|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$31.31
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$31.31 |
| Rate for Payer: Aetna Commercial |
$28.18
|
| Rate for Payer: ASR ASR |
$30.37
|
| Rate for Payer: BCBS Trust/PPO |
$25.71
|
| Rate for Payer: BCN Commercial |
$25.71
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Healthscope Commercial |
$30.37
|
| Rate for Payer: Healthscope Whirlpool |
$31.31
|
| Rate for Payer: Mclaren Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Nomi Health Commercial |
$25.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.55
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$31.31
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$31.31 |
| Rate for Payer: Aetna Commercial |
$28.18
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.65
|
| Rate for Payer: ASR ASR |
$30.37
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$25.82
|
| Rate for Payer: BCN Commercial |
$25.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.32
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$30.37
|
| Rate for Payer: Healthscope Whirlpool |
$31.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.32
|
| Rate for Payer: Mclaren Commercial |
$28.18
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$5.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.59
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Nomi Health Commercial |
$25.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.48
|
| Rate for Payer: PACE Medicare |
$5.05
|
| Rate for Payer: PACE SWMI |
$5.32
|
| Rate for Payer: PHP Commercial |
$5.85
|
| Rate for Payer: PHP Medicaid |
$2.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.82
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health Narrow Network |
$19.86
|
| Rate for Payer: Railroad Medicare Medicare |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.32
|
| Rate for Payer: UHC Exchange |
$8.25
|
| Rate for Payer: UHC Medicaid |
$2.78
|
| Rate for Payer: UHCCP DNSP |
$5.32
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.32
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,631.90
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,973.92 |
| Max. Negotiated Rate |
$2,631.90 |
| Rate for Payer: Aetna Commercial |
$2,368.71
|
| Rate for Payer: ASR ASR |
$2,552.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,161.32
|
| Rate for Payer: BCN Commercial |
$2,161.32
|
| Rate for Payer: Cash Price |
$2,105.52
|
| Rate for Payer: Cofinity Commercial |
$2,473.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.52
|
| Rate for Payer: Healthscope Commercial |
$2,552.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,631.90
|
| Rate for Payer: Mclaren Commercial |
$2,368.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.11
|
| Rate for Payer: Nomi Health Commercial |
$2,158.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,973.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.07
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,631.90
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.80 |
| Max. Negotiated Rate |
$2,631.90 |
| Rate for Payer: Aetna Commercial |
$2,368.71
|
| Rate for Payer: Aetna Medicare |
$973.80
|
| Rate for Payer: ASR ASR |
$2,552.94
|
| Rate for Payer: BCBS Complete |
$1,052.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,170.00
|
| Rate for Payer: BCN Commercial |
$2,170.00
|
| Rate for Payer: Cash Price |
$2,105.52
|
| Rate for Payer: Cofinity Commercial |
$2,473.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.52
|
| Rate for Payer: Healthscope Commercial |
$2,552.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,631.90
|
| Rate for Payer: Mclaren Commercial |
$2,368.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,105.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.11
|
| Rate for Payer: Nomi Health Commercial |
$2,158.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,973.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,306.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,844.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,316.07
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$46.82
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.12 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.45
|
| Rate for Payer: BCN Commercial |
$38.45
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$45.42
|
| Rate for Payer: Healthscope Whirlpool |
$46.82
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$46.82
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: BCBS Complete |
$18.73
|
| Rate for Payer: BCBS Trust/PPO |
$38.60
|
| Rate for Payer: BCN Commercial |
$38.60
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$45.42
|
| Rate for Payer: Healthscope Whirlpool |
$46.82
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.02
|
| Rate for Payer: Priority Health Narrow Network |
$32.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$19.63
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$49.02
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$49.02 |
| Rate for Payer: Aetna Commercial |
$44.12
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$47.55
|
| Rate for Payer: BCBS Complete |
$15.04
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$40.42
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$47.55
|
| Rate for Payer: Healthscope Whirlpool |
$49.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$44.12
|
| Rate for Payer: Mclaren Medicaid |
$27.39
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$15.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.67
|
| Rate for Payer: Nomi Health Commercial |
$40.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.77
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.95
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$34.36
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.39
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicaid |
$14.32
|
| Rate for Payer: UHCCP DNSP |
$27.39
|
| Rate for Payer: UHCCP Medicaid |
$14.32
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$49.02
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$49.02 |
| Rate for Payer: Aetna Commercial |
$44.12
|
| Rate for Payer: ASR ASR |
$47.55
|
| Rate for Payer: BCBS Trust/PPO |
$40.26
|
| Rate for Payer: BCN Commercial |
$40.26
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.22
