|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: ASR ASR |
$60.14
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS Trust/PPO |
$48.07
|
| Rate for Payer: BCN Commercial |
$48.07
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$58.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$62.00
|
| Rate for Payer: Healthscope Whirlpool |
$60.14
|
| Rate for Payer: Mclaren Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.56
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: ASR ASR |
$60.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.07
|
| Rate for Payer: BCN Commercial |
$48.07
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$58.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$62.00
|
| Rate for Payer: Healthscope Whirlpool |
$60.14
|
| Rate for Payer: Mclaren Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.56
|
|
|
HC BARRIER ADHESION
|
Facility
|
IP
|
$578.39
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$404.87 |
| Max. Negotiated Rate |
$578.39 |
| Rate for Payer: Aetna Commercial |
$520.55
|
| Rate for Payer: ASR ASR |
$561.04
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: Cash Price |
$462.71
|
| Rate for Payer: Cofinity Commercial |
$543.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.71
|
| Rate for Payer: Healthscope Commercial |
$578.39
|
| Rate for Payer: Healthscope Whirlpool |
$561.04
|
| Rate for Payer: Mclaren Commercial |
$520.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.98
|
|
|
HC BARRIER ADHESION
|
Facility
|
OP
|
$578.39
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$231.36 |
| Max. Negotiated Rate |
$578.39 |
| Rate for Payer: Aetna Commercial |
$520.55
|
| Rate for Payer: ASR ASR |
$561.04
|
| Rate for Payer: BCBS Complete |
$231.36
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: Cash Price |
$462.71
|
| Rate for Payer: Cofinity Commercial |
$543.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.71
|
| Rate for Payer: Healthscope Commercial |
$578.39
|
| Rate for Payer: Healthscope Whirlpool |
$561.04
|
| Rate for Payer: Mclaren Commercial |
$520.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.33
|
| Rate for Payer: Priority Health Narrow Network |
$410.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.98
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
IP
|
$5,608.69
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,926.08 |
| Max. Negotiated Rate |
$5,608.69 |
| Rate for Payer: Aetna Commercial |
$5,047.82
|
| Rate for Payer: ASR ASR |
$5,440.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,348.42
|
| Rate for Payer: BCN Commercial |
$4,348.42
|
| Rate for Payer: Cash Price |
$4,486.95
|
| Rate for Payer: Cofinity Commercial |
$5,272.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,486.95
|
| Rate for Payer: Healthscope Commercial |
$5,608.69
|
| Rate for Payer: Healthscope Whirlpool |
$5,440.43
|
| Rate for Payer: Mclaren Commercial |
$5,047.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,767.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,926.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,935.65
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
OP
|
$5,608.69
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,243.48 |
| Max. Negotiated Rate |
$5,608.69 |
| Rate for Payer: Aetna Commercial |
$5,047.82
|
| Rate for Payer: ASR ASR |
$5,440.43
|
| Rate for Payer: BCBS Complete |
$2,243.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,348.42
|
| Rate for Payer: BCN Commercial |
$4,348.42
|
| Rate for Payer: Cash Price |
$4,486.95
|
| Rate for Payer: Cofinity Commercial |
$5,272.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,486.95
|
| Rate for Payer: Healthscope Commercial |
$5,608.69
|
| Rate for Payer: Healthscope Whirlpool |
$5,440.43
|
| Rate for Payer: Mclaren Commercial |
$5,047.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,767.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,926.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,103.91
|
| Rate for Payer: Priority Health Narrow Network |
$3,982.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,935.65
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,265.57
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,985.90 |
| Max. Negotiated Rate |
$4,265.57 |
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: ASR ASR |
$4,137.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,307.10
|
| Rate for Payer: BCN Commercial |
$3,307.10
|
| Rate for Payer: Cash Price |
$3,412.46
|
| Rate for Payer: Cofinity Commercial |
$4,009.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,412.46
|
| Rate for Payer: Healthscope Commercial |
$4,265.57
|
| Rate for Payer: Healthscope Whirlpool |
$4,137.60
|
| Rate for Payer: Mclaren Commercial |
$3,839.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,625.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,753.70
