|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.50
|
| Rate for Payer: Priority Health Narrow Network |
$319.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.00
|
| Rate for Payer: Priority Health Narrow Network |
$213.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC SICKLE CELL TEST
|
Facility
|
OP
|
$30.70
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Aetna Commercial |
$27.63
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: ASR ASR |
$29.78
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$23.80
|
| Rate for Payer: BCN Commercial |
$23.80
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$30.70
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.51
|
| Rate for Payer: Mclaren Commercial |
$27.63
|
| Rate for Payer: Mclaren Medicaid |
$3.01
|
| Rate for Payer: Mclaren Medicare |
$5.51
|
| Rate for Payer: Meridian Medicaid |
$3.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: PACE Medicare |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: PHP Medicaid |
$3.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.98
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health Narrow Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| Rate for Payer: UHC Medicare Advantage |
$5.68
|
| Rate for Payer: VA VA |
$5.51
|
|
|
HC SICKLE CELL TEST
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Aetna Commercial |
$27.63
|
| Rate for Payer: ASR ASR |
$29.78
|
| Rate for Payer: BCBS Trust/PPO |
$23.80
|
| Rate for Payer: BCN Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$30.70
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Mclaren Commercial |
$27.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$1,139.69 |
| Rate for Payer: Aetna Commercial |
$1,025.72
|
| Rate for Payer: Aetna Medicare |
$812.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: ASR ASR |
$1,105.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$883.60
|
| Rate for Payer: BCN Commercial |
$883.60
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$1,071.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$1,139.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$1,025.72
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$893.64
|
| Rate for Payer: PHP Medicaid |
$444.38
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$819.92
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$655.94
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.93
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.78 |
| Max. Negotiated Rate |
$1,139.69 |
| Rate for Payer: Aetna Commercial |
$1,025.72
|
| Rate for Payer: ASR ASR |
$1,105.50
|
| Rate for Payer: BCBS Trust/PPO |
$883.60
|
| Rate for Payer: BCN Commercial |
$883.60
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$1,071.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Healthscope Commercial |
$1,139.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.50
|
| Rate for Payer: Mclaren Commercial |
$1,025.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.93
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,569.73
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,798.81 |
| Max. Negotiated Rate |
$2,569.73 |
| Rate for Payer: Aetna Commercial |
$2,312.76
|
| Rate for Payer: ASR ASR |
$2,492.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.31
|
| Rate for Payer: BCN Commercial |
$1,992.31
|
| Rate for Payer: Cash Price |
$2,055.78
|
| Rate for Payer: Cofinity Commercial |
$2,415.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,055.78
|
| Rate for Payer: Healthscope Commercial |
$2,569.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,492.64
|
| Rate for Payer: Mclaren Commercial |
$2,312.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,184.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,798.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,261.36
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,569.73
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,027.89 |
| Max. Negotiated Rate |
$2,569.73 |
| Rate for Payer: Aetna Commercial |
$2,312.76
|
| Rate for Payer: ASR ASR |
$2,492.64
|
| Rate for Payer: BCBS Complete |
$1,027.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.31
|
| Rate for Payer: BCN Commercial |
$1,992.31
|
| Rate for Payer: Cash Price |
$2,055.78
|
| Rate for Payer: Cofinity Commercial |
$2,415.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,055.78
|
| Rate for Payer: Healthscope Commercial |
$2,569.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,492.64
|
| Rate for Payer: Mclaren Commercial |
$2,312.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,184.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,798.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,338.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,824.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,261.36
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$1,240.03
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$1,240.03 |
| Rate for Payer: Aetna Commercial |
$1,116.03
|
| Rate for Payer: Aetna Medicare |
$812.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: ASR ASR |
$1,202.83
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$961.40
|
| Rate for Payer: BCN Commercial |
$961.40
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$992.02
|
| Rate for Payer: Cash Price |
$992.02
|
| Rate for Payer: Cofinity Commercial |
$1,165.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$1,240.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$1,116.03
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.03
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$893.64
|
| Rate for Payer: PHP Medicaid |
$444.38
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,128.43
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$880.42
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,091.23
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$1,240.03
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$868.02 |
| Max. Negotiated Rate |
$1,240.03 |
| Rate for Payer: Aetna Commercial |
$1,116.03
|
| Rate for Payer: ASR ASR |
$1,202.83
|
| Rate for Payer: BCBS Trust/PPO |
$961.40
|
| Rate for Payer: BCN Commercial |
$961.40
|
| Rate for Payer: Cash Price |
$992.02
|
| Rate for Payer: Cofinity Commercial |
$1,165.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.02
|
| Rate for Payer: Healthscope Commercial |
$1,240.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.83
|
| Rate for Payer: Mclaren Commercial |
$1,116.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,091.23
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
IP
|
$247.91
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$247.91 |
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: ASR ASR |
$240.47
|
| Rate for Payer: BCBS Trust/PPO |
