|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| 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 |
$26.49
|
| 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 |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.49
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$29.14
|
| Rate for Payer: PHP Medicaid |
$14.49
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| 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 |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$83.74
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
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 THIOPURINE METABOLITES
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: ASR ASR |
$281.30
|
| Rate for Payer: BCBS Trust/PPO |
$224.84
|
| Rate for Payer: BCN Commercial |
$224.84
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$272.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Healthscope Commercial |
$290.00
|
| Rate for Payer: Healthscope Whirlpool |
$281.30
|
| Rate for Payer: Mclaren Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.20
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$281.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$224.84
|
| Rate for Payer: BCN Commercial |
$224.84
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$272.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$290.00
|
| Rate for Payer: Healthscope Whirlpool |
$281.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$261.00
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.87
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.20
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: ASR ASR |
$314.28
|
| Rate for Payer: BCBS Trust/PPO |
$251.20
|
| Rate for Payer: BCN Commercial |
$251.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$304.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.20
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Healthscope Whirlpool |
$314.28
|
| Rate for Payer: Mclaren Commercial |
$291.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.12
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Medicare |
$22.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: ASR ASR |
$314.28
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$251.20
|
| Rate for Payer: BCN Commercial |
$251.20
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$304.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Healthscope Whirlpool |
$314.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.17
|
| Rate for Payer: Mclaren Commercial |
$291.60
|
| Rate for Payer: Mclaren Medicaid |
$12.13
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Medicaid |
$12.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.40
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$24.39
|
| Rate for Payer: PHP Medicaid |
$12.13
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.84
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$230.04
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.12
|
| Rate for Payer: UHC Medicare Advantage |
$22.84
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$135.80
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$108.54
|
| Rate for Payer: BCN Commercial |
$108.54
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$140.00
|
| Rate for Payer: Healthscope Whirlpool |
$135.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$126.00
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$13.18
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$99.40
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.20
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: ASR ASR |
$135.80
|
| Rate for Payer: BCBS Trust/PPO |
$108.54
|
| Rate for Payer: BCN Commercial |
$108.54
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$140.00
|
| Rate for Payer: Healthscope Whirlpool |
$135.80
|
| Rate for Payer: Mclaren Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.20
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
IP
|
$68.42
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: ASR ASR |
$66.37
|
| Rate for Payer: BCBS Trust/PPO |
$53.05
|
| Rate for Payer: BCN Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$54.74
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.74
|
| Rate for Payer: Healthscope Commercial |
$68.42
|
| Rate for Payer: Healthscope Whirlpool |
$66.37
|
| Rate for Payer: Mclaren Commercial |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.21
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
OP
|
$68.42
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: ASR ASR |
$66.37
|
| Rate for Payer: BCBS Complete |
$27.37
|
| Rate for Payer: BCBS Trust/PPO |
$53.05
|
| Rate for Payer: BCN Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$54.74
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.74
|
| Rate for Payer: Healthscope Commercial |
$68.42
|
| Rate for Payer: Healthscope Whirlpool |
$66.37
|
| Rate for Payer: Mclaren Commercial |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.26
|
| Rate for Payer: Priority Health Narrow Network |
$48.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.21
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
OP
|
$831.27
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$831.27 |
| Rate for Payer: Aetna Commercial |
$748.14
|
| Rate for Payer: ASR ASR |
$806.33
|
| Rate for Payer: BCBS Complete |
$332.51
|
| Rate for Payer: BCBS Trust/PPO |
$644.48
|
| Rate for Payer: BCN Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$665.02
|
| Rate for Payer: Cofinity Commercial |
$781.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.02
|
| Rate for Payer: Healthscope Commercial |
$831.27
|
| Rate for Payer: Healthscope Whirlpool |
$806.33
|
| Rate for Payer: Mclaren Commercial |
$748.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$706.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$756.46
