|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,606.60
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,954.95 |
| Max. Negotiated Rate |
$2,606.60 |
| Rate for Payer: Aetna Commercial |
$2,345.94
|
| Rate for Payer: ASR ASR |
$2,528.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,140.54
|
| Rate for Payer: BCN Commercial |
$2,140.54
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Commercial |
$2,450.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Healthscope Commercial |
$2,528.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,606.60
|
| Rate for Payer: Mclaren Commercial |
$2,345.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Nomi Health Commercial |
$2,137.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,293.81
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,530.67
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,898.00 |
| Max. Negotiated Rate |
$2,530.67 |
| Rate for Payer: Aetna Commercial |
$2,277.60
|
| Rate for Payer: ASR ASR |
$2,454.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,078.19
|
| Rate for Payer: BCN Commercial |
$2,078.19
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,378.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Healthscope Commercial |
$2,454.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,530.67
|
| Rate for Payer: Mclaren Commercial |
$2,277.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.99
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,530.67
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.61 |
| Max. Negotiated Rate |
$2,530.67 |
| Rate for Payer: Aetna Commercial |
$2,277.60
|
| Rate for Payer: Aetna Medicare |
$1,551.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.79
|
| Rate for Payer: ASR ASR |
$2,454.75
|
| Rate for Payer: BCBS Complete |
$852.27
|
| Rate for Payer: BCBS MAPPO |
$1,551.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,086.54
|
| Rate for Payer: BCN Commercial |
$2,086.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.83
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,378.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.83
|
| Rate for Payer: Healthscope Commercial |
$2,454.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,530.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,551.83
|
| Rate for Payer: Mclaren Commercial |
$2,277.60
|
| Rate for Payer: Mclaren Medicaid |
$1,551.83
|
| Rate for Payer: Mclaren Medicare |
$1,551.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.42
|
| Rate for Payer: Meridian Medicaid |
$852.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,707.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PACE Medicare |
$1,474.24
|
| Rate for Payer: PACE SWMI |
$1,551.83
|
| Rate for Payer: PHP Commercial |
$1,707.01
|
| Rate for Payer: PHP Medicaid |
$831.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,065.21
|
| Rate for Payer: Priority Health Medicare |
$1,551.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,652.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,551.83
|
| Rate for Payer: UHC Exchange |
$2,405.34
|
| Rate for Payer: UHC Medicaid |
$811.61
|
| Rate for Payer: UHCCP DNSP |
$1,551.83
|
| Rate for Payer: UHCCP Medicaid |
$811.61
|
| Rate for Payer: VA VA |
$1,551.83
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,530.67
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.61 |
| Max. Negotiated Rate |
$2,530.67 |
| Rate for Payer: Aetna Commercial |
$2,277.60
|
| Rate for Payer: Aetna Medicare |
$1,551.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.79
|
| Rate for Payer: ASR ASR |
$2,454.75
|
| Rate for Payer: BCBS Complete |
$852.27
|
| Rate for Payer: BCBS MAPPO |
$1,551.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,086.54
|
| Rate for Payer: BCN Commercial |
$2,086.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.83
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,378.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.83
|
| Rate for Payer: Healthscope Commercial |
$2,454.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,530.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,551.83
|
| Rate for Payer: Mclaren Commercial |
$2,277.60
|
| Rate for Payer: Mclaren Medicaid |
$1,551.83
|
| Rate for Payer: Mclaren Medicare |
$1,551.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.42
|
| Rate for Payer: Meridian Medicaid |
$852.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,707.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PACE Medicare |
$1,474.24
|
| Rate for Payer: PACE SWMI |
$1,551.83
|
| Rate for Payer: PHP Commercial |
$1,707.01
|
| Rate for Payer: PHP Medicaid |
$831.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,065.21
|
| Rate for Payer: Priority Health Medicare |
$1,551.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,652.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,551.83
|
| Rate for Payer: UHC Exchange |
$2,405.34
|
| Rate for Payer: UHC Medicaid |
$811.61
|
| Rate for Payer: UHCCP DNSP |
$1,551.83
|
| Rate for Payer: UHCCP Medicaid |
$811.61
|
| Rate for Payer: VA VA |
$1,551.83
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,530.67
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,898.00 |
| Max. Negotiated Rate |
$2,530.67 |
| Rate for Payer: Aetna Commercial |
$2,277.60
|
| Rate for Payer: ASR ASR |
$2,454.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,078.19
|
| Rate for Payer: BCN Commercial |
$2,078.19
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,378.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Healthscope Commercial |
$2,454.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,530.67
|
| Rate for Payer: Mclaren Commercial |
$2,277.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,226.99
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$116.73
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: ASR ASR |
$113.23
|
| Rate for Payer: BCBS Trust/PPO |
$95.86
|
| Rate for Payer: BCN Commercial |
$95.86
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$109.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Whirlpool |
$116.73
|
| Rate for Payer: Mclaren Commercial |
$105.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.72
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$116.73
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna Medicare |
$43.19
|
| Rate for Payer: ASR ASR |
$113.23
|
| Rate for Payer: BCBS Complete |
$46.69
|
| Rate for Payer: BCBS Trust/PPO |
$96.24
|
| Rate for Payer: BCN Commercial |
$96.24
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$109.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Whirlpool |
$116.73
|
| Rate for Payer: Mclaren Commercial |
$105.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81.11
|
| Rate for Payer: Priority Health Narrow Network |
$64.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.72
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$880.50