$192.20
|
| Rate for Payer: BCN Commercial |
$192.20
|
| Rate for Payer: Cash Price |
$198.33
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.33
|
| Rate for Payer: Healthscope Commercial |
$247.91
|
| Rate for Payer: Healthscope Whirlpool |
$240.47
|
| Rate for Payer: Mclaren Commercial |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.16
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
OP
|
$247.91
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$247.91 |
| Rate for Payer: Aetna Commercial |
$223.12
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$240.47
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$192.20
|
| Rate for Payer: BCN Commercial |
$192.20
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$198.33
|
| Rate for Payer: Cash Price |
$198.33
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$247.91
|
| Rate for Payer: Healthscope Whirlpool |
$240.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$223.12
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.72
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.60
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$176.02
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.16
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$34.89 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.01
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.29
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Medicaid |
$3.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicaid |
$3.29
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.19
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC SILVADENE 400 GM
|
Facility
|
OP
|
$248.55
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$248.55 |
| Rate for Payer: Aetna Commercial |
$223.70
|
| Rate for Payer: ASR ASR |
$241.09
|
| Rate for Payer: BCBS Complete |
$99.42
|
| Rate for Payer: BCBS Trust/PPO |
$192.70
|
| Rate for Payer: BCN Commercial |
$192.70
|
| Rate for Payer: Cash Price |
$198.84
|
| Rate for Payer: Cofinity Commercial |
$233.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.84
|
| Rate for Payer: Healthscope Commercial |
$248.55
|
| Rate for Payer: Healthscope Whirlpool |
$241.09
|
| Rate for Payer: Mclaren Commercial |
$223.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.18
|
| Rate for Payer: Priority Health Narrow Network |
$176.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.72
|
|
|
HC SILVADENE 400 GM
|
Facility
|
IP
|
$248.55
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.98 |
| Max. Negotiated Rate |
$248.55 |
| Rate for Payer: Aetna Commercial |
$223.70
|
| Rate for Payer: ASR ASR |
$241.09
|
| Rate for Payer: BCBS Trust/PPO |
$192.70
|
| Rate for Payer: BCN Commercial |
$192.70
|
| Rate for Payer: Cash Price |
$198.84
|
| Rate for Payer: Cofinity Commercial |
$233.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.84
|
| Rate for Payer: Healthscope Commercial |
$248.55
|
| Rate for Payer: Healthscope Whirlpool |
$241.09
|
| Rate for Payer: Mclaren Commercial |
$223.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.72
|
|
|
HC SILVADENE 85 GM
|
Facility
|
IP
|
$102.57
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$102.57 |
| Rate for Payer: Aetna Commercial |
$92.31
|
| Rate for Payer: ASR ASR |
$99.49
|
| Rate for Payer: BCBS Trust/PPO |
$79.52
|
| Rate for Payer: BCN Commercial |
$79.52
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cofinity Commercial |
$96.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.06
|
| Rate for Payer: Healthscope Commercial |
$102.57
|
| Rate for Payer: Healthscope Whirlpool |
$99.49
|
| Rate for Payer: Mclaren Commercial |
$92.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.26
|
|
|
HC SILVADENE 85 GM
|
Facility
|
OP
|
$102.57
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$102.57 |
| Rate for Payer: Aetna Commercial |
$92.31
|
| Rate for Payer: ASR ASR |
$99.49
|
| Rate for Payer: BCBS Complete |
$41.03
|
| Rate for Payer: BCBS Trust/PPO |
$79.52
|
| Rate for Payer: BCN Commercial |
$79.52
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cofinity Commercial |
$96.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.06
|
| Rate for Payer: Healthscope Commercial |
$102.57
|
| Rate for Payer: Healthscope Whirlpool |
$99.49
|
| Rate for Payer: Mclaren Commercial |
$92.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.34
|
| Rate for Payer: Priority Health Narrow Network |
$72.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.26
|
|
|
HC SILVER 4X4
|
Facility
|
OP
|
$64.13
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$64.13 |
| Rate for Payer: Aetna Commercial |
$57.72
|
| Rate for Payer: ASR ASR |
$62.21
|
| Rate for Payer: BCBS Complete |
$25.65
|
| Rate for Payer: BCBS Trust/PPO |
$49.72
|
| Rate for Payer: BCN Commercial |
$49.72
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cofinity Commercial |
$60.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$64.13
|
| Rate for Payer: Healthscope Whirlpool |
$62.21
|
| Rate for Payer: Mclaren Commercial |
$57.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.36
|
| Rate for Payer: Priority Health Narrow Network |
$45.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.43
|
|
|
HC SILVER 4X4
|
Facility
|
IP
|
$64.13
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$64.13 |
| Rate for Payer: Aetna Commercial |
$57.72
|
| Rate for Payer: ASR ASR |
$62.21
|
| Rate for Payer: BCBS Trust/PPO |
$49.72
|
| Rate for Payer: BCN Commercial |
$49.72
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cofinity Commercial |
$60.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$64.13
|
| Rate for Payer: Healthscope Whirlpool |
$62.21
|
| Rate for Payer: Mclaren Commercial |
$57.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.43
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,575.06
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,430.02 |
| Max. Negotiated Rate |
$8,575.06 |
| Rate for Payer: Aetna Commercial |
$7,717.55
|
| Rate for Payer: ASR ASR |
$8,317.81
|
| Rate for Payer: BCBS Complete |
$3,430.02
|
| Rate for Payer: BCBS Trust/PPO |
$6,648.24
|
| Rate for Payer: BCN Commercial |
$6,648.24
|
| Rate for Payer: Cash Price |
$6,860.05
|
| Rate for Payer: Cofinity Commercial |
$8,060.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,860.05
|
| Rate for Payer: Healthscope Commercial |
$8,575.06
|
| Rate for Payer: Healthscope Whirlpool |
$8,317.81
|
| Rate for Payer: Mclaren Commercial |
$7,717.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,288.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,002.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,803.30
|
| Rate for Payer: Priority Health Narrow Network |
$6,088.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,546.05
|
|