|
| Rate for Payer: Priority Health Narrow Network |
$590.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$731.52
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
IP
|
$831.27
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$581.89 |
| Max. Negotiated Rate |
$831.27 |
| Rate for Payer: Aetna Commercial |
$748.14
|
| Rate for Payer: ASR ASR |
$806.33
|
| Rate for Payer: BCBS Trust/PPO |
$644.48
|
| Rate for Payer: BCN Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$665.02
|
| Rate for Payer: Cofinity Commercial |
$781.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.02
|
| Rate for Payer: Healthscope Commercial |
$831.27
|
| Rate for Payer: Healthscope Whirlpool |
$806.33
|
| Rate for Payer: Mclaren Commercial |
$748.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$706.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$731.52
|
|
|
HC THORACENT WO TUBE
|
Facility
|
IP
|
$1,088.19
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$761.73 |
| Max. Negotiated Rate |
$1,088.19 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: ASR ASR |
$1,055.54
|
| Rate for Payer: BCBS Trust/PPO |
$843.67
|
| Rate for Payer: BCN Commercial |
$843.67
|
| Rate for Payer: Cash Price |
$870.55
|
| Rate for Payer: Cofinity Commercial |
$1,022.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.55
|
| Rate for Payer: Healthscope Commercial |
$1,088.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,055.54
|
| Rate for Payer: Mclaren Commercial |
$979.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$924.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$957.61
|
|
|
HC THORACENT WO TUBE
|
Facility
|
OP
|
$1,088.19
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$1,088.19 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: Aetna Medicare |
$558.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.00
|
| Rate for Payer: ASR ASR |
$1,055.54
|
| Rate for Payer: BCBS Complete |
$320.74
|
| Rate for Payer: BCBS MAPPO |
$558.40
|
| Rate for Payer: BCBS Trust/PPO |
$843.67
|
| Rate for Payer: BCN Commercial |
$843.67
|
| Rate for Payer: BCN Medicare Advantage |
$558.40
|
| Rate for Payer: Cash Price |
$870.55
|
| Rate for Payer: Cash Price |
$870.55
|
| Rate for Payer: Cofinity Commercial |
$1,022.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.40
|
| Rate for Payer: Healthscope Commercial |
$1,088.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,055.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.40
|
| Rate for Payer: Mclaren Commercial |
$979.37
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Mclaren Medicare |
$558.40
|
| Rate for Payer: Meridian Medicaid |
$320.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$924.96
|
| Rate for Payer: PACE Medicare |
$530.48
|
| Rate for Payer: PACE SWMI |
$558.40
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: PHP Medicaid |
$305.44
|
| Rate for Payer: PHP Medicare Advantage |
$558.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$441.26
|
| Rate for Payer: Priority Health Medicare |
$558.40
|
| Rate for Payer: Priority Health Narrow Network |
$353.01
|
| Rate for Payer: Railroad Medicare Medicare |
$558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$957.61
|
| Rate for Payer: UHC Medicare Advantage |
$575.15
|
| Rate for Payer: VA VA |
$558.40
|
|
|
HC THORACENT W TUBE
|
Facility
|
IP
|
$1,386.74
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$970.72 |
| Max. Negotiated Rate |
$1,386.74 |
| Rate for Payer: Aetna Commercial |
$1,248.07
|
| Rate for Payer: ASR ASR |
$1,345.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.14
|
| Rate for Payer: BCN Commercial |
$1,075.14
|
| Rate for Payer: Cash Price |
$1,109.39
|
| Rate for Payer: Cofinity Commercial |
$1,303.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,109.39
|
| Rate for Payer: Healthscope Commercial |
$1,386.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,345.14
|
| Rate for Payer: Mclaren Commercial |
$1,248.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,178.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,220.33
|
|
|
HC THORACENT W TUBE
|
Facility
|
OP
|
$1,386.74
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$353.01 |
| Max. Negotiated Rate |
$1,779.46 |
| Rate for Payer: Aetna Commercial |
$1,248.07
|
| Rate for Payer: Aetna Medicare |
$1,423.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: ASR ASR |
$1,345.14
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.14
|
| Rate for Payer: BCN Commercial |
$1,075.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Cash Price |
$1,109.39
|
| Rate for Payer: Cash Price |
$1,109.39
|
| Rate for Payer: Cofinity Commercial |
$1,303.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,109.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Healthscope Commercial |
$1,386.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,345.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,423.57
|
| Rate for Payer: Mclaren Commercial |
$1,248.07
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,178.73
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Commercial |
$1,565.93
|
| Rate for Payer: PHP Medicaid |
$778.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$441.26
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$353.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,220.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$691.08
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$483.76 |
| Max. Negotiated Rate |
$691.08 |
| Rate for Payer: Aetna Commercial |
$621.97
|
| Rate for Payer: ASR ASR |
$670.35
|
| Rate for Payer: BCBS Trust/PPO |
$535.79
|
| Rate for Payer: BCN Commercial |
$535.79
|
| Rate for Payer: Cash Price |
$552.86
|
| Rate for Payer: Cofinity Commercial |
