|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR Commercial |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$368.50
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.29
|
| Rate for Payer: Priority Health Narrow Network |
$315.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.12
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$119.69 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.42
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR Commercial |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$245.67
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.86
|
| Rate for Payer: Priority Health Narrow Network |
$210.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR Commercial |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$244.47
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC SICKLE CELL TEST
|
Facility
|
IP
|
$31.31
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$31.31 |
| Rate for Payer: Aetna Commercial |
$28.18
|
| Rate for Payer: ASR ASR |
$30.37
|
| Rate for Payer: ASR Commercial |
$30.37
|
| Rate for Payer: BCBS Trust/PPO |
$25.51
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Healthscope Commercial |
$31.31
|
| Rate for Payer: Healthscope Whirlpool |
$30.37
|
| Rate for Payer: Mclaren Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Nomi Health Commercial |
$25.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.55
|
|
|
HC SICKLE CELL TEST
|
Facility
|
OP
|
$31.31
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$31.31 |
| Rate for Payer: Aetna Commercial |
$28.18
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: ASR ASR |
$30.37
|
| Rate for Payer: ASR Commercial |
$30.37
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$25.64
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$31.31
|
| Rate for Payer: Healthscope Whirlpool |
$30.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.51
|
| Rate for Payer: Mclaren Commercial |
$28.18
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicare |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Nomi Health Commercial |
$25.67
|
| Rate for Payer: PACE Medicare |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: PHP Medicaid |
$2.95
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.31
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health Narrow Network |
$16.25
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.51
|
| Rate for Payer: UHC Exchange |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$5.51
|
| Rate for Payer: UHCCP DNSP |
$5.51
|
| Rate for Payer: UHCCP Medicaid |
$2.95
|
| Rate for Payer: VA VA |
$5.51
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,384.58 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: Aetna Medicare |
$893.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: ASR ASR |
$1,127.61
|
| Rate for Payer: ASR Commercial |
$1,127.61
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$951.95
|
| Rate for Payer: BCN Commercial |
$901.27
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$1,092.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$893.28
|
| Rate for Payer: Mclaren Commercial |
$1,046.23
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: Nomi Health Commercial |
$953.23
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$982.61
|
| Rate for Payer: PHP Medicaid |
$478.80
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.31
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$701.85
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$1,384.58
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP DNSP |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: VA VA |
$893.28
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
IP
|
$1,162.48
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.61 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: ASR ASR |
$1,127.61
|
| Rate for Payer: ASR Commercial |
$1,127.61
|
| Rate for Payer: BCBS Trust/PPO |
$947.30
|
| Rate for Payer: BCN Commercial |
$901.27
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$1,092.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.61
|
| Rate for Payer: Mclaren Commercial |
$1,046.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: Nomi Health Commercial |
$953.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.98
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,621.12
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,703.73 |
| Max. Negotiated Rate |
$2,621.12 |
| Rate for Payer: Aetna Commercial |
$2,359.01
|
| Rate for Payer: ASR ASR |
$2,542.49
|
| Rate for Payer: ASR Commercial |
$2,542.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,135.95
|
| Rate for Payer: BCN Commercial |
$2,032.15
|
| Rate for Payer: Cash Price |
$2,096.90
|
| Rate for Payer: Cofinity Commercial |
$2,463.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.90
|
| Rate for Payer: Healthscope Commercial |
$2,621.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,542.49
|
| Rate for Payer: Mclaren Commercial |
$2,359.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,227.95
|
| Rate for Payer: Nomi Health Commercial |
$2,149.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,306.59
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,621.12
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,048.45 |
| Max. Negotiated Rate |
$2,621.12 |
| Rate for Payer: Aetna Commercial |
$2,359.01
|
| Rate for Payer: Aetna Medicare |
$1,310.56
|
| Rate for Payer: ASR ASR |
$2,542.49
|
| Rate for Payer: ASR Commercial |
$2,542.49
|
| Rate for Payer: BCBS Complete |
$1,048.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,146.44
|
| Rate for Payer: BCN Commercial |
$2,032.15
|
| Rate for Payer: Cash Price |
$2,096.90
|
| Rate for Payer: Cofinity Commercial |
