|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
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
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$26.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.26
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$14.61
|
| Rate for Payer: BCBS MAPPO |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$26.61
|
| 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 |
$26.61
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.61
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$26.61
|
| Rate for Payer: Mclaren Medicare |
$26.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.94
|
| Rate for Payer: Meridian Medicaid |
$14.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.27
|
| 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 |
$25.28
|
| Rate for Payer: PACE SWMI |
$26.61
|
| Rate for Payer: PHP Commercial |
$29.27
|
| Rate for Payer: PHP Medicaid |
$14.26
|
| Rate for Payer: PHP Medicare Advantage |
$26.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.48
|
| Rate for Payer: Priority Health Medicare |
$26.61
|
| Rate for Payer: Priority Health Narrow Network |
$98.78
|
| Rate for Payer: Railroad Medicare Medicare |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.61
|
| Rate for Payer: UHC Exchange |
$41.25
|
| Rate for Payer: UHC Medicaid |
$13.92
|
| Rate for Payer: UHCCP DNSP |
$26.61
|
| Rate for Payer: UHCCP Medicaid |
$13.92
|
| Rate for Payer: VA VA |
$26.61
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
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
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
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 SCREENING AUTO
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$123.48 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$14.55
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| 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 |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.49
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$26.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: Meridian Medicaid |
$14.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.14
|
| 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 |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$29.14
|
| Rate for Payer: PHP Medicaid |
$14.20
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.48
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$98.78
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.49
|
| Rate for Payer: UHC Exchange |
$41.06
|
| Rate for Payer: UHC Medicaid |
$13.85
|
| Rate for Payer: UHCCP DNSP |
$26.49
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
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
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$301.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$226.29 |
| Max. Negotiated Rate |
$301.72 |
| Rate for Payer: Aetna Commercial |
$271.55
|
| Rate for Payer: ASR ASR |
$292.67
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$247.77
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cofinity Commercial |
$283.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.38
|
| Rate for Payer: Healthscope Commercial |
$292.67
|
| Rate for Payer: Healthscope Whirlpool |
$301.72
|
| Rate for Payer: Mclaren Commercial |
$271.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.46
|
| Rate for Payer: Nomi Health Commercial |
$247.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.51
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$301.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$301.72 |
| Rate for Payer: Aetna Commercial |
$271.55
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$292.67
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$248.77
|
| Rate for Payer: BCN Commercial |
$248.77
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cofinity Commercial |
$283.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$292.67
|
| Rate for Payer: Healthscope Whirlpool |
$301.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$271.55
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.46
|
| Rate for Payer: Nomi Health Commercial |
$247.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.29
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$337.09
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$337.09 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: ASR ASR |
$326.98
|
| Rate for Payer: BCBS Trust/PPO |
$276.82
|
| Rate for Payer: BCN Commercial |
$276.82
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cofinity Commercial |
$316.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.67
|
| Rate for Payer: Healthscope Commercial |
$326.98
|
| Rate for Payer: Healthscope Whirlpool |
$337.09
|
| Rate for Payer: Mclaren Commercial |
$303.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.53
|
| Rate for Payer: Nomi Health Commercial |
$276.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.64
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$337.09
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$337.09 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Aetna Medicare |
$22.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: ASR ASR |
$326.98
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$277.93
|
| Rate for Payer: BCN Commercial |
$277.93
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cofinity Commercial |
$316.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$326.98
|
| Rate for Payer: Healthscope Whirlpool |
$337.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.17
|
| Rate for Payer: Mclaren Commercial |
$303.38
|
| Rate for Payer: Mclaren Medicaid |
$22.17
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$12.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.53
|
| Rate for Payer: Nomi Health Commercial |
$276.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.82
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$24.39
|
| Rate for Payer: PHP Medicaid |
$11.88
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.36
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$236.30
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.17
|
| Rate for Payer: UHC Exchange |
$34.36
|
| Rate for Payer: UHC Medicaid |
$11.59
|
| Rate for Payer: UHCCP DNSP |
$22.17
|
| Rate for Payer: UHCCP Medicaid |
$11.59
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$145.66
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.25 |
| Max. Negotiated Rate |
$145.66 |
| Rate for Payer: Aetna Commercial |
$131.09
|
| Rate for Payer: ASR ASR |
$141.29
|
| Rate for Payer: BCBS Trust/PPO |
$119.62
|
| Rate for Payer: BCN Commercial |
$119.62
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cofinity Commercial |
$136.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.53
|
| Rate for Payer: Healthscope Commercial |
$141.29
|
| Rate for Payer: Healthscope Whirlpool |
$145.66
|
| Rate for Payer: Mclaren Commercial |
$131.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.81
|
| Rate for Payer: Nomi Health Commercial |
