|
HC POC URINE PREG TEST
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: ASR ASR |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$23.85
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.61
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$4.61
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$9.47
|
| Rate for Payer: PHP Medicaid |
$4.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health Narrow Network |
$20.42
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Exchange |
$13.35
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: UHCCP DNSP |
$8.61
|
| Rate for Payer: UHCCP Medicaid |
$4.61
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC POC WET PREP
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$41.81
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
|
|
HC POC WET PREP
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.28
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Complete |
$3.28
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$42.02
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.82
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$3.12
|
| Rate for Payer: Mclaren Medicare |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Meridian Medicaid |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Medicare |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$6.40
|
| Rate for Payer: PHP Medicaid |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.96
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Narrow Network |
$35.97
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: UHCCP DNSP |
$5.82
|
| Rate for Payer: UHCCP Medicaid |
$3.12
|
| Rate for Payer: VA VA |
$5.82
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$274.17 |
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: ASR ASR |
$265.94
|
| Rate for Payer: ASR Commercial |
$265.94
|
| Rate for Payer: BCBS Trust/PPO |
$223.42
|
| Rate for Payer: BCN Commercial |
$212.56
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$257.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$274.17
|
| Rate for Payer: Healthscope Whirlpool |
$265.94
|
| Rate for Payer: Mclaren Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.27
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$274.17 |
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Medicare |
$137.09
|
| Rate for Payer: ASR ASR |
$265.94
|
| Rate for Payer: ASR Commercial |
$265.94
|
| Rate for Payer: BCBS Complete |
$109.67
|
| Rate for Payer: BCBS Trust/PPO |
$224.52
|
| Rate for Payer: BCN Commercial |
$212.56
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$257.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$274.17
|
| Rate for Payer: Healthscope Whirlpool |
$265.94
|
| Rate for Payer: Mclaren Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.23
|
| Rate for Payer: Priority Health Narrow Network |
$192.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.27
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$43.49 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: ASR ASR |
$42.19
|
| Rate for Payer: ASR Commercial |
$42.19
|
| Rate for Payer: BCBS Trust/PPO |
$35.44
|
| Rate for Payer: BCN Commercial |
$33.72
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$40.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$43.49
|
| Rate for Payer: Healthscope Whirlpool |
$42.19
|
| Rate for Payer: Mclaren Commercial |
$39.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: Nomi Health Commercial |
$35.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.27
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$43.49 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: ASR ASR |
$42.19
|
| Rate for Payer: ASR Commercial |
$42.19
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$35.61
|
| Rate for Payer: BCN Commercial |
$33.72
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$40.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$43.49
|
| Rate for Payer: Healthscope Whirlpool |
$42.19
|
| Rate for Payer: Mclaren Commercial |
$39.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: Nomi Health Commercial |
$35.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.11
|
| Rate for Payer: Priority Health Narrow Network |
$30.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.27
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.79 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna Commercial |
$481.02
|
| Rate for Payer: Aetna Medicare |
$267.24
|
| Rate for Payer: ASR ASR |
$518.44
|
| Rate for Payer: ASR Commercial |
$518.44
|
| Rate for Payer: BCBS Complete |
$213.79
|
| Rate for Payer: BCBS Trust/PPO |
$437.68
|
| Rate for Payer: BCN Commercial |
$414.37
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$502.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Healthscope Whirlpool |
$518.44
|
| Rate for Payer: Mclaren Commercial |
$481.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: Nomi Health Commercial |
$438.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.30
|
| Rate for Payer: Priority Health Narrow Network |
$374.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.33
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna Commercial |
$481.02
|
| Rate for Payer: ASR ASR |
$518.44
|
| Rate for Payer: ASR Commercial |
$518.44
|
| Rate for Payer: BCBS Trust/PPO |
$435.54
|
| Rate for Payer: BCN Commercial |
$414.37
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$502.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Healthscope Whirlpool |
$518.44
|
| Rate for Payer: Mclaren Commercial |
$481.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: Nomi Health Commercial |
$438.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.33
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.77 |
| Max. Negotiated Rate |
$182.73 |
| Rate for Payer: Aetna Commercial |
$164.46
|
| Rate for Payer: ASR ASR |
$177.25
|
| Rate for Payer: ASR Commercial |
$177.25
|
| Rate for Payer: BCBS Trust/PPO |
$148.91
|
| Rate for Payer: BCN Commercial |
$141.67
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$182.73
|
| Rate for Payer: Healthscope Whirlpool |
$177.25
|
| Rate for Payer: Mclaren Commercial |
$164.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: Nomi Health Commercial |
$149.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.80
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$182.73 |
| Rate for Payer: Aetna Commercial |
$164.46
|
| Rate for Payer: Aetna Medicare |
$91.36
|
| Rate for Payer: ASR ASR |
$177.25
|
| Rate for Payer: ASR Commercial |
$177.25
|
| Rate for Payer: BCBS Complete |
$73.09
|
| Rate for Payer: BCBS Trust/PPO |
$149.64
|
| Rate for Payer: BCN Commercial |
$141.67
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$182.73
|
| Rate for Payer: Healthscope Whirlpool |
$177.25
|
| Rate for Payer: Mclaren Commercial |
$164.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: Nomi Health Commercial |
$149.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.11
|
| Rate for Payer: Priority Health Narrow Network |
$128.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.80
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$33.29 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: ASR ASR |
$32.29
|
| Rate for Payer: ASR Commercial |
$32.29
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$25.81
