|
HC SOMATOMEDIN
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$55.14 |
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: ASR ASR |
$53.49
|
| Rate for Payer: ASR Commercial |
$53.49
|
| Rate for Payer: BCBS Trust/PPO |
$44.93
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$55.14
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Mclaren Commercial |
$49.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.52
|
|
|
HC SOYBEAN IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC SOYBEAN IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
OP
|
$6,048.60
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,419.44 |
| Max. Negotiated Rate |
$6,048.60 |
| Rate for Payer: Aetna Commercial |
$5,443.74
|
| Rate for Payer: Aetna Medicare |
$3,024.30
|
| Rate for Payer: ASR ASR |
$5,867.14
|
| Rate for Payer: ASR Commercial |
$5,867.14
|
| Rate for Payer: BCBS Complete |
$2,419.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,953.20
|
| Rate for Payer: BCN Commercial |
$4,689.48
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,685.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$6,048.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.14
|
| Rate for Payer: Mclaren Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,141.31
|
| Rate for Payer: Nomi Health Commercial |
$4,959.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,299.78
|
| Rate for Payer: Priority Health Narrow Network |
$4,240.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,322.77
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
IP
|
$6,048.60
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,931.59 |
| Max. Negotiated Rate |
$6,048.60 |
| Rate for Payer: Aetna Commercial |
$5,443.74
|
| Rate for Payer: ASR ASR |
$5,867.14
|
| Rate for Payer: ASR Commercial |
$5,867.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,929.00
|
| Rate for Payer: BCN Commercial |
$4,689.48
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,685.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$6,048.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.14
|
| Rate for Payer: Mclaren Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,141.31
|
| Rate for Payer: Nomi Health Commercial |
$4,959.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,322.77
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,152.34
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,372.91
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,698.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,849.48 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.94
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
|
|
HC SP ANGIOGRAPHY RENAL UNI
|
Facility
|
OP
|
$3,982.07
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
36100347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,583.86
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,862.61
|
| Rate for Payer: ASR Commercial |
$3,862.61
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,260.92
|
| Rate for Payer: BCN Commercial |
$3,087.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,185.66
|
| Rate for Payer: Cash Price |
$3,185.66
|
| Rate for Payer: Cofinity Commercial |
$3,743.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,185.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,982.07
|
| Rate for Payer: Healthscope Whirlpool |
$3,862.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,583.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,384.76
|
| Rate for Payer: Nomi Health Commercial |
$3,265.30
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,588.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,489.09
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,791.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,504.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC SP ANGIOGRAPHY RENAL UNI
|
Facility
|
IP
|
$3,982.07
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
36100347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.35 |
| Max. Negotiated Rate |
$3,982.07 |
| Rate for Payer: Aetna Commercial |
$3,583.86
|
| Rate for Payer: ASR ASR |
$3,862.61
|
| Rate for Payer: ASR Commercial |
$3,862.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,244.99
|
| Rate for Payer: BCN Commercial |
$3,087.30
|
| Rate for Payer: Cash Price |
$3,185.66
|
| Rate for Payer: Cofinity Commercial |
$3,743.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,185.66
|
| Rate for Payer: Healthscope Commercial |
$3,982.07
|
| Rate for Payer: Healthscope Whirlpool |
$3,862.61
|
| Rate for Payer: Mclaren Commercial |
$3,583.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,384.76
|
| Rate for Payer: Nomi Health Commercial |
$3,265.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,588.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,504.22
|
|
|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
OP
|
$3,266.13
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$2,939.52
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,168.15
|
| Rate for Payer: ASR Commercial |
$3,168.15
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,674.63
|
| Rate for Payer: BCN Commercial |
$2,532.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$3,070.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,266.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,168.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$2,939.52
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: Nomi Health Commercial |
$2,678.23
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,861.78
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,289.56
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,874.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
IP
|
$3,266.13
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,122.98 |
| Max. Negotiated Rate |
$3,266.13 |
| Rate for Payer: Aetna Commercial |
$2,939.52
|
| Rate for Payer: ASR ASR |
$3,168.15
|
| Rate for Payer: ASR Commercial |
$3,168.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,661.57
|
| Rate for Payer: BCN Commercial |
$2,532.23
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$3,070.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$3,266.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,168.15
|
| Rate for Payer: Mclaren Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: Nomi Health Commercial |
$2,678.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,874.19
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
