|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,432.40
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,702.68 |
| Max. Negotiated Rate |
$2,432.40 |
| Rate for Payer: Aetna Commercial |
$2,189.16
|
| Rate for Payer: ASR ASR |
$2,359.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,885.84
|
| Rate for Payer: BCN Commercial |
$1,885.84
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,286.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Healthscope Commercial |
$2,432.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,359.43
|
| Rate for Payer: Mclaren Commercial |
$2,189.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,140.51
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,432.40
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,702.68 |
| Max. Negotiated Rate |
$2,432.40 |
| Rate for Payer: Aetna Commercial |
$2,189.16
|
| Rate for Payer: ASR ASR |
$2,359.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,885.84
|
| Rate for Payer: BCN Commercial |
$1,885.84
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,286.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Healthscope Commercial |
$2,432.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,359.43
|
| Rate for Payer: Mclaren Commercial |
$2,189.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,140.51
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,432.40
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.02 |
| Max. Negotiated Rate |
$2,432.40 |
| Rate for Payer: Aetna Commercial |
$2,189.16
|
| Rate for Payer: Aetna Medicare |
$1,363.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,704.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,704.79
|
| Rate for Payer: ASR ASR |
$2,359.43
|
| Rate for Payer: BCBS Complete |
$783.38
|
| Rate for Payer: BCBS MAPPO |
$1,363.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,885.84
|
| Rate for Payer: BCN Commercial |
$1,885.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.83
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,286.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.83
|
| Rate for Payer: Healthscope Commercial |
$2,432.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,359.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,363.83
|
| Rate for Payer: Mclaren Commercial |
$2,189.16
|
| Rate for Payer: Mclaren Medicaid |
$746.02
|
| Rate for Payer: Mclaren Medicare |
$1,363.83
|
| Rate for Payer: Meridian Medicaid |
$783.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,432.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,568.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PACE Medicare |
$1,295.64
|
| Rate for Payer: PACE SWMI |
$1,363.83
|
| Rate for Payer: PHP Commercial |
$1,500.21
|
| Rate for Payer: PHP Medicaid |
$746.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,750.66
|
| Rate for Payer: Priority Health Medicare |
$1,363.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,400.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,363.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,140.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,404.74
|
| Rate for Payer: VA VA |
$1,363.83
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS Trust/PPO |
$86.99
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.76
|
| Rate for Payer: Priority Health Narrow Network |
$55.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: BCBS Trust/PPO |
$86.99
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$846.31
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$846.31 |
| Rate for Payer: Aetna Commercial |
$761.68
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$820.92
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$656.14
|
| Rate for Payer: BCN Commercial |
$656.14
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cofinity Commercial |
$795.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$846.31
|
| Rate for Payer: Healthscope Whirlpool |
$820.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$761.68
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.36
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.28
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$71.42
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.75
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$846.31
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$592.42 |
| Max. Negotiated Rate |
$846.31 |
| Rate for Payer: Aetna Commercial |
$761.68
|
| Rate for Payer: ASR ASR |
$820.92
|
| Rate for Payer: BCBS Trust/PPO |
$656.14
|
| Rate for Payer: BCN Commercial |
$656.14
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cofinity Commercial |
$795.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.05
|
| Rate for Payer: Healthscope Commercial |
$846.31
|
| Rate for Payer: Healthscope Whirlpool |
$820.92
|
| Rate for Payer: Mclaren Commercial |
$761.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.75
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS Trust/PPO |
$45.17
|
| Rate for Payer: BCN Commercial |
$45.17
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Healthscope Whirlpool |
$56.51
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.02
|
| Rate for Payer: Priority Health Narrow Network |
$41.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Trust/PPO |
$45.17
|
| Rate for Payer: BCN Commercial |
$45.17
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Healthscope Whirlpool |
$56.51
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
IP
|
$180.52
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$180.52 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: ASR ASR |
$175.10
|
| Rate for Payer: BCBS Trust/PPO |
$139.96
|
| Rate for Payer: BCN Commercial |
$139.96
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$169.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$180.52
|
| Rate for Payer: Healthscope Whirlpool |
$175.10
|
| Rate for Payer: Mclaren Commercial |
$162.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.86
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
OP
|
$180.52
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.21 |
| Max. Negotiated Rate |
$180.52 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: ASR ASR |
$175.10
|
| Rate for Payer: BCBS Complete |
$72.21
|
| Rate for Payer: BCBS Trust/PPO |
$139.96
|
| Rate for Payer: BCN Commercial |
$139.96
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$169.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$180.52
|
| Rate for Payer: Healthscope Whirlpool |
$175.10
|
| Rate for Payer: Mclaren Commercial |
$162.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.27
|
| Rate for Payer: Priority Health Narrow Network |
$128.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.86
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
OP
|
$82.89
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$82.89 |
| Rate for Payer: Aetna Commercial |