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,265.57
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,706.23 |
| Max. Negotiated Rate |
$4,265.57 |
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: ASR ASR |
$4,137.60
|
| Rate for Payer: BCBS Complete |
$1,706.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,307.10
|
| Rate for Payer: BCN Commercial |
$3,307.10
|
| Rate for Payer: Cash Price |
$3,412.46
|
| Rate for Payer: Cofinity Commercial |
$4,009.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,412.46
|
| Rate for Payer: Healthscope Commercial |
$4,265.57
|
| Rate for Payer: Healthscope Whirlpool |
$4,137.60
|
| Rate for Payer: Mclaren Commercial |
$3,839.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,625.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,881.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,028.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,753.70
|
|
|
HC BARRX RFA
|
Facility
|
IP
|
$2,004.30
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,403.01 |
| Max. Negotiated Rate |
$2,004.30 |
| Rate for Payer: Aetna Commercial |
$1,803.87
|
| Rate for Payer: ASR ASR |
$1,944.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.93
|
| Rate for Payer: BCN Commercial |
$1,553.93
|
| Rate for Payer: Cash Price |
$1,603.44
|
| Rate for Payer: Cofinity Commercial |
$1,884.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.44
|
| Rate for Payer: Healthscope Commercial |
$2,004.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,944.17
|
| Rate for Payer: Mclaren Commercial |
$1,803.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,403.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.78
|
|
|
HC BARRX RFA
|
Facility
|
OP
|
$2,004.30
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$801.72 |
| Max. Negotiated Rate |
$2,004.30 |
| Rate for Payer: Aetna Commercial |
$1,803.87
|
| Rate for Payer: ASR ASR |
$1,944.17
|
| Rate for Payer: BCBS Complete |
$801.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.93
|
| Rate for Payer: BCN Commercial |
$1,553.93
|
| Rate for Payer: Cash Price |
$1,603.44
|
| Rate for Payer: Cofinity Commercial |
$1,884.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.44
|
| Rate for Payer: Healthscope Commercial |
$2,004.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,944.17
|
| Rate for Payer: Mclaren Commercial |
$1,803.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,403.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,423.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.78
|
|
|
HC BARRX ULTRA LONG RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,333.46
|
|
| Hospital Charge Code |
27200288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,033.42 |
| Max. Negotiated Rate |
$4,333.46 |
| Rate for Payer: Aetna Commercial |
$3,900.11
|
| Rate for Payer: ASR ASR |
$4,203.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,359.73
|
| Rate for Payer: BCN Commercial |
$3,359.73
|
| Rate for Payer: Cash Price |
$3,466.77
|
| Rate for Payer: Cofinity Commercial |
$4,073.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,466.77
|
| Rate for Payer: Healthscope Commercial |
$4,333.46
|
| Rate for Payer: Healthscope Whirlpool |
$4,203.46
|
| Rate for Payer: Mclaren Commercial |
$3,900.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,683.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,033.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,813.44
|
|
|
HC BARRX ULTRA LONG RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,333.46
|
|
| Hospital Charge Code |
27200288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.38 |
| Max. Negotiated Rate |
$4,333.46 |
| Rate for Payer: Aetna Commercial |
$3,900.11
|
| Rate for Payer: ASR ASR |
$4,203.46
|
| Rate for Payer: BCBS Complete |
$1,733.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,359.73
|
| Rate for Payer: BCN Commercial |
$3,359.73
|
| Rate for Payer: Cash Price |
$3,466.77
|
| Rate for Payer: Cofinity Commercial |
$4,073.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,466.77
|
| Rate for Payer: Healthscope Commercial |
$4,333.46
|
| Rate for Payer: Healthscope Whirlpool |
$4,203.46
|
| Rate for Payer: Mclaren Commercial |
$3,900.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,683.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,033.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,943.45
|
| Rate for Payer: Priority Health Narrow Network |
$3,076.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,813.44
|
|
|
HC BARTONELLA HENSELAE CMPT
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HC BARTONELLA HENSELAE CMPT
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Mclaren Medicaid |
$5.57
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Medicaid |