$649.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.86
|
| Rate for Payer: Healthscope Commercial |
$691.08
|
| Rate for Payer: Healthscope Whirlpool |
$670.35
|
| Rate for Payer: Mclaren Commercial |
$621.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.15
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$691.08
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$691.08 |
| Rate for Payer: Aetna Commercial |
$621.97
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$670.35
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$535.79
|
| Rate for Payer: BCN Commercial |
$535.79
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$552.86
|
| Rate for Payer: Cash Price |
$552.86
|
| Rate for Payer: Cofinity Commercial |
$649.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$691.08
|
| Rate for Payer: Healthscope Whirlpool |
$670.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$621.97
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.42
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.72
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$85.38
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.15
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,050.86
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.34 |
| Max. Negotiated Rate |
$2,050.86 |
| Rate for Payer: Aetna Commercial |
$1,845.77
|
| Rate for Payer: ASR ASR |
$1,989.33
|
| Rate for Payer: BCBS Complete |
$820.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,590.03
|
| Rate for Payer: BCN Commercial |
$1,590.03
|
| Rate for Payer: Cash Price |
$1,640.69
|
| Rate for Payer: Cofinity Commercial |
$1,927.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.69
|
| Rate for Payer: Healthscope Commercial |
$2,050.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,989.33
|
| Rate for Payer: Mclaren Commercial |
$1,845.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,866.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,456.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,804.76
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,050.86
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,435.60 |
| Max. Negotiated Rate |
$2,050.86 |
| Rate for Payer: Aetna Commercial |
$1,845.77
|
| Rate for Payer: ASR ASR |
$1,989.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,590.03
|
| Rate for Payer: BCN Commercial |
$1,590.03
|
| Rate for Payer: Cash Price |
$1,640.69
|
| Rate for Payer: Cofinity Commercial |
$1,927.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.69
|
| Rate for Payer: Healthscope Commercial |
$2,050.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,989.33
|
| Rate for Payer: Mclaren Commercial |
$1,845.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,804.76
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$4,870.71
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,409.50 |
| Max. Negotiated Rate |
$4,870.71 |
| Rate for Payer: Aetna Commercial |
$4,383.64
|
| Rate for Payer: ASR ASR |
$4,724.59
|
| Rate for Payer: BCBS Trust/PPO |
$3,776.26
|
| Rate for Payer: BCN Commercial |
$3,776.26
|
| Rate for Payer: Cash Price |
$3,896.57
|
| Rate for Payer: Cofinity Commercial |
$4,578.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,896.57
|
| Rate for Payer: Healthscope Commercial |
$4,870.71
|
| Rate for Payer: Healthscope Whirlpool |
$4,724.59
|
| Rate for Payer: Mclaren Commercial |
$4,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,140.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,409.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,286.22
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$4,870.71
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,948.28 |
| Max. Negotiated Rate |
$4,870.71 |
| Rate for Payer: Aetna Commercial |
$4,383.64
|
| Rate for Payer: ASR ASR |
$4,724.59
|
| Rate for Payer: BCBS Complete |
$1,948.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,776.26
|
| Rate for Payer: BCN Commercial |
$3,776.26
|
| Rate for Payer: Cash Price |
$3,896.57
|
| Rate for Payer: Cofinity Commercial |
$4,578.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,896.57
|
| Rate for Payer: Healthscope Commercial |
$4,870.71
|
| Rate for Payer: Healthscope Whirlpool |
$4,724.59
|
| Rate for Payer: Mclaren Commercial |
$4,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,140.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,432.35
|
| Rate for Payer: Priority Health Narrow Network |
$3,458.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,286.22
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: ASR ASR |
$72.23
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.77
|
| Rate for Payer: Mclaren Commercial |
$67.01
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$6.35
|
| Rate for Payer: PHP Medicaid |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.76
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health Narrow Network |
$52.87
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.52
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| Rate for Payer: VA VA |
$5.77
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: ASR ASR |
$72.23
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.23
|
| Rate for Payer: Mclaren Commercial |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.52
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$102.93
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.05 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$92.64
|
| Rate for Payer: ASR ASR |
$99.84
|
| Rate for Payer: BCBS Trust/PPO |
$79.80
|
| Rate for Payer: BCN Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Healthscope Commercial |
$102.93
|
| Rate for Payer: Healthscope Whirlpool |
$99.84
|
| Rate for Payer: Mclaren Commercial |
$92.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.58
|
|