|
| Rate for Payer: Healthscope Commercial |
$47.55
|
| Rate for Payer: Healthscope Whirlpool |
$49.02
|
| Rate for Payer: Mclaren Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.67
|
| Rate for Payer: Nomi Health Commercial |
$40.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.14
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$49.02
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$49.02 |
| Rate for Payer: Aetna Commercial |
$44.12
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$47.55
|
| Rate for Payer: BCBS Complete |
$15.04
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$40.42
|
| Rate for Payer: BCN Commercial |
$40.42
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$47.55
|
| Rate for Payer: Healthscope Whirlpool |
$49.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$44.12
|
| Rate for Payer: Mclaren Medicaid |
$27.39
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$15.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.67
|
| Rate for Payer: Nomi Health Commercial |
$40.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.77
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.95
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$34.36
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.39
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicaid |
$14.32
|
| Rate for Payer: UHCCP DNSP |
$27.39
|
| Rate for Payer: UHCCP Medicaid |
$14.32
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$49.02
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$49.02 |
| Rate for Payer: Aetna Commercial |
$44.12
|
| Rate for Payer: ASR ASR |
$47.55
|
| Rate for Payer: BCBS Trust/PPO |
$40.26
|
| Rate for Payer: BCN Commercial |
$40.26
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.22
|
| Rate for Payer: Healthscope Commercial |
$47.55
|
| Rate for Payer: Healthscope Whirlpool |
$49.02
|
| Rate for Payer: Mclaren Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.67
|
| Rate for Payer: Nomi Health Commercial |
$40.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.14
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$392.42
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$510.14 |
| Rate for Payer: Aetna Commercial |
$353.18
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$380.65
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$323.55
|
| Rate for Payer: BCN Commercial |
$323.55
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$313.94
|
| Rate for Payer: Cash Price |
$313.94
|
| Rate for Payer: Cofinity Commercial |
$368.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$380.65
|
| Rate for Payer: Healthscope Whirlpool |
$392.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$353.18
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.56
|
| Rate for Payer: Nomi Health Commercial |
$321.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.31
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$343.84
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$275.09
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$392.42
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$294.31 |
| Max. Negotiated Rate |
$392.42 |
| Rate for Payer: Aetna Commercial |
$353.18
|
| Rate for Payer: ASR ASR |
$380.65
|
| Rate for Payer: BCBS Trust/PPO |
$322.26
|
| Rate for Payer: BCN Commercial |
$322.26
|
| Rate for Payer: Cash Price |
$313.94
|
| Rate for Payer: Cofinity Commercial |
$368.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.94
|
| Rate for Payer: Healthscope Commercial |
$380.65
|
| Rate for Payer: Healthscope Whirlpool |
$392.42
|
| Rate for Payer: Mclaren Commercial |
$353.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.56
|
| Rate for Payer: Nomi Health Commercial |
$321.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.33
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$1.52
|
| Rate for Payer: BCN Commercial |
$1.52
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.48
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Healthscope Whirlpool |
$1.85
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.57
|
| Rate for Payer: Nomi Health Commercial |
$1.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.63
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: ASR ASR |
$1.79
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.48
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Healthscope Whirlpool |
$1.85
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.57
|
| Rate for Payer: Nomi Health Commercial |
$1.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.63
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
OP
|
$5,919.88
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,190.36 |
| Max. Negotiated Rate |
$5,919.88 |
| Rate for Payer: Aetna Commercial |
$5,327.89
|
| Rate for Payer: Aetna Medicare |
$2,190.36
|
| Rate for Payer: ASR ASR |
$5,742.28
|
| Rate for Payer: BCBS Complete |
$2,367.95
|
| Rate for Payer: BCBS Trust/PPO |
$4,880.94
|
| Rate for Payer: BCN Commercial |
$4,880.94
|
| Rate for Payer: Cash Price |
$4,735.90
|
| Rate for Payer: Cofinity Commercial |
$5,564.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,735.90
|
| Rate for Payer: Healthscope Commercial |
$5,742.28
|
| Rate for Payer: Healthscope Whirlpool |
$5,919.88
|
| Rate for Payer: Mclaren Commercial |
$5,327.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,735.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,031.90
|
| Rate for Payer: Nomi Health Commercial |
$4,854.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,439.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,187.00
|
| Rate for Payer: Priority Health Narrow Network |
$4,149.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,209.49
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
IP
|
$5,919.88
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,439.91 |
| Max. Negotiated Rate |
$5,919.88 |
| Rate for Payer: Aetna Commercial |
$5,327.89
|
| Rate for Payer: ASR ASR |
$5,742.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,861.41
|
| Rate for Payer: BCN Commercial |
$4,861.41
|
| Rate for Payer: Cash Price |
$4,735.90
|
| Rate for Payer: Cofinity Commercial |
$5,564.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,735.90
|
| Rate for Payer: Healthscope Commercial |
$5,742.28
|