$119.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.18
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
OP
|
$145.66
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$145.66 |
| Rate for Payer: Aetna Commercial |
$131.09
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$141.29
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$120.10
|
| Rate for Payer: BCN Commercial |
$120.10
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cofinity Commercial |
$136.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$141.29
|
| Rate for Payer: Healthscope Whirlpool |
$145.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$131.09
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.81
|
| Rate for Payer: Nomi Health Commercial |
$119.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.25
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.63
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$102.11
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
OP
|
$71.19
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: Aetna Commercial |
$64.07
|
| Rate for Payer: Aetna Medicare |
$26.34
|
| Rate for Payer: ASR ASR |
$69.05
|
| Rate for Payer: BCBS Complete |
$28.48
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$58.70
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$66.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.95
|
| Rate for Payer: Healthscope Commercial |
$69.05
|
| Rate for Payer: Healthscope Whirlpool |
$71.19
|
| Rate for Payer: Mclaren Commercial |
$64.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.51
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.38
|
| Rate for Payer: Priority Health Narrow Network |
$49.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.65
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
IP
|
$71.19
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.39 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: Aetna Commercial |
$64.07
|
| Rate for Payer: ASR ASR |
$69.05
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$66.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.95
|
| Rate for Payer: Healthscope Commercial |
$69.05
|
| Rate for Payer: Healthscope Whirlpool |
$71.19
|
| Rate for Payer: Mclaren Commercial |
$64.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.51
|
| Rate for Payer: Nomi Health Commercial |
$58.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.65
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$1,910.00 |
| Rate for Payer: Aetna Commercial |
$1,719.00
|
| Rate for Payer: Aetna Medicare |
$625.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: ASR ASR |
$1,852.70
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.80
|
| Rate for Payer: BCN Commercial |
$1,574.80
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cofinity Commercial |
$1,795.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$1,852.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,910.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.05
|
| Rate for Payer: Mclaren Commercial |
$1,719.00
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$343.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.50
|
| Rate for Payer: Nomi Health Commercial |
$1,566.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.50
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$687.55
|
| Rate for Payer: PHP Medicaid |
$335.03
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$520.55
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Narrow Network |
$416.44
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,680.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Exchange |
$968.83
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP DNSP |
$625.05
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,432.50 |
| Max. Negotiated Rate |
$1,910.00 |
| Rate for Payer: Aetna Commercial |
$1,719.00
|
| Rate for Payer: ASR ASR |
$1,852.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,568.49
|
| Rate for Payer: BCN Commercial |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cofinity Commercial |
$1,795.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.00
|
| Rate for Payer: Healthscope Commercial |
$1,852.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,910.00
|
| Rate for Payer: Mclaren Commercial |
$1,719.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.50
|
| Rate for Payer: Nomi Health Commercial |
$1,566.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,680.80
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
OP
|
$864.86
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$864.86 |
| Rate for Payer: Aetna Commercial |
$778.37
|
| Rate for Payer: Aetna Medicare |
$320.00
|
| Rate for Payer: ASR ASR |
$838.91
|
| Rate for Payer: BCBS Complete |
$345.94
|
| Rate for Payer: BCBS Trust/PPO |
$713.08
|
| Rate for Payer: BCN Commercial |
$713.08
|
| Rate for Payer: Cash Price |
$691.89
|
| Rate for Payer: Cofinity Commercial |
$812.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.89
|
| Rate for Payer: Healthscope Commercial |
$838.91
|
| Rate for Payer: Healthscope Whirlpool |
$864.86
|
| Rate for Payer: Mclaren Commercial |
$778.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$691.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.13
|
| Rate for Payer: Nomi Health Commercial |
$709.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$757.79
|
| Rate for Payer: Priority Health Narrow Network |
$606.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$761.08
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
IP
|
$864.86
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$864.86 |
| Rate for Payer: Aetna Commercial |
$778.37
|
| Rate for Payer: ASR ASR |
$838.91
|
| Rate for Payer: BCBS Trust/PPO |
$710.22
|
| Rate for Payer: BCN Commercial |
$710.22
|
| Rate for Payer: Cash Price |
$691.89
|
| Rate for Payer: Cofinity Commercial |
$812.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.89
|
| Rate for Payer: Healthscope Commercial |
$838.91
|
| Rate for Payer: Healthscope Whirlpool |
$864.86
|
| Rate for Payer: Mclaren Commercial |
$778.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.13
|
| Rate for Payer: Nomi Health Commercial |
$709.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$761.08
|
|
|
HC THORACENT WO TUBE
|
Facility
|
IP
|
$1,331.95
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$998.96 |
| Max. Negotiated Rate |
$1,331.95 |
| Rate for Payer: Aetna Commercial |
$1,198.76
|
| Rate for Payer: ASR ASR |
$1,291.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.80
|
| Rate for Payer: BCN Commercial |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,065.56
|
| Rate for Payer: Cofinity Commercial |
$1,252.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,065.56
|
| Rate for Payer: Healthscope Commercial |
$1,291.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,331.95
|
| Rate for Payer: Mclaren Commercial |
$1,198.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.16
|
| Rate for Payer: Nomi Health Commercial |
