|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.30
|
| Rate for Payer: BCN Commercial |
$9.30
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$12.00
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.30
|
| Rate for Payer: BCN Commercial |
$9.30
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$12.00
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.92
|
| Rate for Payer: Priority Health Narrow Network |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$8,727.45
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,109.22 |
| Max. Negotiated Rate |
$8,727.45 |
| Rate for Payer: Aetna Commercial |
$7,854.70
|
| Rate for Payer: ASR ASR |
$8,465.63
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.39
|
| Rate for Payer: BCN Commercial |
$6,766.39
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$8,203.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Healthscope Commercial |
$8,727.45
|
| Rate for Payer: Healthscope Whirlpool |
$8,465.63
|
| Rate for Payer: Mclaren Commercial |
$7,854.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,680.16
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$8,727.45
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8,727.45 |
| Rate for Payer: Aetna Commercial |
$7,854.70
|
| Rate for Payer: ASR ASR |
$8,465.63
|
| Rate for Payer: BCBS Complete |
$3,490.98
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.39
|
| Rate for Payer: BCN Commercial |
$6,766.39
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$8,203.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Healthscope Commercial |
$8,727.45
|
| Rate for Payer: Healthscope Whirlpool |
$8,465.63
|
| Rate for Payer: Mclaren Commercial |
$7,854.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,680.16
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$8,727.45
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,109.22 |
| Max. Negotiated Rate |
$8,727.45 |
| Rate for Payer: Aetna Commercial |
$7,854.70
|
| Rate for Payer: ASR ASR |
$8,465.63
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.39
|
| Rate for Payer: BCN Commercial |
$6,766.39
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$8,203.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Healthscope Commercial |
$8,727.45
|
| Rate for Payer: Healthscope Whirlpool |
$8,465.63
|
| Rate for Payer: Mclaren Commercial |
$7,854.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,680.16
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$8,727.45
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8,727.45 |
| Rate for Payer: Aetna Commercial |
$7,854.70
|
| Rate for Payer: ASR ASR |
$8,465.63
|
| Rate for Payer: BCBS Complete |
$3,490.98
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.39
|
| Rate for Payer: BCN Commercial |
$6,766.39
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$8,203.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.96
|
| Rate for Payer: Healthscope Commercial |
$8,727.45
|
| Rate for Payer: Healthscope Whirlpool |
$8,465.63
|
| Rate for Payer: Mclaren Commercial |
$7,854.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,680.16
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$53.55
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: ASR ASR |
$51.94
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$41.52
|
| Rate for Payer: BCN Commercial |
$41.52
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Healthscope Whirlpool |
$51.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.00
|
| Rate for Payer: Mclaren Commercial |
$48.20
|
| Rate for Payer: Mclaren Medicaid |
$5.47
|
| Rate for Payer: Mclaren Medicare |
$10.00
|
| Rate for Payer: Meridian Medicaid |
$5.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.52
|
| Rate for Payer: PACE Medicare |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$11.00
|
| Rate for Payer: PHP Medicaid |
$5.47
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.70
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health Narrow Network |
$8.56
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.12
|
| Rate for Payer: UHC Medicare Advantage |
$10.30
|
| Rate for Payer: VA VA |
$10.00
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$53.55
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: ASR ASR |
$51.94
|
| Rate for Payer: BCBS Trust/PPO |
$41.52
|
| Rate for Payer: BCN Commercial |
$41.52
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Healthscope Whirlpool |
$51.94
|
| Rate for Payer: Mclaren Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.12
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.82
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$72.42
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$100.98
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$90.88
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$97.95
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$78.29
|
| Rate for Payer: BCN Commercial |
$78.29
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Healthscope Whirlpool |
$97.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$90.88
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.83
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.89
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$71.70
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.86
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$100.98
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$90.88
|
| Rate for Payer: ASR ASR |
$97.95
|
| Rate for Payer: BCBS Trust/PPO |
$78.29
|
| Rate for Payer: BCN Commercial |
$78.29
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Healthscope Whirlpool |
$97.95
|
| Rate for Payer: Mclaren Commercial |
$90.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.86
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$26.08
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$23.47
|
| Rate for Payer: ASR ASR |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$24.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Healthscope Whirlpool |
$25.30
|
| Rate for Payer: Mclaren Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.95
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$26.08
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$23.47
|
| Rate for Payer: ASR ASR |
$25.30
|
| Rate for Payer: BCBS Complete |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$24.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Healthscope Whirlpool |
$25.30
|
| Rate for Payer: Mclaren Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.73
|
| Rate for Payer: Priority Health Narrow Network |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.95
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$77.50
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.65
|
| Rate for Payer: Priority Health Narrow Network |
$51.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: BCBS Trust/PPO |
$77.50
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: ASR ASR |
$556.78
|
| Rate for Payer: BCBS Trust/PPO |
$445.02
|
| Rate for Payer: BCN Commercial |
$445.02
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$539.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.20
|
| Rate for Payer: Healthscope Commercial |
$574.00
|
| Rate for Payer: Healthscope Whirlpool |
$556.78
|
| Rate for Payer: Mclaren Commercial |
$516.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$505.12
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: ASR ASR |
$556.78
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$445.02
|
| Rate for Payer: BCN Commercial |
$445.02
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$539.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$574.00
|
| Rate for Payer: Healthscope Whirlpool |
$556.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.59
|
| Rate for Payer: Mclaren Commercial |
$516.60
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.90
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicaid |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.34
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$407.54
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$505.12
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: VA VA |
$189.59
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$83.04
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$83.04 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: ASR ASR |
$80.55
|
| Rate for Payer: BCBS Trust/PPO |
$64.38
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.43
|
| Rate for Payer: Healthscope Commercial |
$83.04
|
| Rate for Payer: Healthscope Whirlpool |
$80.55
|
| Rate for Payer: Mclaren Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.08
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$83.04
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$83.04 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: ASR ASR |
$80.55
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: BCBS Trust/PPO |
$64.38
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.43
|
| Rate for Payer: Healthscope Commercial |
$83.04
|
| Rate for Payer: Healthscope Whirlpool |
$80.55
|
| Rate for Payer: Mclaren Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.57
|
| Rate for Payer: Priority Health Narrow Network |
$58.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.08
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$83.04
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$83.04 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: ASR ASR |
$80.55
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: BCBS Trust/PPO |
$64.38
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.43
|
| Rate for Payer: Healthscope Commercial |
$83.04
|
| Rate for Payer: Healthscope Whirlpool |
$80.55
|
| Rate for Payer: Mclaren Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.57
|
| Rate for Payer: Priority Health Narrow Network |
$58.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.08
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$83.04
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$83.04 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: ASR ASR |
$80.55
|
| Rate for Payer: BCBS Trust/PPO |
$64.38
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.43
|
| Rate for Payer: Healthscope Commercial |
$83.04
|
| Rate for Payer: Healthscope Whirlpool |
$80.55
|
| Rate for Payer: Mclaren Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.08
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.89 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$420.28
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$462.31
|
| Rate for Payer: PHP Medicaid |
$229.89
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$372.24
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: VA VA |
$420.28
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.28 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.28 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
|
