|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$243.98
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.27 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$219.58
|
| Rate for Payer: Aetna Medicare |
$90.27
|
| Rate for Payer: ASR ASR |
$236.66
|
| Rate for Payer: BCBS Complete |
$97.59
|
| Rate for Payer: BCBS Trust/PPO |
$201.16
|
| Rate for Payer: BCN Commercial |
$201.16
|
| Rate for Payer: Cash Price |
$195.18
|
| Rate for Payer: Cofinity Commercial |
$229.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.18
|
| Rate for Payer: Healthscope Commercial |
$236.66
|
| Rate for Payer: Healthscope Whirlpool |
$243.98
|
| Rate for Payer: Mclaren Commercial |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.38
|
| Rate for Payer: Nomi Health Commercial |
$200.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.78
|
| Rate for Payer: Priority Health Narrow Network |
$171.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.70
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$243.98
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$219.58
|
| Rate for Payer: ASR ASR |
$236.66
|
| Rate for Payer: BCBS Trust/PPO |
$200.36
|
| Rate for Payer: BCN Commercial |
$200.36
|
| Rate for Payer: Cash Price |
$195.18
|
| Rate for Payer: Cofinity Commercial |
$229.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.18
|
| Rate for Payer: Healthscope Commercial |
$236.66
|
| Rate for Payer: Healthscope Whirlpool |
$243.98
|
| Rate for Payer: Mclaren Commercial |
$219.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.38
|
| Rate for Payer: Nomi Health Commercial |
$200.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.70
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$65.47
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$157.38 |
| Rate for Payer: Aetna Commercial |
$58.92
|
| Rate for Payer: Aetna Medicare |
$36.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.71
|
| Rate for Payer: ASR ASR |
$63.51
|
| Rate for Payer: BCBS Complete |
$20.08
|
| Rate for Payer: BCBS MAPPO |
$36.57
|
| Rate for Payer: BCBS Trust/PPO |
$53.98
|
| Rate for Payer: BCN Commercial |
$53.98
|
| Rate for Payer: BCN Medicare Advantage |
$36.57
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$63.51
|
| Rate for Payer: Healthscope Whirlpool |
$65.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$36.57
|
| Rate for Payer: Mclaren Commercial |
$58.92
|
| Rate for Payer: Mclaren Medicaid |
$36.57
|
| Rate for Payer: Mclaren Medicare |
$36.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.40
|
| Rate for Payer: Meridian Medicaid |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.65
|
| Rate for Payer: Nomi Health Commercial |
$53.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.10
|
| Rate for Payer: PACE Medicare |
$34.74
|
| Rate for Payer: PACE SWMI |
$36.57
|
| Rate for Payer: PHP Commercial |
$40.23
|
| Rate for Payer: PHP Medicaid |
$19.60
|
| Rate for Payer: PHP Medicare Advantage |
$36.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.38
|
| Rate for Payer: Priority Health Medicare |
$36.57
|
| Rate for Payer: Priority Health Narrow Network |
$125.91
|
| Rate for Payer: Railroad Medicare Medicare |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.57
|
| Rate for Payer: UHC Exchange |
$56.68
|
| Rate for Payer: UHC Medicaid |
$19.13
|
| Rate for Payer: UHCCP DNSP |
$36.57
|
| Rate for Payer: UHCCP Medicaid |
$19.13
|
| Rate for Payer: VA VA |
$36.57
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$65.47
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$65.47 |
| Rate for Payer: Aetna Commercial |
$58.92
|
| Rate for Payer: ASR ASR |
$63.51
|
| Rate for Payer: BCBS Trust/PPO |
$53.76
|
| Rate for Payer: BCN Commercial |
$53.76
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Commercial |
$61.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Healthscope Commercial |
$63.51
|
| Rate for Payer: Healthscope Whirlpool |
$65.47
|
| Rate for Payer: Mclaren Commercial |
$58.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.65
|
| Rate for Payer: Nomi Health Commercial |
$53.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.61
|
|
|
HC SOMATOMEDIN
|
Facility
|
IP
|
$56.24
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: ASR ASR |
$54.55
|
| Rate for Payer: BCBS Trust/PPO |
$46.18
|
| Rate for Payer: BCN Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Commercial |
$52.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Healthscope Commercial |
$54.55
|
| Rate for Payer: Healthscope Whirlpool |
$56.24
|
| Rate for Payer: Mclaren Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$46.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.49
|
|
|
HC SOMATOMEDIN
|
Facility
|
OP
|
$56.24
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna Commercial |
$50.62
|
| Rate for Payer: Aetna Medicare |
$21.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.57
|
| Rate for Payer: ASR ASR |
$54.55
|
| Rate for Payer: BCBS Complete |
$11.68
|
| Rate for Payer: BCBS MAPPO |
$21.26
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: BCN Medicare Advantage |
$21.26
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Commercial |
$52.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$54.55
|
| Rate for Payer: Healthscope Whirlpool |
