|
HC PICC INTRODUCER
|
Facility
|
OP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$88.49
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: ASR ASR |
$95.37
|
| Rate for Payer: ASR Commercial |
$95.37
|
| Rate for Payer: BCBS Complete |
$39.33
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$76.23
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$92.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Healthscope Whirlpool |
$95.37
|
| Rate for Payer: Mclaren Commercial |
$88.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.15
|
| Rate for Payer: Priority Health Narrow Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.52
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
IP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$112.59 |
| Rate for Payer: Aetna Commercial |
$101.33
|
| Rate for Payer: ASR ASR |
$109.21
|
| Rate for Payer: ASR Commercial |
$109.21
|
| Rate for Payer: BCBS Trust/PPO |
$91.75
|
| Rate for Payer: BCN Commercial |
$87.29
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$105.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Healthscope Commercial |
$112.59
|
| Rate for Payer: Healthscope Whirlpool |
$109.21
|
| Rate for Payer: Mclaren Commercial |
$101.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.08
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
OP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$112.59 |
| Rate for Payer: Aetna Commercial |
$101.33
|
| Rate for Payer: Aetna Medicare |
$56.30
|
| Rate for Payer: ASR ASR |
$109.21
|
| Rate for Payer: ASR Commercial |
$109.21
|
| Rate for Payer: BCBS Complete |
$45.04
|
| Rate for Payer: BCBS Trust/PPO |
$92.20
|
| Rate for Payer: BCN Commercial |
$87.29
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$105.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Healthscope Commercial |
$112.59
|
| Rate for Payer: Healthscope Whirlpool |
$109.21
|
| Rate for Payer: Mclaren Commercial |
$101.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.65
|
| Rate for Payer: Priority Health Narrow Network |
$78.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.08
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: ASR ASR |
$194.91
|
| Rate for Payer: ASR Commercial |
$194.91
|
| Rate for Payer: BCBS Trust/PPO |
$163.75
|
| Rate for Payer: BCN Commercial |
$155.79
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$188.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$200.94
|
| Rate for Payer: Healthscope Whirlpool |
$194.91
|
| Rate for Payer: Mclaren Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.83
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: Aetna Medicare |
$100.47
|
| Rate for Payer: ASR ASR |
$194.91
|
| Rate for Payer: ASR Commercial |
$194.91
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS Trust/PPO |
$164.55
|
| Rate for Payer: BCN Commercial |
$155.79
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$188.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$200.94
|
| Rate for Payer: Healthscope Whirlpool |
$194.91
|
| Rate for Payer: Mclaren Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.83
|
|
|
HC PICU OR PED CRITICAL CARE R&B
|
Facility
|
IP
|
$7,801.90
|
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,071.24 |
| Max. Negotiated Rate |
$7,801.90 |
| Rate for Payer: Aetna Commercial |
$7,021.71
|
| Rate for Payer: ASR ASR |
$7,567.84
|
| Rate for Payer: ASR Commercial |
$7,567.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,357.77
|
| Rate for Payer: BCN Commercial |
$6,048.81
|
| Rate for Payer: Cash Price |
$6,241.52
|
| Rate for Payer: Cofinity Commercial |
$7,333.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,241.52
|
| Rate for Payer: Healthscope Commercial |
$7,801.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,567.84
|
| Rate for Payer: Mclaren Commercial |
$7,021.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,631.62
|
| Rate for Payer: Nomi Health Commercial |
$6,397.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,071.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,865.67
|
|
|
HC PICU OR PED INTERMEDIATE CARE R&B
|
Facility
|
IP
|
$6,510.25
|
|
| Hospital Charge Code |
20600002
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,231.66 |
| Max. Negotiated Rate |
$6,510.25 |
| Rate for Payer: Aetna Commercial |
$5,859.22
|
| Rate for Payer: ASR ASR |
$6,314.94
|
| Rate for Payer: ASR Commercial |
$6,314.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,305.20
|
| Rate for Payer: BCN Commercial |
$5,047.40
|
| Rate for Payer: Cash Price |
$5,208.20
|
| Rate for Payer: Cofinity Commercial |
$6,119.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,208.20