$1,092.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$998.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,172.12
|
|
|
HC THORACENT WO TUBE
|
Facility
|
OP
|
$1,331.95
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$1,331.95 |
| Rate for Payer: Aetna Commercial |
$1,198.76
|
| Rate for Payer: Aetna Medicare |
$625.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: ASR ASR |
$1,291.99
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.19
|
| Rate for Payer: BCN Commercial |
$1,098.19
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$1,065.56
|
| Rate for Payer: Cash Price |
$1,065.56
|
| Rate for Payer: Cofinity Commercial |
$1,252.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,065.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$1,291.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,331.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.05
|
| Rate for Payer: Mclaren Commercial |
$1,198.76
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$343.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.16
|
| Rate for Payer: Nomi Health Commercial |
$1,092.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$998.96
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$687.55
|
| Rate for Payer: PHP Medicaid |
$335.03
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$520.55
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Narrow Network |
$416.44
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,172.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Exchange |
$968.83
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP DNSP |
$625.05
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC THORACENT W TUBE
|
Facility
|
IP
|
$1,442.76
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,082.07 |
| Max. Negotiated Rate |
$1,442.76 |
| Rate for Payer: Aetna Commercial |
$1,298.48
|
| Rate for Payer: ASR ASR |
$1,399.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.79
|
| Rate for Payer: BCN Commercial |
$1,184.79
|
| Rate for Payer: Cash Price |
$1,154.21
|
| Rate for Payer: Cofinity Commercial |
$1,356.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.21
|
| Rate for Payer: Healthscope Commercial |
$1,399.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,442.76
|
| Rate for Payer: Mclaren Commercial |
$1,298.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.35
|
| Rate for Payer: Nomi Health Commercial |
$1,183.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,269.63
|
|
|
HC THORACENT W TUBE
|
Facility
|
OP
|
$1,442.76
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.44 |
| Max. Negotiated Rate |
$2,431.16 |
| Rate for Payer: Aetna Commercial |
$1,298.48
|
| Rate for Payer: Aetna Medicare |
$1,568.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: ASR ASR |
$1,399.48
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.56
|
| Rate for Payer: BCN Commercial |
$1,189.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,154.21
|
| Rate for Payer: Cash Price |
$1,154.21
|
| Rate for Payer: Cofinity Commercial |
$1,356.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$1,399.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,442.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.49
|
| Rate for Payer: Mclaren Commercial |
$1,298.48
|
| Rate for Payer: Mclaren Medicaid |
$1,568.49
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$861.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.35
|
| Rate for Payer: Nomi Health Commercial |
$1,183.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.07
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,725.34
|
| Rate for Payer: PHP Medicaid |
$840.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$520.55
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health Narrow Network |
$416.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,269.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Exchange |
$2,431.16
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP DNSP |
$1,568.49
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC THORACIC FASCIAL PLANE BLOCK BILAT CONT
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT 64469
|
| Hospital Charge Code |
37000028
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$843.75 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$1,012.50
|
| Rate for Payer: ASR ASR |
$1,091.25
|
| Rate for Payer: BCBS Trust/PPO |
$923.85
|
| Rate for Payer: BCN Commercial |
$923.85
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.00
|
| Rate for Payer: Healthscope Commercial |
$1,091.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.00
|
| Rate for Payer: Mclaren Commercial |
$1,012.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.25
|
| Rate for Payer: Nomi Health Commercial |
$922.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$843.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.00
|
|
|
HC THORACIC FASCIAL PLANE BLOCK BILAT CONT
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT 64469
|
| Hospital Charge Code |
37000028
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$416.25 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$1,012.50
|
| Rate for Payer: Aetna Medicare |
$416.25
|
| Rate for Payer: ASR ASR |
$1,091.25
|
| Rate for Payer: BCBS Complete |
$450.00
|
| Rate for Payer: BCBS Trust/PPO |
$927.56
|
| Rate for Payer: BCN Commercial |
$927.56
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.00
|
| Rate for Payer: Healthscope Commercial |
$1,091.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.00
|
| Rate for Payer: Mclaren Commercial |
$1,012.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.25
|
| Rate for Payer: Nomi Health Commercial |
$922.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$843.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$907.25
|
| Rate for Payer: Priority Health Narrow Network |
$725.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.00
|
|
|
HC THORACIC FASCIAL PLANE BLOCK BILAT INJ
|
Facility
|
OP
|
$1,111.79
|
|
|
Service Code
|
CPT 64468
|
| Hospital Charge Code |
37000022
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$209.70 |
| Max. Negotiated Rate |
$1,111.79 |
| Rate for Payer: Aetna Commercial |
$1,000.61
|
| Rate for Payer: Aetna Medicare |
$411.36
|
| Rate for Payer: ASR ASR |
$1,078.44
|
| Rate for Payer: BCBS Complete |
$444.72
|
| Rate for Payer: BCBS Trust/PPO |
$916.67
|
| Rate for Payer: BCN Commercial |
$916.67
|
| Rate for Payer: Cash Price |
$889.43
|
| Rate for Payer: Cash Price |
$889.43
|
| Rate for Payer: Cofinity Commercial |
$1,045.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.43
|
| Rate for Payer: Healthscope Commercial |
$1,078.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.79
|
| Rate for Payer: Mclaren Commercial |
$1,000.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$889.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.02
|
| Rate for Payer: Nomi Health Commercial |
$911.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.12
|
| Rate for Payer: Priority Health Narrow Network |
$209.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.38
|
|