$56.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.26
|
| Rate for Payer: Mclaren Commercial |
$50.62
|
| Rate for Payer: Mclaren Medicaid |
$21.26
|
| Rate for Payer: Mclaren Medicare |
$21.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.32
|
| Rate for Payer: Meridian Medicaid |
$11.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$46.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PACE Medicare |
$20.20
|
| Rate for Payer: PACE SWMI |
$21.26
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Medicaid |
$11.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$21.26
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$21.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.26
|
| Rate for Payer: UHC Exchange |
$32.95
|
| Rate for Payer: UHC Medicaid |
$11.12
|
| Rate for Payer: UHCCP DNSP |
$21.26
|
| Rate for Payer: UHCCP Medicaid |
$11.12
|
| Rate for Payer: VA VA |
$21.26
|
|
|
HC SOYBEAN IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC SOYBEAN IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
IP
|
$6,169.57
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,627.18 |
| Max. Negotiated Rate |
$6,169.57 |
| Rate for Payer: Aetna Commercial |
$5,552.61
|
| Rate for Payer: ASR ASR |
$5,984.48
|
| Rate for Payer: BCBS Trust/PPO |
$5,066.45
|
| Rate for Payer: BCN Commercial |
$5,066.45
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$5,799.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,984.48
|
| Rate for Payer: Healthscope Whirlpool |
$6,169.57
|
| Rate for Payer: Mclaren Commercial |
$5,552.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Nomi Health Commercial |
$5,059.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,627.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,429.22
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
OP
|
$6,169.57
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.74 |
| Max. Negotiated Rate |
$6,169.57 |
| Rate for Payer: Aetna Commercial |
$5,552.61
|
| Rate for Payer: Aetna Medicare |
$2,282.74
|
| Rate for Payer: ASR ASR |
$5,984.48
|
| Rate for Payer: BCBS Complete |
$2,467.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,086.81
|
| Rate for Payer: BCN Commercial |
$5,086.81
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$5,799.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,984.48
|
| Rate for Payer: Healthscope Whirlpool |
$6,169.57
|
| Rate for Payer: Mclaren Commercial |
$5,552.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,935.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Nomi Health Commercial |
$5,059.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,627.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,405.78
|
| Rate for Payer: Priority Health Narrow Network |
$4,324.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,429.22
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,237.37
|
| Rate for Payer: BCN Commercial |
$3,237.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,440.37
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,752.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,944.85 |
| Max. Negotiated Rate |
$3,926.47 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,224.42
|
| Rate for Payer: BCN Commercial |
$3,224.42
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
|
|
HC SP ANGIOGRAPHY RENAL UNI
|
Facility
|
IP
|
$4,061.71
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
36100347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,046.28 |
| Max. Negotiated Rate |
$4,061.71 |
| Rate for Payer: Aetna Commercial |
$3,655.54
|
| Rate for Payer: ASR ASR |
$3,939.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,335.48
|
| Rate for Payer: BCN Commercial |
$3,335.48
|
| Rate for Payer: Cash Price |
$3,249.37
|
| Rate for Payer: Cofinity Commercial |
$3,818.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,249.37
|
| Rate for Payer: Healthscope Commercial |
$3,939.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,061.71
|
| Rate for Payer: Mclaren Commercial |
$3,655.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,452.45
|
| Rate for Payer: Nomi Health Commercial |
$3,330.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,046.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,574.30
|
|
|
HC SP ANGIOGRAPHY RENAL UNI
|
Facility
|
OP
|
$4,061.71
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
36100347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,655.54
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,939.86
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,348.88
|
| Rate for Payer: BCN Commercial |
$3,348.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,249.37
|
| Rate for Payer: Cash Price |
$3,249.37
|
| Rate for Payer: Cofinity Commercial |
$3,818.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,249.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,939.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,061.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,655.54
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,452.45
|
| Rate for Payer: Nomi Health Commercial |
$3,330.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,046.28
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,558.87