$2,463.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.90
|
| Rate for Payer: Healthscope Commercial |
$2,621.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,542.49
|
| Rate for Payer: Mclaren Commercial |
$2,359.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,227.95
|
| Rate for Payer: Nomi Health Commercial |
$2,149.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,296.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,837.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,306.59
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$1,264.83
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,384.58 |
| Rate for Payer: Aetna Commercial |
$1,138.35
|
| Rate for Payer: Aetna Medicare |
$893.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: ASR ASR |
$1,226.89
|
| Rate for Payer: ASR Commercial |
$1,226.89
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.77
|
| Rate for Payer: BCN Commercial |
$980.62
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$1,011.86
|
| Rate for Payer: Cash Price |
$1,011.86
|
| Rate for Payer: Cofinity Commercial |
$1,188.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$1,264.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,226.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$893.28
|
| Rate for Payer: Mclaren Commercial |
$1,138.35
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.11
|
| Rate for Payer: Nomi Health Commercial |
$1,037.16
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$982.61
|
| Rate for Payer: PHP Medicaid |
$478.80
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,108.24
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$886.65
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,113.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$1,384.58
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP DNSP |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: VA VA |
$893.28
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$1,264.83
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.14 |
| Max. Negotiated Rate |
$1,264.83 |
| Rate for Payer: Aetna Commercial |
$1,138.35
|
| Rate for Payer: ASR ASR |
$1,226.89
|
| Rate for Payer: ASR Commercial |
$1,226.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$980.62
|
| Rate for Payer: Cash Price |
$1,011.86
|
| Rate for Payer: Cofinity Commercial |
$1,188.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.86
|
| Rate for Payer: Healthscope Commercial |
$1,264.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,226.89
|
| Rate for Payer: Mclaren Commercial |
$1,138.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.11
|
| Rate for Payer: Nomi Health Commercial |
$1,037.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,113.05
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
IP
|
$252.87
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$164.37 |
| Max. Negotiated Rate |
$252.87 |
| Rate for Payer: Aetna Commercial |
$227.58
|
| Rate for Payer: ASR ASR |
$245.28
|
| Rate for Payer: ASR Commercial |
$245.28
|
| Rate for Payer: BCBS Trust/PPO |
$206.06
|
| Rate for Payer: BCN Commercial |
$196.05
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: Cofinity Commercial |
$237.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.30
|
| Rate for Payer: Healthscope Commercial |
$252.87
|
| Rate for Payer: Healthscope Whirlpool |
$245.28
|
| Rate for Payer: Mclaren Commercial |
$227.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.94
|
| Rate for Payer: Nomi Health Commercial |
$207.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.53
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
OP
|
$252.87
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$252.87 |
| Rate for Payer: Aetna Commercial |
$227.58
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$245.28
|
| Rate for Payer: ASR Commercial |
$245.28
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$207.08
|
| Rate for Payer: BCN Commercial |
$196.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: Cofinity Commercial |
$237.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$252.87
|
| Rate for Payer: Healthscope Whirlpool |
$245.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$227.58
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.94
|
| Rate for Payer: Nomi Health Commercial |
$207.35
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.56
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$177.26
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.01
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicaid |
$3.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.32
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP DNSP |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$3.22
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC SILVADENE 400 GM
|
Facility
|
IP
|
$253.52
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$164.79 |
| Max. Negotiated Rate |
$253.52 |
| Rate for Payer: Aetna Commercial |
$228.17
|
| Rate for Payer: ASR ASR |
$245.91
|
| Rate for Payer: ASR Commercial |
$245.91
|
| Rate for Payer: BCBS Trust/PPO |
$206.59
|
| Rate for Payer: BCN Commercial |
$196.55
|
| Rate for Payer: Cash Price |
$202.82
|
| Rate for Payer: Cofinity Commercial |
$238.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.82
|
| Rate for Payer: Healthscope Commercial |
$253.52
|
| Rate for Payer: Healthscope Whirlpool |
$245.91
|
| Rate for Payer: Mclaren Commercial |
$228.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.49
|
| Rate for Payer: Nomi Health Commercial |
$207.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.10
|
|
|
HC SILVADENE 400 GM
|
Facility
|
OP
|
$253.52
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$253.52 |