|
| Rate for Payer: Healthscope Commercial |
$6,510.25
|
| Rate for Payer: Healthscope Whirlpool |
$6,314.94
|
| Rate for Payer: Mclaren Commercial |
$5,859.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,533.71
|
| Rate for Payer: Nomi Health Commercial |
$5,338.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,729.02
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
IP
|
$315.06
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$315.06 |
| Rate for Payer: Aetna Commercial |
$283.55
|
| Rate for Payer: ASR ASR |
$305.61
|
| Rate for Payer: ASR Commercial |
$305.61
|
| Rate for Payer: BCBS Trust/PPO |
$256.74
|
| Rate for Payer: BCN Commercial |
$244.27
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$296.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$315.06
|
| Rate for Payer: Healthscope Whirlpool |
$305.61
|
| Rate for Payer: Mclaren Commercial |
$283.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.25
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
OP
|
$315.06
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$126.02 |
| Max. Negotiated Rate |
$315.06 |
| Rate for Payer: Aetna Commercial |
$283.55
|
| Rate for Payer: Aetna Medicare |
$157.53
|
| Rate for Payer: ASR ASR |
$305.61
|
| Rate for Payer: ASR Commercial |
$305.61
|
| Rate for Payer: BCBS Complete |
$126.02
|
| Rate for Payer: BCBS Trust/PPO |
$258.00
|
| Rate for Payer: BCN Commercial |
$244.27
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$296.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$315.06
|
| Rate for Payer: Healthscope Whirlpool |
$305.61
|
| Rate for Payer: Mclaren Commercial |
$283.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.06
|
| Rate for Payer: Priority Health Narrow Network |
$220.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.25
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
OP
|
$1,560.60
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$178.19 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna Commercial |
$1,404.54
|
| Rate for Payer: Aetna Medicare |
$332.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$415.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$415.55
|
| Rate for Payer: ASR ASR |
$1,513.78
|
| Rate for Payer: ASR Commercial |
$1,513.78
|
| Rate for Payer: BCBS Complete |
$187.10
|
| Rate for Payer: BCBS MAPPO |
$332.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.98
|
| Rate for Payer: BCN Commercial |
$1,209.93
|
| Rate for Payer: BCN Medicare Advantage |
$332.44
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cofinity Commercial |
$1,466.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.44
|
| Rate for Payer: Healthscope Commercial |
$1,560.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,513.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$332.44
|
| Rate for Payer: Mclaren Commercial |
$1,404.54
|
| Rate for Payer: Mclaren Medicaid |
$178.19
|
| Rate for Payer: Mclaren Medicare |
$332.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.06
|
| Rate for Payer: Meridian Medicaid |
$187.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$382.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.51
|
| Rate for Payer: Nomi Health Commercial |
$1,279.69
|
| Rate for Payer: PACE Medicare |
$315.82
|
| Rate for Payer: PACE SWMI |
$332.44
|
| Rate for Payer: PHP Commercial |
$365.68
|
| Rate for Payer: PHP Medicaid |
$178.19
|
| Rate for Payer: PHP Medicare Advantage |
$332.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.36
|
| Rate for Payer: Priority Health Medicare |
$332.44
|
| Rate for Payer: Priority Health Narrow Network |
$501.89
|
| Rate for Payer: Railroad Medicare Medicare |
$332.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.44
|
| Rate for Payer: UHC Exchange |
$515.28
|
| Rate for Payer: UHC Medicare Advantage |
$332.44
|
| Rate for Payer: UHCCP DNSP |
$332.44
|
| Rate for Payer: UHCCP Medicaid |
$178.19
|
| Rate for Payer: VA VA |
$332.44
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
IP
|
$1,560.60
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,014.39 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna Commercial |
$1,404.54
|
| Rate for Payer: ASR ASR |
$1,513.78
|
| Rate for Payer: ASR Commercial |
$1,513.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.73
|
| Rate for Payer: BCN Commercial |
$1,209.93
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cofinity Commercial |
$1,466.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.48
|
| Rate for Payer: Healthscope Commercial |
$1,560.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,513.78
|