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$33.29
|
| Rate for Payer: Healthscope Whirlpool |
$32.29
|
| Rate for Payer: Mclaren Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.30
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$33.29 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: ASR ASR |
$32.29
|
| Rate for Payer: ASR Commercial |
$32.29
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$27.26
|
| Rate for Payer: BCN Commercial |
$25.81
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$33.29
|
| Rate for Payer: Healthscope Whirlpool |
$32.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.71
|
| Rate for Payer: Mclaren Commercial |
$29.96
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Medicaid |
$7.88
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.17
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow Network |
$23.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.71
|
| Rate for Payer: UHC Exchange |
$22.80
|
| Rate for Payer: UHC Medicare Advantage |
$14.71
|
| Rate for Payer: UHCCP DNSP |
$14.71
|
| Rate for Payer: UHCCP Medicaid |
$7.88
|
| Rate for Payer: VA VA |
$14.71
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: ASR Commercial |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$25.77
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: ASR Commercial |
$30.67
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.44
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: PHP Medicaid |
$4.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.71
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Narrow Network |
$22.17
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Exchange |
$13.08
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: UHCCP DNSP |
$8.44
|
| Rate for Payer: UHCCP Medicaid |
$4.52
|
| Rate for Payer: VA VA |
$8.44
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$267.38 |
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: ASR ASR |
$259.36
|
| Rate for Payer: ASR Commercial |
$259.36
|
| Rate for Payer: BCBS Trust/PPO |
$217.89
|
| Rate for Payer: BCN Commercial |
$207.30
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$267.38
|
| Rate for Payer: Healthscope Whirlpool |
$259.36
|
| Rate for Payer: Mclaren Commercial |
$240.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Nomi Health Commercial |
$219.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.29
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$267.38 |
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: ASR ASR |
$259.36
|
| Rate for Payer: ASR Commercial |
$259.36
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Trust/PPO |
$218.96
|
| Rate for Payer: BCN Commercial |
$207.30
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$267.38
|
| Rate for Payer: Healthscope Whirlpool |
$259.36
|
| Rate for Payer: Mclaren Commercial |
$240.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Nomi Health Commercial |
$219.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.28
|
| Rate for Payer: Priority Health Narrow Network |
$187.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.29
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$553.49 |
| Rate for Payer: Aetna Commercial |
$498.14
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$536.89
|
| Rate for Payer: ASR Commercial |
$536.89
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$453.25
|
| Rate for Payer: BCN Commercial |
$429.12
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$553.49
|
| Rate for Payer: Healthscope Whirlpool |
$536.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$498.14
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$484.97
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$388.00
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$553.49 |
| Rate for Payer: Aetna Commercial |
$498.14
|
| Rate for Payer: ASR ASR |
$536.89
|
| Rate for Payer: ASR Commercial |
$536.89
|
| Rate for Payer: BCBS Trust/PPO |
$451.04
|
| Rate for Payer: BCN Commercial |
$429.12
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Healthscope Commercial |
$553.49
|
| Rate for Payer: Healthscope Whirlpool |
$536.89
|
| Rate for Payer: Mclaren Commercial |
$498.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.07
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$1,629.13 |
| Rate for Payer: Aetna Commercial |
$1,466.22
|
| Rate for Payer: Aetna Medicare |
$671.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$839.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$839.02
|
| Rate for Payer: ASR ASR |
$1,580.26
|
| Rate for Payer: ASR Commercial |
$1,580.26
|
| Rate for Payer: BCBS Complete |
$377.76
|
| Rate for Payer: BCBS MAPPO |
$671.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,334.09
|
| Rate for Payer: BCN Commercial |
$1,263.06
|
| Rate for Payer: BCN Medicare Advantage |
$671.22
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,531.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.22
|
| Rate for Payer: Healthscope Commercial |
$1,629.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,580.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$671.22
|
| Rate for Payer: Mclaren Commercial |
$1,466.22
|
| Rate for Payer: Mclaren Medicaid |
$359.77
|
| Rate for Payer: Mclaren Medicare |
$671.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.78
|
| Rate for Payer: Meridian Medicaid |
$377.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$771.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: Nomi Health Commercial |
$1,335.89
|
| Rate for Payer: PACE Medicare |
$637.66
|
| Rate for Payer: PACE SWMI |
$671.22
|
| Rate for Payer: PHP Commercial |
$738.34
|
| Rate for Payer: PHP Medicaid |
$359.77
|
| Rate for Payer: PHP Medicare Advantage |
$671.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,427.44
|
| Rate for Payer: Priority Health Medicare |
$671.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.02
|
| Rate for Payer: Railroad Medicare Medicare |
$671.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,433.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$671.22
|
| Rate for Payer: UHC Exchange |
$1,040.39
|
| Rate for Payer: UHC Medicare Advantage |
$671.22
|
| Rate for Payer: UHCCP DNSP |
$671.22
|
| Rate for Payer: UHCCP Medicaid |
$359.77
|
| Rate for Payer: VA VA |
$671.22
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,058.93 |
| Max. Negotiated Rate |
$1,629.13 |
| Rate for Payer: Aetna Commercial |
$1,466.22
|
| Rate for Payer: ASR ASR |
$1,580.26
|
| Rate for Payer: ASR Commercial |
$1,580.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.58
|
| Rate for Payer: BCN Commercial |
$1,263.06
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,531.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Healthscope Commercial |
$1,629.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,580.26
|
| Rate for Payer: Mclaren Commercial |
$1,466.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: Nomi Health Commercial |
$1,335.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,433.63
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.77
|
| Rate for Payer: Priority Health Narrow Network |
$48.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.52
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$66.82
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