$74.60
|
| Rate for Payer: ASR ASR |
$80.40
|
| Rate for Payer: BCBS Complete |
$33.16
|
| Rate for Payer: BCBS Trust/PPO |
$64.26
|
| Rate for Payer: BCN Commercial |
$64.26
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$77.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.31
|
| Rate for Payer: Healthscope Commercial |
$82.89
|
| Rate for Payer: Healthscope Whirlpool |
$80.40
|
| Rate for Payer: Mclaren Commercial |
$74.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.43
|
| Rate for Payer: Priority Health Narrow Network |
$58.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.94
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
IP
|
$82.89
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$82.89 |
| Rate for Payer: Aetna Commercial |
$74.60
|
| Rate for Payer: ASR ASR |
$80.40
|
| Rate for Payer: BCBS Trust/PPO |
$64.26
|
| Rate for Payer: BCN Commercial |
$64.26
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$77.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.31
|
| Rate for Payer: Healthscope Commercial |
$82.89
|
| Rate for Payer: Healthscope Whirlpool |
$80.40
|
| Rate for Payer: Mclaren Commercial |
$74.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.94
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$412.78
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$288.95 |
| Max. Negotiated Rate |
$412.78 |
| Rate for Payer: Aetna Commercial |
$371.50
|
| Rate for Payer: ASR ASR |
$400.40
|
| Rate for Payer: BCBS Trust/PPO |
$320.03
|
| Rate for Payer: BCN Commercial |
$320.03
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$388.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$412.78
|
| Rate for Payer: Healthscope Whirlpool |
$400.40
|
| Rate for Payer: Mclaren Commercial |
$371.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.25
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$412.78
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$412.78 |
| Rate for Payer: Aetna Commercial |
$371.50
|
| Rate for Payer: ASR ASR |
$400.40
|
| Rate for Payer: BCBS Complete |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$320.03
|
| Rate for Payer: BCN Commercial |
$320.03
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$388.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$412.78
|
| Rate for Payer: Healthscope Whirlpool |
$400.40
|
| Rate for Payer: Mclaren Commercial |
$371.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.63
|
| Rate for Payer: Priority Health Narrow Network |
$293.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.25
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.17 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Healthscope Whirlpool |
$83.38
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| 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 |
$83.38
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Healthscope Whirlpool |
$83.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| 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 |
$73.07
|
| 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 |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.85
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$50.28
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: ASR ASR |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$46.66
|
| Rate for Payer: BCN Commercial |
$46.66
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$60.18
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Mclaren Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.96
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$95.43 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Aetna Medicare |
$21.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.54
|
| Rate for Payer: ASR ASR |
$58.37
|
| Rate for Payer: BCBS Complete |
$12.19
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$46.66
|
| Rate for Payer: BCN Commercial |
$46.66
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$60.18
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$54.16
|
| Rate for Payer: Mclaren Medicaid |
$11.61
|
| Rate for Payer: Mclaren Medicare |
$21.23
|
| Rate for Payer: Meridian Medicaid |
$12.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PACE Medicare |
$20.17
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: PHP Medicaid |
$11.61
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.43
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow Network |
$76.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.96
|
| Rate for Payer: UHC Medicare Advantage |
$21.87
|
| Rate for Payer: VA VA |
$21.23
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$20.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$11.64
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.26
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Medicaid |
$11.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$22.29
|
| Rate for Payer: PHP Medicaid |
$11.08
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.67
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$83.74
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$20.87
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$26.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.26
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$15.28
|
| Rate for Payer: BCBS MAPPO |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCCCP Commercial |
$26.49
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$26.61
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.61
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.61
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$14.56
|
| Rate for Payer: Mclaren Medicare |
$26.61
|
| Rate for Payer: Meridian Medicaid |
$15.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$25.28
|
| Rate for Payer: PACE SWMI |
$26.61
|
| Rate for Payer: PHP Commercial |
$29.27
|
| Rate for Payer: PHP Medicaid |
$14.56
|
| Rate for Payer: PHP Medicare Advantage |
$26.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.67
|
| Rate for Payer: Priority Health Medicare |
$26.61
|
| Rate for Payer: Priority Health Narrow Network |
$83.74
|
| Rate for Payer: Railroad Medicare Medicare |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$27.41
|
| Rate for Payer: VA VA |
$26.61
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$20.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$11.64
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.26
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Medicaid |
$11.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$22.29
|
| Rate for Payer: PHP Medicaid |
$11.08
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.67
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$83.74
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$20.87
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$59.31
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