| Rate for Payer: Mclaren Commercial |
$1,404.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.51
|
| Rate for Payer: Nomi Health Commercial |
$1,279.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.33
|
|
|
HC PIGWEED IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC PIGWEED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PI LINKED ANTIGEN
|
Facility
|
OP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$153.70
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$165.66
|
| Rate for Payer: ASR Commercial |
$165.66
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$139.85
|
| Rate for Payer: BCN Commercial |
$132.41
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$160.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$170.78
|
| Rate for Payer: Healthscope Whirlpool |
$165.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$153.70
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: Nomi Health Commercial |
$140.04
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC PI LINKED ANTIGEN
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$170.78 |
| Rate for Payer: Aetna Commercial |
$153.70
|
| Rate for Payer: ASR ASR |
$165.66
|
| Rate for Payer: ASR Commercial |
$165.66
|
| Rate for Payer: BCBS Trust/PPO |
$139.17
|
| Rate for Payer: BCN Commercial |
$132.41
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$160.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Healthscope Commercial |
$170.78
|
| Rate for Payer: Healthscope Whirlpool |
$165.66
|
| Rate for Payer: Mclaren Commercial |
$153.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: Nomi Health Commercial |
$140.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.29
|
|
|
HC PI LINKED ANTIGEN CMPT
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$170.78 |
| Rate for Payer: Aetna Commercial |
$153.70
|
| Rate for Payer: ASR ASR |
$165.66
|
| Rate for Payer: ASR Commercial |
$165.66
|
| Rate for Payer: BCBS Trust/PPO |
$139.17
|
| Rate for Payer: BCN Commercial |
$132.41
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$160.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Healthscope Commercial |
$170.78
|
| Rate for Payer: Healthscope Whirlpool |
$165.66
|
| Rate for Payer: Mclaren Commercial |
$153.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: Nomi Health Commercial |
$140.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.29
|
|
|
HC PI LINKED ANTIGEN CMPT
|
Facility
|
OP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$153.70
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$165.66
|
| Rate for Payer: ASR Commercial |
$165.66
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$139.85
|
| Rate for Payer: BCN Commercial |
$132.41
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$160.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$170.78
|
| Rate for Payer: Healthscope Whirlpool |
$165.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$153.70
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: Nomi Health Commercial |
$140.04
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
OP
|
$61.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: Aetna Medicare |
$30.92
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: ASR Commercial |
$59.99
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$50.65
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.57
|
| Rate for Payer: Nomi Health Commercial |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
IP
|
$61.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: ASR Commercial |
$59.99
|
| Rate for Payer: BCBS Trust/PPO |
$50.40
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.57
|
| Rate for Payer: Nomi Health Commercial |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC PINWORM EXAM
|
Facility
|
OP
|
$55.49
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$53.83
|
| Rate for Payer: ASR Commercial |
$53.83
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$45.44
|
| Rate for Payer: BCN Commercial |
$43.02
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$55.49
|
| Rate for Payer: Healthscope Whirlpool |
$53.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$49.94
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.17
|
| Rate for Payer: Nomi Health Commercial |
$45.50
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.91
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$21.53
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC PINWORM EXAM
|
Facility
|
IP
|
$55.49
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.07 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: ASR ASR |
$53.83
|
| Rate for Payer: ASR Commercial |
$53.83
|
