|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$421.04 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: Aetna Medicare |
$210.52
|
| Rate for Payer: ASR ASR |
$408.41
|
| Rate for Payer: ASR Commercial |
$408.41
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS Trust/PPO |
$344.79
|
| Rate for Payer: BCN Commercial |
$326.43
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$421.04
|
| Rate for Payer: Healthscope Whirlpool |
$408.41
|
| Rate for Payer: Mclaren Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.74
|
| Rate for Payer: Priority Health Narrow Network |
$42.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.52
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$421.04 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: ASR ASR |
$408.41
|
| Rate for Payer: ASR Commercial |
$408.41
|
| Rate for Payer: BCBS Trust/PPO |
$343.11
|
| Rate for Payer: BCN Commercial |
$326.43
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$421.04
|
| Rate for Payer: Healthscope Whirlpool |
$408.41
|
| Rate for Payer: Mclaren Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.52
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: ASR Commercial |
$85.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.45
|
| Rate for Payer: BCN Commercial |
$67.98
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$87.68
|
| Rate for Payer: Healthscope Whirlpool |
$85.05
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: Aetna Medicare |
$23.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: ASR Commercial |
$85.05
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$71.80
|
| Rate for Payer: BCN Commercial |
$67.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$87.68
|
| Rate for Payer: Healthscope Whirlpool |
$85.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.99
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicaid |
$12.86
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.25
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$53.80
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$37.18
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP DNSP |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: VA VA |
$23.99
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$55.24
|
| Rate for Payer: ASR ASR |
$59.54
|
| Rate for Payer: ASR Commercial |
$59.54
|
| Rate for Payer: BCBS Trust/PPO |
$50.02
|
| Rate for Payer: BCN Commercial |
$47.59
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$61.38
|
| Rate for Payer: Healthscope Whirlpool |
$59.54
|
| Rate for Payer: Mclaren Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.01
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$102.11 |
| Rate for Payer: Aetna Commercial |
$55.24
|
| 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 |
$59.54
|
| Rate for Payer: ASR Commercial |
$59.54
|
| Rate for Payer: BCBS Complete |
$11.95
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$50.26
|
| Rate for Payer: BCN Commercial |
$47.59
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$61.38
|
| Rate for Payer: Healthscope Whirlpool |
$59.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$55.24
|
| Rate for Payer: Mclaren Medicaid |
$11.38
|
| 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 |
$11.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| 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 |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.11
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow Network |
$81.69
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.23
|
| Rate for Payer: UHC Exchange |
$32.91
|
| Rate for Payer: UHC Medicare Advantage |
$21.23
|
| Rate for Payer: UHCCP DNSP |
$21.23
|
| Rate for Payer: UHCCP Medicaid |
$11.38
|
| Rate for Payer: VA VA |
$21.23
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| 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 |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.26
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$10.86
|
| 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 |
$11.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| 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 |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UHC Medicare Advantage |
$20.26
|
| Rate for Payer: UHCCP DNSP |
$20.26
|
| Rate for Payer: UHCCP Medicaid |
$10.86
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| 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 |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$14.98
|
| Rate for Payer: BCBS MAPPO |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$26.61
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.61
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.61
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$14.26
|
| 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 |
$14.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| 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 |
$14.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$26.61
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: Railroad Medicare Medicare |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.61
|
| Rate for Payer: UHC Exchange |
$41.25
|
| Rate for Payer: UHC Medicare Advantage |
$26.61
|
| Rate for Payer: UHCCP DNSP |
$26.61
|
| Rate for Payer: UHCCP Medicaid |
$14.26
|
| Rate for Payer: VA VA |
$26.61
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| 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 |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.26
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$10.86
|
| 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 |
$11.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| 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 |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UHC Medicare Advantage |
$20.26
|
| Rate for Payer: UHCCP DNSP |
$20.26
|
| Rate for Payer: UHCCP Medicaid |
$10.86
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| 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 |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$14.91
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.49
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$14.20
|
| 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 |
$14.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| 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 |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$41.06
|
| Rate for Payer: UHC Medicare Advantage |
$26.49
|
| Rate for Payer: UHCCP DNSP |
$26.49
|
| Rate for Payer: UHCCP Medicaid |
$14.20
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$295.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Aetna Commercial |
$266.22
|
| 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 |
$286.93
|
| Rate for Payer: ASR Commercial |
$286.93
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$242.23
|
| Rate for Payer: BCN Commercial |
$229.33
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$278.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$295.80
|
| Rate for Payer: Healthscope Whirlpool |
$286.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$266.22
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| 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 |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.43
|
| Rate for Payer: Nomi Health Commercial |
$242.56
|
| 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 |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$295.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.27 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Aetna Commercial |
$266.22
|
| Rate for Payer: ASR ASR |
$286.93
|
| Rate for Payer: ASR Commercial |
$286.93
|
| Rate for Payer: BCBS Trust/PPO |
$241.05
|
| Rate for Payer: BCN Commercial |
$229.33
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$278.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Healthscope Commercial |
$295.80
|
| Rate for Payer: Healthscope Whirlpool |
$286.93
|
| Rate for Payer: Mclaren Commercial |
