|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
OP
|
$106.48
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$106.48 |
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.36
|
| Rate for Payer: ASR ASR |
$103.29
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: BCBS Trust/PPO |
$82.55
|
| Rate for Payer: BCN Commercial |
$82.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cofinity Commercial |
$100.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$106.48
|
| Rate for Payer: Healthscope Whirlpool |
$103.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.29
|
| Rate for Payer: Mclaren Commercial |
$95.83
|
| Rate for Payer: Mclaren Medicaid |
$6.72
|
| Rate for Payer: Mclaren Medicare |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.51
|
| Rate for Payer: PACE Medicare |
$11.68
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Medicaid |
$6.72
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.90
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$75.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.66
|
| Rate for Payer: VA VA |
$12.29
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
IP
|
$106.48
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.54 |
| Max. Negotiated Rate |
$106.48 |
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: ASR ASR |
$103.29
|
| Rate for Payer: BCBS Trust/PPO |
$82.55
|
| Rate for Payer: BCN Commercial |
$82.55
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cofinity Commercial |
$100.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.18
|
| Rate for Payer: Healthscope Commercial |
$106.48
|
| Rate for Payer: Healthscope Whirlpool |
$103.29
|
| Rate for Payer: Mclaren Commercial |
$95.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.70
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.83 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.01
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$68.01
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACNE SURGERY
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$267.34 |
| Rate for Payer: Aetna Commercial |
$240.61
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$259.32
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$207.27
|
| Rate for Payer: BCN Commercial |
$207.27
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$251.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$267.34
|
| Rate for Payer: Healthscope Whirlpool |
$259.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$240.61
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.28
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$189.81
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.26
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC ACNE SURGERY
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.14 |
| Max. Negotiated Rate |
$267.34 |
| Rate for Payer: Aetna Commercial |
$240.61
|
| Rate for Payer: ASR ASR |
$259.32
|
| Rate for Payer: BCBS Trust/PPO |
$207.27
|
| Rate for Payer: BCN Commercial |
$207.27
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$251.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Healthscope Commercial |
$267.34
|
| Rate for Payer: Healthscope Whirlpool |
$259.32
|
| Rate for Payer: Mclaren Commercial |
$240.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.26
|
|
|
HC ACOUSTIC IMMITANCE TESTING
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$141.62
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$113.19
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$146.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.86
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$103.66
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC ACOUSTIC IMMITANCE TESTING
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: ASR ASR |
$141.62
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$113.19
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.80
|
| Rate for Payer: Healthscope Commercial |
$146.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.62
|
| Rate for Payer: Mclaren Commercial |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
|
|
HC ACTIGRAPHY
|
Facility
|
IP
|
$270.16
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$189.11 |
| Max. Negotiated Rate |
$270.16 |
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: ASR ASR |
$262.06
|
| Rate for Payer: BCBS Trust/PPO |
$209.46
|
| Rate for Payer: BCN Commercial |
$209.46
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cofinity Commercial |
$253.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.13
|
| Rate for Payer: Healthscope Commercial |
$270.16
|
| Rate for Payer: Healthscope Whirlpool |
$262.06
|
| Rate for Payer: Mclaren Commercial |
$243.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.74
|
|
|
HC ACTIGRAPHY
|
Facility
|
OP
|
$270.16
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$270.16 |
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$262.06
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$209.46
|
| Rate for Payer: BCN Commercial |
$209.46
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cofinity Commercial |
$253.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$270.16
|
| Rate for Payer: Healthscope Whirlpool |
$262.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$243.14
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.64
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.85
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$191.81
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.74
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Mclaren Medicaid |
$8.38
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Medicaid |
$8.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.38
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.61
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$64.45
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE.
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE.
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500084
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Mclaren Medicaid |
$8.38
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Medicaid |
$8.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Medicaid |
$8.38
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.40
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: VA VA |
$15.32
|
|
|
HC ACT TEST
|
Facility
|
IP
|
$75.13
|
|
| Hospital Charge Code |
62200001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.59 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: ASR ASR |
$72.88
|
| Rate for Payer: BCBS Trust/PPO |
$58.25
|
| Rate for Payer: BCN Commercial |
$58.25
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$70.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.10
|
| Rate for Payer: Healthscope Commercial |
$75.13
|
| Rate for Payer: Healthscope Whirlpool |
$72.88
|
| Rate for Payer: Mclaren Commercial |
$67.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.11
|
|
|
HC ACT TEST
|
Facility
|
OP
|
$75.13
|
|
| Hospital Charge Code |
62200001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: ASR ASR |
$72.88
|
| Rate for Payer: BCBS Complete |
$30.05
|
| Rate for Payer: BCBS Trust/PPO |
$58.25
|
| Rate for Payer: BCN Commercial |
$58.25
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$70.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.10
|
| Rate for Payer: Healthscope Commercial |
$75.13
|
| Rate for Payer: Healthscope Whirlpool |
$72.88
|
| Rate for Payer: Mclaren Commercial |
$67.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Narrow Network |
$53.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.11
|
|
|
HC ACUNAV CATHETER
|
Facility
|
IP
|
$5,610.00
|
|
|
Service Code
|
HCPCS C1759
|
| Hospital Charge Code |
27200010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,927.00 |
| Max. Negotiated Rate |
$5,610.00 |
| Rate for Payer: Aetna Commercial |
$5,049.00
|
| Rate for Payer: ASR ASR |
$5,441.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,349.43
|
| Rate for Payer: BCN Commercial |
$4,349.43
|
| Rate for Payer: Cash Price |
$4,488.00
|
| Rate for Payer: Cofinity Commercial |
$5,273.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,488.00
|
| Rate for Payer: Healthscope Commercial |
$5,610.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,441.70
|
| Rate for Payer: Mclaren Commercial |
$5,049.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,768.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,936.80
|
|
|
HC ACUNAV CATHETER
|
Facility
|
OP
|
$5,610.00
|
|
|
Service Code
|
HCPCS C1759
|
| Hospital Charge Code |
27200010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,244.00 |
| Max. Negotiated Rate |
$5,610.00 |
| Rate for Payer: Aetna Commercial |
$5,049.00
|
| Rate for Payer: ASR ASR |
$5,441.70
|
| Rate for Payer: BCBS Complete |
$2,244.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,349.43
|
| Rate for Payer: BCN Commercial |
$4,349.43
|
| Rate for Payer: Cash Price |
$4,488.00
|
| Rate for Payer: Cofinity Commercial |
$5,273.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,488.00
|
| Rate for Payer: Healthscope Commercial |
$5,610.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,441.70
|
| Rate for Payer: Mclaren Commercial |
$5,049.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,768.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,105.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,983.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,936.80
|
|
|
HC ACU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ACU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ACU OBS OVERFLOW PER HOUR
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
76900001
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ACU OBS OVERFLOW PER HOUR
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
76900001
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.24
|
| Rate for Payer: Priority Health Narrow Network |
$95.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ACUTE MYELOID LEUKEMIA FISH
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31100023
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: ASR ASR |
$35.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.69
|
| Rate for Payer: BCN Commercial |
$28.69
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$34.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$37.00
|
| Rate for Payer: Healthscope Whirlpool |
$35.89
|
| Rate for Payer: Mclaren Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.56
|
|