| Rate for Payer: BCBS Trust/PPO |
$45.22
|
| Rate for Payer: BCN Commercial |
$43.02
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.39
|
| Rate for Payer: Healthscope Commercial |
$55.49
|
| Rate for Payer: Healthscope Whirlpool |
$53.83
|
| Rate for Payer: Mclaren Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.17
|
| Rate for Payer: Nomi Health Commercial |
$45.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.83
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
IP
|
$9,316.79
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,055.91 |
| Max. Negotiated Rate |
$9,316.79 |
| Rate for Payer: Aetna Commercial |
$8,385.11
|
| Rate for Payer: ASR ASR |
$9,037.29
|
| Rate for Payer: ASR Commercial |
$9,037.29
|
| Rate for Payer: BCBS Trust/PPO |
$7,592.25
|
| Rate for Payer: BCN Commercial |
$7,223.31
|
| Rate for Payer: Cash Price |
$7,453.43
|
| Rate for Payer: Cofinity Commercial |
$8,757.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,453.43
|
| Rate for Payer: Healthscope Commercial |
$9,316.79
|
| Rate for Payer: Healthscope Whirlpool |
$9,037.29
|
| Rate for Payer: Mclaren Commercial |
$8,385.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,919.27
|
| Rate for Payer: Nomi Health Commercial |
$7,639.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,055.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,198.78
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
OP
|
$9,316.79
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,726.72 |
| Max. Negotiated Rate |
$9,316.79 |
| Rate for Payer: Aetna Commercial |
$8,385.11
|
| Rate for Payer: Aetna Medicare |
$4,658.40
|
| Rate for Payer: ASR ASR |
$9,037.29
|
| Rate for Payer: ASR Commercial |
$9,037.29
|
| Rate for Payer: BCBS Complete |
$3,726.72
|
| Rate for Payer: BCBS Trust/PPO |
$7,629.52
|
| Rate for Payer: BCN Commercial |
$7,223.31
|
| Rate for Payer: Cash Price |
$7,453.43
|
| Rate for Payer: Cofinity Commercial |
$8,757.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,453.43
|
| Rate for Payer: Healthscope Commercial |
$9,316.79
|
| Rate for Payer: Healthscope Whirlpool |
$9,037.29
|
| Rate for Payer: Mclaren Commercial |
$8,385.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,919.27
|
| Rate for Payer: Nomi Health Commercial |
$7,639.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,055.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,163.37
|
| Rate for Payer: Priority Health Narrow Network |
$6,531.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,198.78
|
|
|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
OP
|
$19,571.39
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,828.56 |
| Max. Negotiated Rate |
$19,571.39 |
| Rate for Payer: Aetna Commercial |
$17,614.25
|
| Rate for Payer: Aetna Medicare |
$9,785.70
|
| Rate for Payer: ASR ASR |
$18,984.25
|
| Rate for Payer: ASR Commercial |
$18,984.25
|
| Rate for Payer: BCBS Complete |
$7,828.56
|
| Rate for Payer: BCBS Trust/PPO |
$16,027.01
|
| Rate for Payer: BCN Commercial |
$15,173.70
|
| Rate for Payer: Cash Price |
$15,657.11
|
| Rate for Payer: Cofinity Commercial |
$18,397.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,657.11
|
| Rate for Payer: Healthscope Commercial |
$19,571.39
|
| Rate for Payer: Healthscope Whirlpool |
$18,984.25
|
| Rate for Payer: Mclaren Commercial |
$17,614.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,635.68
|
| Rate for Payer: Nomi Health Commercial |
$16,048.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,721.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,148.45
|
| Rate for Payer: Priority Health Narrow Network |
$13,719.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,222.82
|
|
|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
IP
|
$19,571.39
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.40 |
| Max. Negotiated Rate |
$19,571.39 |
| Rate for Payer: Aetna Commercial |
$17,614.25
|
| Rate for Payer: ASR ASR |
$18,984.25
|
| Rate for Payer: ASR Commercial |
$18,984.25
|
| Rate for Payer: BCBS Trust/PPO |
$15,948.73
|
| Rate for Payer: BCN Commercial |
$15,173.70
|
| Rate for Payer: Cash Price |
$15,657.11
|
| Rate for Payer: Cofinity Commercial |
$18,397.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,657.11
|
| Rate for Payer: Healthscope Commercial |
$19,571.39
|
| Rate for Payer: Healthscope Whirlpool |
$18,984.25
|
| Rate for Payer: Mclaren Commercial |
$17,614.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,635.68
|
| Rate for Payer: Nomi Health Commercial |
$16,048.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,721.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,222.82
|
|