$266.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.43
|
| Rate for Payer: Nomi Health Commercial |
$242.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.30
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$330.48
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$330.48 |
| Rate for Payer: Aetna Commercial |
$297.43
|
| 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 |
$320.57
|
| Rate for Payer: ASR Commercial |
$320.57
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$270.63
|
| Rate for Payer: BCN Commercial |
$256.22
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cofinity Commercial |
$310.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$330.48
|
| Rate for Payer: Healthscope Whirlpool |
$320.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.17
|
| Rate for Payer: Mclaren Commercial |
$297.43
|
| Rate for Payer: Mclaren Medicaid |
$11.88
|
| 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 |
$12.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.91
|
| Rate for Payer: Nomi Health Commercial |
$270.99
|
| 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 |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.57
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$231.67
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.17
|
| Rate for Payer: UHC Exchange |
$34.36
|
| Rate for Payer: UHC Medicare Advantage |
$22.17
|
| Rate for Payer: UHCCP DNSP |
$22.17
|
| Rate for Payer: UHCCP Medicaid |
$11.88
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$330.48
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$214.81 |
| Max. Negotiated Rate |
$330.48 |
| Rate for Payer: Aetna Commercial |
$297.43
|
| Rate for Payer: ASR ASR |
$320.57
|
| Rate for Payer: ASR Commercial |
$320.57
|
| Rate for Payer: BCBS Trust/PPO |
$269.31
|
| Rate for Payer: BCN Commercial |
$256.22
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cofinity Commercial |
$310.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.38
|
| Rate for Payer: Healthscope Commercial |
$330.48
|
| Rate for Payer: Healthscope Whirlpool |
$320.57
|
| Rate for Payer: Mclaren Commercial |
$297.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.91
|
| Rate for Payer: Nomi Health Commercial |
$270.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.82
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$142.80
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: ASR ASR |
$138.52
|
| Rate for Payer: ASR Commercial |
$138.52
|
| Rate for Payer: BCBS Trust/PPO |
$116.37
|
| Rate for Payer: BCN Commercial |
$110.71
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$134.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Healthscope Commercial |
$142.80
|
| Rate for Payer: Healthscope Whirlpool |
$138.52
|
| Rate for Payer: Mclaren Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.66
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
OP
|
$142.80
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| 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 |
$138.52
|
| Rate for Payer: ASR Commercial |
$138.52
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$116.94
|
| Rate for Payer: BCN Commercial |
$110.71
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$134.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$142.80
|
| Rate for Payer: Healthscope Whirlpool |
$138.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$128.52
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| 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 |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| 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 |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.12
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
OP
|
$69.79
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$69.79 |
| Rate for Payer: Aetna Commercial |
$62.81
|
| Rate for Payer: Aetna Medicare |
$34.90
|
| Rate for Payer: ASR ASR |
$67.70
|
| Rate for Payer: ASR Commercial |
$67.70
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$57.15
|
| Rate for Payer: BCN Commercial |
$54.11
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$65.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$69.79
|
| Rate for Payer: Healthscope Whirlpool |
$67.70
|
| Rate for Payer: Mclaren Commercial |
$62.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.32
|
| Rate for Payer: Nomi Health Commercial |
$57.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.15
|
| Rate for Payer: Priority Health Narrow Network |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.42
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
IP
|
$69.79
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$69.79 |
| Rate for Payer: Aetna Commercial |
$62.81
|
| Rate for Payer: ASR ASR |
$67.70
|
| Rate for Payer: ASR Commercial |
$67.70
|
| Rate for Payer: BCBS Trust/PPO |
$56.87
|
| Rate for Payer: BCN Commercial |
$54.11
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$65.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$69.79
|
| Rate for Payer: Healthscope Whirlpool |
$67.70
|
| Rate for Payer: Mclaren Commercial |
$62.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.32
|
| Rate for Payer: Nomi Health Commercial |
$57.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.42
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
IP
|
$847.90
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$551.14 |
| Max. Negotiated Rate |
$847.90 |
| Rate for Payer: Aetna Commercial |
$763.11
|
| Rate for Payer: ASR ASR |
$822.46
|
| Rate for Payer: ASR Commercial |
$822.46
|
| Rate for Payer: BCBS Trust/PPO |
$690.95
|
| Rate for Payer: BCN Commercial |
$657.38
|
| Rate for Payer: Cash Price |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$797.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.32
|
| Rate for Payer: Healthscope Commercial |
$847.90
|
| Rate for Payer: Healthscope Whirlpool |
$822.46
|
| Rate for Payer: Mclaren Commercial |
$763.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.72
|
| Rate for Payer: Nomi Health Commercial |
$695.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$746.15
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
OP
|
$847.90
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.16 |
| Max. Negotiated Rate |
$847.90 |
| Rate for Payer: Aetna Commercial |
$763.11
|
| Rate for Payer: Aetna Medicare |
$423.95
|
| Rate for Payer: ASR ASR |
$822.46
|
| Rate for Payer: ASR Commercial |
$822.46
|
| Rate for Payer: BCBS Complete |
$339.16
|
| Rate for Payer: BCBS Trust/PPO |
$694.35
|
| Rate for Payer: BCN Commercial |
$657.38
|
| Rate for Payer: Cash Price |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$797.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.32
|
| Rate for Payer: Healthscope Commercial |
$847.90
|
| Rate for Payer: Healthscope Whirlpool |
$822.46
|
| Rate for Payer: Mclaren Commercial |
$763.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.72
|
| Rate for Payer: Nomi Health Commercial |
$695.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.93
|
| Rate for Payer: Priority Health Narrow Network |
$594.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$746.15
|
|
|
HC THORACENT WO TUBE
|
Facility
|
IP
|
$1,305.83
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$848.79 |
| Max. Negotiated Rate |
$1,305.83 |
| Rate for Payer: Aetna Commercial |
$1,175.25
|
| Rate for Payer: ASR ASR |
$1,266.66
|
| Rate for Payer: ASR Commercial |
$1,266.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,064.12
|
| Rate for Payer: BCN Commercial |
$1,012.41
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cofinity Commercial |
$1,227.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.66
|
| Rate for Payer: Healthscope Commercial |
$1,305.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,266.66
|
| Rate for Payer: Mclaren Commercial |
$1,175.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.96
|
| Rate for Payer: Nomi Health Commercial |
$1,070.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.13
|
|