| Rate for Payer: Aetna Commercial |
$228.17
|
| Rate for Payer: Aetna Medicare |
$126.76
|
| Rate for Payer: ASR ASR |
$245.91
|
| Rate for Payer: ASR Commercial |
$245.91
|
| Rate for Payer: BCBS Complete |
$101.41
|
| Rate for Payer: BCBS Trust/PPO |
$207.61
|
| Rate for Payer: BCN Commercial |
$196.55
|
| Rate for Payer: Cash Price |
$202.82
|
| Rate for Payer: Cofinity Commercial |
$238.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.82
|
| Rate for Payer: Healthscope Commercial |
$253.52
|
| Rate for Payer: Healthscope Whirlpool |
$245.91
|
| Rate for Payer: Mclaren Commercial |
$228.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.49
|
| Rate for Payer: Nomi Health Commercial |
$207.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.13
|
| Rate for Payer: Priority Health Narrow Network |
$177.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.10
|
|
|
HC SILVADENE 85 GM
|
Facility
|
IP
|
$104.62
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: ASR ASR |
$101.48
|
| Rate for Payer: ASR Commercial |
$101.48
|
| Rate for Payer: BCBS Trust/PPO |
$85.25
|
| Rate for Payer: BCN Commercial |
$81.11
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Healthscope Whirlpool |
$101.48
|
| Rate for Payer: Mclaren Commercial |
$94.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.07
|
|
|
HC SILVADENE 85 GM
|
Facility
|
OP
|
$104.62
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: Aetna Medicare |
$52.31
|
| Rate for Payer: ASR ASR |
$101.48
|
| Rate for Payer: ASR Commercial |
$101.48
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: BCBS Trust/PPO |
$85.67
|
| Rate for Payer: BCN Commercial |
$81.11
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Healthscope Whirlpool |
$101.48
|
| Rate for Payer: Mclaren Commercial |
$94.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.67
|
| Rate for Payer: Priority Health Narrow Network |
$73.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.07
|
|
|
HC SILVER 4X4
|
Facility
|
IP
|
$65.41
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$65.41 |
| Rate for Payer: Aetna Commercial |
$58.87
|
| Rate for Payer: ASR ASR |
$63.45
|
| Rate for Payer: ASR Commercial |
$63.45
|
| Rate for Payer: BCBS Trust/PPO |
$53.30
|
| Rate for Payer: BCN Commercial |
$50.71
|
| Rate for Payer: Cash Price |
$52.33
|
| Rate for Payer: Cofinity Commercial |
$61.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.33
|
| Rate for Payer: Healthscope Commercial |
$65.41
|
| Rate for Payer: Healthscope Whirlpool |
$63.45
|
| Rate for Payer: Mclaren Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.60
|
| Rate for Payer: Nomi Health Commercial |
$53.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.56
|
|
|
HC SILVER 4X4
|
Facility
|
OP
|
$65.41
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$65.41 |
| Rate for Payer: Aetna Commercial |
$58.87
|
| Rate for Payer: Aetna Medicare |
$32.70
|
| Rate for Payer: ASR ASR |
$63.45
|
| Rate for Payer: ASR Commercial |
$63.45
|
| Rate for Payer: BCBS Complete |
$26.16
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCN Commercial |
$50.71
|
| Rate for Payer: Cash Price |
$52.33
|
| Rate for Payer: Cofinity Commercial |
$61.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.33
|
| Rate for Payer: Healthscope Commercial |
$65.41
|
| Rate for Payer: Healthscope Whirlpool |
$63.45
|
| Rate for Payer: Mclaren Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.60
|
| Rate for Payer: Nomi Health Commercial |
$53.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.31
|
| Rate for Payer: Priority Health Narrow Network |
$45.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.56
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,746.56
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,685.26 |
| Max. Negotiated Rate |
$8,746.56 |
| Rate for Payer: Aetna Commercial |
$7,871.90
|
| Rate for Payer: ASR ASR |
$8,484.16
|
| Rate for Payer: ASR Commercial |
$8,484.16
|
| Rate for Payer: BCBS Trust/PPO |
$7,127.57
|
| Rate for Payer: BCN Commercial |
$6,781.21
|
| Rate for Payer: Cash Price |
$6,997.25
|
| Rate for Payer: Cofinity Commercial |
$8,221.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,997.25
|
| Rate for Payer: Healthscope Commercial |
$8,746.56
|
| Rate for Payer: Healthscope Whirlpool |
$8,484.16
|
| Rate for Payer: Mclaren Commercial |
$7,871.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,434.58
|
| Rate for Payer: Nomi Health Commercial |
$7,172.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,685.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,696.97
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,746.56
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,498.62 |
| Max. Negotiated Rate |
$8,746.56 |
| Rate for Payer: Aetna Commercial |
$7,871.90
|
| Rate for Payer: Aetna Medicare |
$4,373.28
|
| Rate for Payer: ASR ASR |
$8,484.16
|
| Rate for Payer: ASR Commercial |
$8,484.16
|
| Rate for Payer: BCBS Complete |
$3,498.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,162.56
|
| Rate for Payer: BCN Commercial |
$6,781.21
|
| Rate for Payer: Cash Price |
$6,997.25
|
| Rate for Payer: Cofinity Commercial |
$8,221.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,997.25
|
| Rate for Payer: Healthscope Commercial |
$8,746.56
|
| Rate for Payer: Healthscope Whirlpool |
$8,484.16
|
| Rate for Payer: Mclaren Commercial |
$7,871.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,434.58
|
| Rate for Payer: Nomi Health Commercial |
$7,172.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,685.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,663.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,131.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,696.97
|
|