IP
|
$153.98
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$153.98 |
| Rate for Payer: Aetna Commercial |
$138.58
|
| Rate for Payer: ASR ASR |
$149.36
|
| Rate for Payer: ASR Commercial |
$149.36
|
| Rate for Payer: BCBS Trust/PPO |
$125.48
|
| Rate for Payer: BCN Commercial |
$119.38
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.18
|
| Rate for Payer: Healthscope Commercial |
$153.98
|
| Rate for Payer: Healthscope Whirlpool |
$149.36
|
| Rate for Payer: Mclaren Commercial |
$138.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.88
|
| Rate for Payer: Nomi Health Commercial |
$126.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.50
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
OP
|
$153.98
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$201.64 |
| Rate for Payer: Aetna Commercial |
$138.58
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$149.36
|
| Rate for Payer: ASR Commercial |
$149.36
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$126.09
|
| Rate for Payer: BCN Commercial |
$119.38
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$153.98
|
| Rate for Payer: Healthscope Whirlpool |
$149.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$138.58
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.88
|
| Rate for Payer: Nomi Health Commercial |
$126.26
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.92
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$107.94
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC SPECIAL STAINS
|
Facility
|
OP
|
$225.55
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
31000053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Commercial |
$203.00
|
| Rate for Payer: Aetna Medicare |
$52.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.44
|
| Rate for Payer: ASR ASR |
$218.78
|
| Rate for Payer: ASR Commercial |
$218.78
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$52.35
|
| Rate for Payer: BCBS Trust/PPO |
$184.70
|
| Rate for Payer: BCN Commercial |
$174.87
|
| Rate for Payer: BCN Medicare Advantage |
$52.35
|
| Rate for Payer: Cash Price |
$180.44
|
| Rate for Payer: Cash Price |
$180.44
|
| Rate for Payer: Cofinity Commercial |
$212.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$225.55
|
| Rate for Payer: Healthscope Whirlpool |
$218.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.35
|
| Rate for Payer: Mclaren Commercial |
$203.00
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Mclaren Medicare |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.97
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.72
|
| Rate for Payer: Nomi Health Commercial |
$184.95
|
| Rate for Payer: PACE Medicare |
$49.73
|
| Rate for Payer: PACE SWMI |
$52.35
|
| Rate for Payer: PHP Commercial |
$57.58
|
| Rate for Payer: PHP Medicaid |
$28.06
|
| Rate for Payer: PHP Medicare Advantage |
$52.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Medicare |
$52.35
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: Railroad Medicare Medicare |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.35
|
| Rate for Payer: UHC Exchange |
$81.14
|
| Rate for Payer: UHC Medicare Advantage |
$52.35
|
| Rate for Payer: UHCCP DNSP |
$52.35
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: VA VA |
$52.35
|
|
|
HC SPECIAL STAINS
|
Facility
|
IP
|
$225.55
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
31000053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Commercial |
$203.00
|
| Rate for Payer: ASR ASR |
$218.78
|
| Rate for Payer: ASR Commercial |
$218.78
|
| Rate for Payer: BCBS Trust/PPO |
$183.80
|
| Rate for Payer: BCN Commercial |
$174.87
|
| Rate for Payer: Cash Price |
$180.44
|
| Rate for Payer: Cofinity Commercial |
$212.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.44
|
| Rate for Payer: Healthscope Commercial |
$225.55
|
| Rate for Payer: Healthscope Whirlpool |
$218.78
|
| Rate for Payer: Mclaren Commercial |
$203.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.72
|
| Rate for Payer: Nomi Health Commercial |
$184.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.48
|
|
|
HC SPECIAL STAINS II
|
Facility
|
OP
|
$186.45
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31000054
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$167.80
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$180.86
|
| Rate for Payer: ASR Commercial |
$180.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$152.68
|
| Rate for Payer: BCN Commercial |
$144.55
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$149.16
|
| Rate for Payer: Cash Price |
$149.16
|
| Rate for Payer: Cofinity Commercial |
$175.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$186.45
|
| Rate for Payer: Healthscope Whirlpool |
$180.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$167.80
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.48
|
| Rate for Payer: Nomi Health Commercial |
$152.89
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC SPECIAL STAINS II
|
Facility
|
IP
|
$186.45
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31000054
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.19 |
| Max. Negotiated Rate |
$186.45 |
| Rate for Payer: Aetna Commercial |
$167.80
|
| Rate for Payer: ASR ASR |
$180.86
|
| Rate for Payer: ASR Commercial |
$180.86
|
| Rate for Payer: BCBS Trust/PPO |
$151.94
|
| Rate for Payer: BCN Commercial |
$144.55
|
| Rate for Payer: Cash Price |
$149.16
|
| Rate for Payer: Cofinity Commercial |
$175.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.16
|
| Rate for Payer: Healthscope Commercial |
$186.45
|
| Rate for Payer: Healthscope Whirlpool |
$180.86
|
| Rate for Payer: Mclaren Commercial |
$167.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.48
|
| Rate for Payer: Nomi Health Commercial |
$152.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.08
|
|
|
HC SPECIFIC GRAVITY FLUID NOT URINE
|
Facility
|
OP
|
$12.34
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
30100426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Aetna Commercial |
$11.11
|
| 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 |
$11.97
|
| Rate for Payer: ASR Commercial |
$11.97
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Commercial |
$9.57
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$12.34
|
| Rate for Payer: Healthscope Whirlpool |
$11.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$11.11
|
| Rate for Payer: Mclaren Medicaid |
$1.76
|