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.38 |
| Max. Negotiated Rate |
$880.50 |
| Rate for Payer: Aetna Commercial |
$792.45
|
| Rate for Payer: ASR ASR |
$854.09
|
| Rate for Payer: BCBS Trust/PPO |
$723.07
|
| Rate for Payer: BCN Commercial |
$723.07
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cofinity Commercial |
$827.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.40
|
| Rate for Payer: Healthscope Commercial |
$854.09
|
| Rate for Payer: Healthscope Whirlpool |
$880.50
|
| Rate for Payer: Mclaren Commercial |
$792.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.42
|
| Rate for Payer: Nomi Health Commercial |
$722.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.84
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$880.50
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$880.50 |
| Rate for Payer: Aetna Commercial |
$792.45
|
| 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 |
$854.09
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$725.97
|
| Rate for Payer: BCN Commercial |
$725.97
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cofinity Commercial |
$827.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$854.09
|
| Rate for Payer: Healthscope Whirlpool |
$880.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$792.45
|
| 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 |
$748.42
|
| Rate for Payer: Nomi Health Commercial |
$722.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.38
|
| 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 |
$105.33
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$84.26
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.84
|
| 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 THERASKIN 1.75X1.75 PER SQ CM
|
Facility
|
IP
|
$588.13
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$441.10 |
| Max. Negotiated Rate |
$588.13 |
| Rate for Payer: Aetna Commercial |
$529.32
|
| Rate for Payer: ASR ASR |
$570.49
|
| Rate for Payer: BCBS Trust/PPO |
$482.97
|
| Rate for Payer: BCN Commercial |
$482.97
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cofinity Commercial |
$552.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.50
|
| Rate for Payer: Healthscope Commercial |
$570.49
|
| Rate for Payer: Healthscope Whirlpool |
$588.13
|
| Rate for Payer: Mclaren Commercial |
$529.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.91
|
| Rate for Payer: Nomi Health Commercial |
$482.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.55
|
|
|
HC THERASKIN 1.75X1.75 PER SQ CM
|
Facility
|
OP
|
$588.13
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$588.13 |
| Rate for Payer: Aetna Commercial |
$529.32
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$570.49
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$484.91
|
| Rate for Payer: BCN Commercial |
$484.91
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cofinity Commercial |
$552.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$570.49
|
| Rate for Payer: Healthscope Whirlpool |
$588.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$529.32
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.91
|
| Rate for Payer: Nomi Health Commercial |
$482.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.10
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.74
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$43.79
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 2.5X2.5 PER SQ CM
|
Facility
|
OP
|
$429.46
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$429.46 |
| Rate for Payer: Aetna Commercial |
$386.51
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$416.58
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$354.09
|
| Rate for Payer: BCN Commercial |
$354.09
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cofinity Commercial |
$403.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$416.58
|
| Rate for Payer: Healthscope Whirlpool |
$429.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$386.51
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.04
|
| Rate for Payer: Nomi Health Commercial |
$352.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.10
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.74
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$43.79
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 2.5X2.5 PER SQ CM
|
Facility
|
IP
|
$429.46
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.10 |
| Max. Negotiated Rate |
$429.46 |
| Rate for Payer: Aetna Commercial |
$386.51
|
| Rate for Payer: ASR ASR |
$416.58
|
| Rate for Payer: BCBS Trust/PPO |
$352.67
|
| Rate for Payer: BCN Commercial |
$352.67
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cofinity Commercial |
$403.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.57
|
| Rate for Payer: Healthscope Commercial |
$416.58
|
| Rate for Payer: Healthscope Whirlpool |
$429.46
|
| Rate for Payer: Mclaren Commercial |
$386.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.04
|
| Rate for Payer: Nomi Health Commercial |
$352.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.92
|
|
|
HC THERASKIN 2.5X5.1 PER SQ CM
|
Facility
|
OP
|
$187.81
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$169.03
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$182.18
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.85
|
| Rate for Payer: BCN Commercial |
$154.85
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cofinity Commercial |
$176.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$182.18
|
| Rate for Payer: Healthscope Whirlpool |
$187.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$169.03
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.64
|
| Rate for Payer: Nomi Health Commercial |
$154.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.86
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.74
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$43.79
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 2.5X5.1 PER SQ CM
|
Facility
|
IP
|
$187.81
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna Commercial |
$169.03
|
| Rate for Payer: ASR ASR |
$182.18
|
| Rate for Payer: BCBS Trust/PPO |
$154.23
|
| Rate for Payer: BCN Commercial |
$154.23
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cofinity Commercial |
$176.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.25
|
| Rate for Payer: Healthscope Commercial |
$182.18
|
| Rate for Payer: Healthscope Whirlpool |
$187.81
|
| Rate for Payer: Mclaren Commercial |
$169.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.64
|
| Rate for Payer: Nomi Health Commercial |
$154.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.27
|
|
|
HC THERASKIN 5.1X7.6 PER SQ CM
|
Facility
|
OP
|
$86.24
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$77.62
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$83.65
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$71.10