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,847.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,574.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
IP
|
$3,331.45
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,498.59 |
| Max. Negotiated Rate |
$3,331.45 |
| Rate for Payer: Aetna Commercial |
$2,998.30
|
| Rate for Payer: ASR ASR |
$3,231.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.79
|
| Rate for Payer: BCN Commercial |
$2,735.79
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cofinity Commercial |
$3,131.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,665.16
|
| Rate for Payer: Healthscope Commercial |
$3,231.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,331.45
|
| Rate for Payer: Mclaren Commercial |
$2,998.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,831.73
|
| Rate for Payer: Nomi Health Commercial |
$2,731.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,498.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,931.68
|
|
|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
OP
|
$3,331.45
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$2,998.30
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,231.51
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,746.78
|
| Rate for Payer: BCN Commercial |
$2,746.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cofinity Commercial |
$3,131.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,665.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,231.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,331.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$2,998.30
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,831.73
|
| Rate for Payer: Nomi Health Commercial |
$2,731.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,498.59
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,919.02
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,335.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,931.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
OP
|
$157.06
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$207.59 |
| Rate for Payer: Aetna Commercial |
$141.35
|
| Rate for Payer: Aetna Medicare |
$133.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: ASR ASR |
$152.35
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$129.50
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$125.65
|
| Rate for Payer: Cash Price |
$125.65
|
| Rate for Payer: Cofinity Commercial |
$147.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$152.35
|
| Rate for Payer: Healthscope Whirlpool |
$157.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$133.93
|
| Rate for Payer: Mclaren Commercial |
$141.35
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$73.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.50
|
| Rate for Payer: Nomi Health Commercial |
$128.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.80
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$147.32
|
| Rate for Payer: PHP Medicaid |
$71.79
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.62
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health Narrow Network |
$110.10
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$207.59
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP DNSP |
$133.93
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
IP
|
$157.06
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Aetna Commercial |
$141.35
|
| Rate for Payer: ASR ASR |
$152.35
|
| Rate for Payer: BCBS Trust/PPO |
$128.98
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$125.65
|
| Rate for Payer: Cofinity Commercial |
$147.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.65
|
| Rate for Payer: Healthscope Commercial |
$152.35
|
| Rate for Payer: Healthscope Whirlpool |
$157.06
|
| Rate for Payer: Mclaren Commercial |
$141.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.50
|
| Rate for Payer: Nomi Health Commercial |
$128.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.21
|
|
|
HC SPECIAL STAINS
|
Facility
|
OP
|
$245.98
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
31000053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$245.98 |
| Rate for Payer: Aetna Commercial |
$221.38
|
| Rate for Payer: Aetna Medicare |
$51.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: ASR ASR |
$238.60
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$202.81
|
| Rate for Payer: BCN Commercial |
$202.81
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$196.78
|
| Rate for Payer: Cash Price |
$196.78
|
| Rate for Payer: Cofinity Commercial |
$231.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$238.60
|
| Rate for Payer: Healthscope Whirlpool |
$245.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.92
|
| Rate for Payer: Mclaren Commercial |
$221.38
|
| Rate for Payer: Mclaren Medicaid |
$51.92
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$28.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.08
|
| Rate for Payer: Nomi Health Commercial |
$201.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.49
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicaid |
$27.83
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.48
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP DNSP |
$51.92
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC SPECIAL STAINS
|
Facility
|
IP