| 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 |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.49
|
| Rate for Payer: Nomi Health Commercial |
$10.12
|
| 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 |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.73
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
| Rate for Payer: UHCCP DNSP |
$3.28
|
| Rate for Payer: UHCCP Medicaid |
$1.76
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC SPECIFIC GRAVITY FLUID NOT URINE
|
Facility
|
IP
|
$12.34
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
30100426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$12.34 |
| Rate for Payer: Aetna Commercial |
$11.11
|
| Rate for Payer: ASR ASR |
$11.97
|
| Rate for Payer: ASR Commercial |
$11.97
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$9.57
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$12.34
|
| Rate for Payer: Healthscope Whirlpool |
$11.97
|
| Rate for Payer: Mclaren Commercial |
$11.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.49
|
| Rate for Payer: Nomi Health Commercial |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.86
|
|
|
HC SPECIMEN CONCENTRATION FOR INFECTIOUS AGENTS
|
Facility
|
OP
|
$44.06
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$39.65
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: ASR ASR |
$42.74
|
| Rate for Payer: ASR Commercial |
$42.74
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$36.08
|
| Rate for Payer: BCN Commercial |
$34.16
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$41.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Healthscope Whirlpool |
$42.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$39.65
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.45
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: PACE Medicare |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.35
|
| Rate for Payer: PHP Medicaid |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.87
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow Network |
$16.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$10.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: UHCCP DNSP |
$6.68
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC SPECIMEN CONCENTRATION FOR INFECTIOUS AGENTS
|
Facility
|
IP
|
$44.06
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$39.65
|
| Rate for Payer: ASR ASR |
$42.74
|
| Rate for Payer: ASR Commercial |
$42.74
|
| Rate for Payer: BCBS Trust/PPO |
$35.90
|
| Rate for Payer: BCN Commercial |
$34.16
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$41.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Healthscope Whirlpool |
$42.74
|
| Rate for Payer: Mclaren Commercial |
$39.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.45
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.77
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$556.61
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$556.61 |
| Rate for Payer: Aetna Commercial |
$500.95
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$539.91
|
| Rate for Payer: ASR Commercial |
$539.91
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$455.81
|
| Rate for Payer: BCN Commercial |
$431.54
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$445.29
|
| Rate for Payer: Cash Price |
$445.29
|
| Rate for Payer: Cofinity Commercial |
$523.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$556.61
|
| Rate for Payer: Healthscope Whirlpool |
$539.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$500.95
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.12
|
| Rate for Payer: Nomi Health Commercial |
$456.42
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.70
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$390.18
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$556.61
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$556.61 |
| Rate for Payer: Aetna Commercial |
$500.95
|
| Rate for Payer: ASR ASR |
$539.91
|
| Rate for Payer: ASR Commercial |
$539.91
|
| Rate for Payer: BCBS Trust/PPO |
$453.58
|
| Rate for Payer: BCN Commercial |
$431.54
|
| Rate for Payer: Cash Price |
$445.29
|
| Rate for Payer: Cofinity Commercial |
$523.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.29
|
| Rate for Payer: Healthscope Commercial |
$556.61
|
| Rate for Payer: Healthscope Whirlpool |
$539.91
|
| Rate for Payer: Mclaren Commercial |
$500.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.12
|
| Rate for Payer: Nomi Health Commercial |
$456.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.82
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
IP
|
$493.59
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$320.83 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Aetna Commercial |
$444.23
|
| Rate for Payer: ASR ASR |
$478.78
|
| Rate for Payer: ASR Commercial |
$478.78
|
| Rate for Payer: BCBS Trust/PPO |
$402.23
|
| Rate for Payer: BCN Commercial |
$382.68
|
| Rate for Payer: Cash Price |
$394.87
|
| Rate for Payer: Cofinity Commercial |
$463.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.87
|
| Rate for Payer: Healthscope Commercial |
$493.59
|
| Rate for Payer: Healthscope Whirlpool |
$478.78
|
| Rate for Payer: Mclaren Commercial |
$444.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.55
|
| Rate for Payer: Nomi Health Commercial |
$404.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.36
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
OP
|
$493.59
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$197.44 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Aetna Commercial |
$444.23
|
| Rate for Payer: Aetna Medicare |
$246.80
|
| Rate for Payer: ASR ASR |
$478.78
|
| Rate for Payer: ASR Commercial |
$478.78
|
| Rate for Payer: BCBS Complete |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$404.20
|
| Rate for Payer: BCN Commercial |
$382.68
|
| Rate for Payer: Cash Price |
$394.87
|
| Rate for Payer: Cash Price |
$394.87
|
| Rate for Payer: Cofinity Commercial |
$463.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.87
|
| Rate for Payer: Healthscope Commercial |
$493.59
|
| Rate for Payer: Healthscope Whirlpool |
$478.78
|
| Rate for Payer: Mclaren Commercial |
$444.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.55
|
| Rate for Payer: Nomi Health Commercial |
$404.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.35
|
| Rate for Payer: Priority Health Narrow Network |
$312.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.36
|
|
