medicare |
$929.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,219.01
|
| Rate for Payer: Railroad Medicare Medicare |
$929.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,395.96
|
| Rate for Payer: UHC Medicare Advantage |
$957.24
|
| Rate for Payer: VA VA |
$929.36
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
IP
|
$3,859.04
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,701.33 |
| Max. Negotiated Rate |
$3,859.04 |
| Rate for Payer: Aetna Commercial |
$3,473.14
|
| Rate for Payer: ASR ASR |
$3,743.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,991.91
|
| Rate for Payer: BCN Commercial |
$2,991.91
|
| Rate for Payer: Cash Price |
$3,087.23
|
| Rate for Payer: Cofinity Commercial |
$3,627.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,087.23
|
| Rate for Payer: Healthscope Commercial |
$3,859.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,743.27
|
| Rate for Payer: Mclaren Commercial |
$3,473.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,280.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,701.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,395.96
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
OP
|
$720.47
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$288.19 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$648.42
|
| Rate for Payer: ASR ASR |
$698.86
|
| Rate for Payer: BCBS Complete |
$288.19
|
| Rate for Payer: BCBS Trust/PPO |
$558.58
|
| Rate for Payer: BCN Commercial |
$558.58
|
| Rate for Payer: Cash Price |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$677.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.38
|
| Rate for Payer: Healthscope Commercial |
$720.47
|
| Rate for Payer: Healthscope Whirlpool |
$698.86
|
| Rate for Payer: Mclaren Commercial |
$648.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.63
|
| Rate for Payer: Priority Health Narrow Network |
$511.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.01
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
IP
|
$720.47
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$504.33 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$648.42
|
| Rate for Payer: ASR ASR |
$698.86
|
| Rate for Payer: BCBS Trust/PPO |
$558.58
|
| Rate for Payer: BCN Commercial |
$558.58
|
| Rate for Payer: Cash Price |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$677.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.38
|
| Rate for Payer: Healthscope Commercial |
$720.47
|
| Rate for Payer: Healthscope Whirlpool |
$698.86
|
| Rate for Payer: Mclaren Commercial |
$648.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.01
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.38
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$1.48
|
| Rate for Payer: Mclaren Medicare |
$2.70
|
| Rate for Payer: Meridian Medicaid |
$1.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$2.56
|
| Rate for Payer: PACE SWMI |
$2.70
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: PHP Medicaid |
$1.48
|
| Rate for Payer: PHP Medicare Advantage |
$2.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.78
|
| Rate for Payer: VA VA |
$2.70
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