| Rate for Payer: Healthscope Whirlpool |
$5,919.88
|
| Rate for Payer: Mclaren Commercial |
$5,327.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,031.90
|
| Rate for Payer: Nomi Health Commercial |
$4,854.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,439.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,209.49
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$962.88
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$356.27 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$866.59
|
| Rate for Payer: Aetna Medicare |
$356.27
|
| Rate for Payer: ASR ASR |
$933.99
|
| Rate for Payer: BCBS Complete |
$385.15
|
| Rate for Payer: BCBS Trust/PPO |
$793.89
|
| Rate for Payer: BCN Commercial |
$793.89
|
| Rate for Payer: Cash Price |
$770.30
|
| Rate for Payer: Cofinity Commercial |
$905.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.30
|
| Rate for Payer: Healthscope Commercial |
$933.99
|
| Rate for Payer: Healthscope Whirlpool |
$962.88
|
| Rate for Payer: Mclaren Commercial |
$866.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$770.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.45
|
| Rate for Payer: Nomi Health Commercial |
$789.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$843.68
|
| Rate for Payer: Priority Health Narrow Network |
$674.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$847.33
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$962.88
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$722.16 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$866.59
|
| Rate for Payer: ASR ASR |
$933.99
|
| Rate for Payer: BCBS Trust/PPO |
$790.72
|
| Rate for Payer: BCN Commercial |
$790.72
|
| Rate for Payer: Cash Price |
$770.30
|
| Rate for Payer: Cofinity Commercial |
$905.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.30
|
| Rate for Payer: Healthscope Commercial |
$933.99
|
| Rate for Payer: Healthscope Whirlpool |
$962.88
|
| Rate for Payer: Mclaren Commercial |
$866.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.45
|
| Rate for Payer: Nomi Health Commercial |
$789.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$847.33
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$563.42
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$208.47 |
| Max. Negotiated Rate |
$563.42 |
| Rate for Payer: Aetna Commercial |
$507.08
|
| Rate for Payer: Aetna Medicare |
$208.47
|
| Rate for Payer: ASR ASR |
$546.52
|
| Rate for Payer: BCBS Complete |
$225.37
|
| Rate for Payer: BCBS Trust/PPO |
$464.54
|
| Rate for Payer: BCN Commercial |
$464.54
|
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Cofinity Commercial |
$529.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.74
|
| Rate for Payer: Healthscope Commercial |
$546.52
|
| Rate for Payer: Healthscope Whirlpool |
$563.42
|
| Rate for Payer: Mclaren Commercial |
$507.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.91
|
| Rate for Payer: Nomi Health Commercial |
$462.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$493.67
|
| Rate for Payer: Priority Health Narrow Network |
$394.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.81
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$563.42
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$422.56 |
| Max. Negotiated Rate |
$563.42 |
| Rate for Payer: Aetna Commercial |
$507.08
|
| Rate for Payer: ASR ASR |
$546.52
|
| Rate for Payer: BCBS Trust/PPO |
$462.68
|
| Rate for Payer: BCN Commercial |
$462.68
|
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Cofinity Commercial |
$529.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.74
|
| Rate for Payer: Healthscope Commercial |
$546.52
|
| Rate for Payer: Healthscope Whirlpool |
$563.42
|
| Rate for Payer: Mclaren Commercial |
$507.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.91
|
| Rate for Payer: Nomi Health Commercial |
$462.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.81
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$356.21
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$267.16 |
| Max. Negotiated Rate |
$356.21 |
| Rate for Payer: Aetna Commercial |
$320.59
|
| Rate for Payer: ASR ASR |
$345.52
|
| Rate for Payer: BCBS Trust/PPO |
$292.52
|
| Rate for Payer: BCN Commercial |
$292.52
|
| Rate for Payer: Cash Price |
$284.97
|
| Rate for Payer: Cofinity Commercial |
$334.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.97
|
| Rate for Payer: Healthscope Commercial |
$345.52
|
| Rate for Payer: Healthscope Whirlpool |
$356.21
|
| Rate for Payer: Mclaren Commercial |
$320.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.78
|
| Rate for Payer: Nomi Health Commercial |
$292.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.46
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$356.21
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$356.21 |
| Rate for Payer: Aetna Commercial |
$320.59
|
| Rate for Payer: Aetna Medicare |
$131.80
|
| Rate for Payer: ASR ASR |
$345.52
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: BCBS Trust/PPO |
$293.70
|
| Rate for Payer: BCN Commercial |
$293.70
|
| Rate for Payer: Cash Price |
$284.97
|
| Rate for Payer: Cofinity Commercial |
$334.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.97
|
| Rate for Payer: Healthscope Commercial |
$345.52
|
| Rate for Payer: Healthscope Whirlpool |
$356.21
|
| Rate for Payer: Mclaren Commercial |
$320.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.78
|
| Rate for Payer: Nomi Health Commercial |
$292.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$312.11
|
| Rate for Payer: Priority Health Narrow Network |
$249.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.46
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$197.13
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$147.85 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$177.42
|
| Rate for Payer: ASR ASR |
$191.22
|
| Rate for Payer: BCBS Trust/PPO |
$161.88
|
| Rate for Payer: BCN Commercial |
$161.88
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Commercial |
$185.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$191.22
|
| Rate for Payer: Healthscope Whirlpool |
$197.13
|
| Rate for Payer: Mclaren Commercial |
$177.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Nomi Health Commercial |
$161.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.47
|
|