|
| Rate for Payer: BCN Commercial |
$71.10
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cofinity Commercial |
$81.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$83.65
|
| Rate for Payer: Healthscope Whirlpool |
$86.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$77.62
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.30
|
| Rate for Payer: Nomi Health Commercial |
$70.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.68
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.74
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$43.79
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 5.1X7.6 PER SQ CM
|
Facility
|
IP
|
$86.24
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$86.24 |
| Rate for Payer: Aetna Commercial |
$77.62
|
| Rate for Payer: ASR ASR |
$83.65
|
| Rate for Payer: BCBS Trust/PPO |
$70.82
|
| Rate for Payer: BCN Commercial |
$70.82
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cofinity Commercial |
$81.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.99
|
| Rate for Payer: Healthscope Commercial |
$83.65
|
| Rate for Payer: Healthscope Whirlpool |
$86.24
|
| Rate for Payer: Mclaren Commercial |
$77.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.30
|
| Rate for Payer: Nomi Health Commercial |
$70.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.89
|
|
|
HC THERASKIN 7.6X15.24 PER SQ CM
|
Facility
|
IP
|
$60.62
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$60.62 |
| Rate for Payer: Aetna Commercial |
$54.56
|
| Rate for Payer: ASR ASR |
$58.80
|
| Rate for Payer: BCBS Trust/PPO |
$49.78
|
| Rate for Payer: BCN Commercial |
$49.78
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$56.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Whirlpool |
$60.62
|
| Rate for Payer: Mclaren Commercial |
$54.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.53
|
| Rate for Payer: Nomi Health Commercial |
$49.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.35
|
|
|
HC THERASKIN 7.6X15.24 PER SQ CM
|
Facility
|
OP
|
$60.62
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$54.56
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$58.80
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.98
|
| Rate for Payer: BCN Commercial |
$49.98
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$56.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Whirlpool |
$60.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$54.56
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.53
|
| Rate for Payer: Nomi Health Commercial |
$49.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.47
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.74
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$43.79
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$89.43
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.07 |
| Max. Negotiated Rate |
$89.43 |
| Rate for Payer: Aetna Commercial |
$80.49
|
| Rate for Payer: ASR ASR |
$86.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.44
|
| Rate for Payer: BCN Commercial |
$73.44
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cofinity Commercial |
$84.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.54
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Whirlpool |
$89.43
|
| Rate for Payer: Mclaren Commercial |
$80.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.02
|
| Rate for Payer: Nomi Health Commercial |
$73.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.70
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$89.43
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$89.43 |
| Rate for Payer: Aetna Commercial |
$80.49
|
| Rate for Payer: Aetna Medicare |
$28.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: ASR ASR |
$86.75
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$73.74
|
| Rate for Payer: BCN Commercial |
$73.74
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cofinity Commercial |
$84.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Whirlpool |
$89.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$28.82
|
| Rate for Payer: Mclaren Commercial |
$80.49
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.02
|
| Rate for Payer: Nomi Health Commercial |
$73.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.07
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$31.70
|
| Rate for Payer: PHP Medicaid |
$15.45
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74.14
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Narrow Network |
$59.31
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$44.67
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP DNSP |
$28.82
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$21.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.54
|
| Rate for Payer: ASR ASR |
$60.73
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$51.62
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$58.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$60.73
|
| Rate for Payer: Healthscope Whirlpool |
$62.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$56.35
|
| Rate for Payer: Mclaren Medicaid |
$21.23
|
| Rate for Payer: Mclaren Medicare |
$21.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: Meridian Medicaid |
$11.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PACE Medicare |
$20.17
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: PHP Medicaid |
$11.38
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$112.58
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow Network |
$90.06
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.23
|
| Rate for Payer: UHC Exchange |
$32.91
|
| Rate for Payer: UHC Medicaid |
$11.10
|
| Rate for Payer: UHCCP DNSP |
$21.23
|
| Rate for Payer: UHCCP Medicaid |
$11.10
|
| Rate for Payer: VA VA |
$21.23
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: ASR ASR |
$60.73
|
| Rate for Payer: BCBS Trust/PPO |
$51.42
|
| Rate for Payer: BCN Commercial |
$51.42
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$58.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$60.73
|
| Rate for Payer: Healthscope Whirlpool |
$62.61
|
| Rate for Payer: Mclaren Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.10
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$20.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.26
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$20.26
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$11.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$22.29
|
| Rate for Payer: PHP Medicaid |
$10.86
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.48
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$98.78
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHCCP DNSP |
$20.26
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.36
|
| Rate for Payer: BCN Commercial |
$65.36
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
|