|
$245.98
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
31000053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.49 |
| Max. Negotiated Rate |
$245.98 |
| Rate for Payer: Aetna Commercial |
$221.38
|
| Rate for Payer: ASR ASR |
$238.60
|
| Rate for Payer: BCBS Trust/PPO |
$202.00
|
| Rate for Payer: BCN Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$196.78
|
| Rate for Payer: Cofinity Commercial |
$231.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.78
|
| Rate for Payer: Healthscope Commercial |
$238.60
|
| Rate for Payer: Healthscope Whirlpool |
$245.98
|
| Rate for Payer: Mclaren Commercial |
$221.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.08
|
| Rate for Payer: Nomi Health Commercial |
$201.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.46
|
|
|
HC SPECIAL STAINS II
|
Facility
|
OP
|
$201.18
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31000054
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$181.06
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$195.14
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$165.87
|
| Rate for Payer: BCN Commercial |
$165.87
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cofinity Commercial |
$189.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$195.14
|
| Rate for Payer: Healthscope Whirlpool |
$201.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$181.06
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.00
|
| Rate for Payer: Nomi Health Commercial |
$164.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.88
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SPECIAL STAINS II
|
Facility
|
IP
|
$201.18
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31000054
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$150.88 |
| Max. Negotiated Rate |
$201.18 |
| Rate for Payer: Aetna Commercial |
$181.06
|
| Rate for Payer: ASR ASR |
$195.14
|
| Rate for Payer: BCBS Trust/PPO |
$165.21
|
| Rate for Payer: BCN Commercial |
$165.21
|
| Rate for Payer: Cash Price |
$160.94
|
| Rate for Payer: Cofinity Commercial |
$189.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.94
|
| Rate for Payer: Healthscope Commercial |
$195.14
|
| Rate for Payer: Healthscope Whirlpool |
$201.18
|
| Rate for Payer: Mclaren Commercial |
$181.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.00
|
| Rate for Payer: Nomi Health Commercial |
$164.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.04
|
|
|
HC SPECIFIC GRAVITY FLUID NOT URINE
|
Facility
|
IP
|
$12.59
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
30100426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$12.59 |
| Rate for Payer: Aetna Commercial |
$11.33
|
| Rate for Payer: ASR ASR |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.34
|
| Rate for Payer: BCN Commercial |
$10.34
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$11.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.07
|
| Rate for Payer: Healthscope Commercial |
$12.21
|
| Rate for Payer: Healthscope Whirlpool |
$12.59
|
| Rate for Payer: Mclaren Commercial |
$11.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.70
|
| Rate for Payer: Nomi Health Commercial |
$10.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.08
|
|
|
HC SPECIFIC GRAVITY FLUID NOT URINE
|
Facility
|
OP
|
$12.59
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
30100426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: Aetna Commercial |
$11.33
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: ASR ASR |
$12.21
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.38
|
| Rate for Payer: BCN Commercial |
$10.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$11.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$12.21
|
| Rate for Payer: Healthscope Whirlpool |
$12.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$11.33
|
| Rate for Payer: Mclaren Medicaid |
$3.28
|
| Rate for Payer: Mclaren Medicare |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: Meridian Medicaid |
$1.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.70
|
| Rate for Payer: Nomi Health Commercial |
$10.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.44
|
| Rate for Payer: PACE Medicare |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: PHP Medicaid |
$1.76
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.14
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$12.11
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.28
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicaid |
$1.72
|
| Rate for Payer: UHCCP DNSP |
$3.28
|
| Rate for Payer: UHCCP Medicaid |
$1.72
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC SPECIMEN CONCENTRATION FOR INFECTIOUS AGENTS
|
Facility
|
IP
|
$44.94
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.70 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: ASR ASR |
$43.59
|
| Rate for Payer: BCBS Trust/PPO |
$36.90
|
| Rate for Payer: BCN Commercial |
$36.90
|
| Rate for Payer: Cash Price |
$35.95
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.95
|
| Rate for Payer: Healthscope Commercial |
$43.59
|
| Rate for Payer: Healthscope Whirlpool |
$44.94
|
| Rate for Payer: Mclaren Commercial |
$40.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$36.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.55
|
|