$5.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.57
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$11.59
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
| Rate for Payer: UHC Medicare Advantage |
$10.49
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BARTONELLA HENSELAE IGG IGM
|
Facility
|
IP
|
$17.34
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: ASR ASR |
$16.82
|
| Rate for Payer: BCBS Trust/PPO |
$13.44
|
| Rate for Payer: BCN Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$13.87
|
| Rate for Payer: Cofinity Commercial |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.87
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Whirlpool |
$16.82
|
| Rate for Payer: Mclaren Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.26
|
|
|
HC BARTONELLA HENSELAE IGG IGM
|
Facility
|
OP
|
$17.34
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$16.82
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$13.44
|
| Rate for Payer: BCN Commercial |
$13.44
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$13.87
|
| Rate for Payer: Cash Price |
$13.87
|
| Rate for Payer: Cofinity Commercial |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$17.34
|
| Rate for Payer: Healthscope Whirlpool |
$16.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$5.57
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Medicaid |
$5.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.74
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.57
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.78
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$12.31
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.26
|
| Rate for Payer: UHC Medicare Advantage |
$10.49
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$31.22
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
30100010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$31.22 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: ASR ASR |
$30.28
|
| Rate for Payer: BCBS Trust/PPO |
$24.20
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cofinity Commercial |
$29.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.98
|
| Rate for Payer: Healthscope Commercial |
$31.22
|
| Rate for Payer: Healthscope Whirlpool |
$30.28
|
| Rate for Payer: Mclaren Commercial |
$28.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.47
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$31.22
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
30100010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$57.98 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.58
|
| Rate for Payer: ASR ASR |
$30.28
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS MAPPO |
$8.46
|
| Rate for Payer: BCBS Trust/PPO |
$24.20
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$8.46
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cofinity Commercial |
$29.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.46
|
| Rate for Payer: Healthscope Commercial |
$31.22
|
| Rate for Payer: Healthscope Whirlpool |
$30.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.46
|
| Rate for Payer: Mclaren Commercial |
$28.10
|
| Rate for Payer: Mclaren Medicaid |
$4.63
|
| Rate for Payer: Mclaren Medicare |
$8.46
|
| Rate for Payer: Meridian Medicaid |
$4.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.54
|
| Rate for Payer: PACE Medicare |
$8.04
|
| Rate for Payer: PACE SWMI |
$8.46
|
| Rate for Payer: PHP Commercial |
$9.31
|
| Rate for Payer: PHP Medicaid |
$4.63
|
| Rate for Payer: PHP Medicare Advantage |
$8.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.98
|
| Rate for Payer: Priority Health Medicare |
$8.46
|
| Rate for Payer: Priority Health Narrow Network |
$46.38
|
| Rate for Payer: Railroad Medicare Medicare |
$8.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.47
|
| Rate for Payer: UHC Medicare Advantage |
$8.71
|
| Rate for Payer: VA VA |
$8.46
|
|
|
HC BASIC METABOLIC W ION CALCIUM
|
Facility
|
IP
|
$92.92
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$83.63
|
| Rate for Payer: ASR ASR |
$90.13
|
| Rate for Payer: BCBS Trust/PPO |
$72.04
|
| Rate for Payer: BCN Commercial |
$72.04
|
| Rate for Payer: Cash Price |
$74.34
|
| Rate for Payer: Cofinity Commercial |
$87.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.34
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: Healthscope Whirlpool |
$90.13
|
| Rate for Payer: Mclaren Commercial |
$83.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.77
|
|
|
HC BASIC METABOLIC W ION CALCIUM
|
Facility
|
OP
|
$92.92
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$83.63
|
| Rate for Payer: Aetna Medicare |
$13.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: ASR ASR |
$90.13
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$72.04
|
| Rate for Payer: BCN Commercial |
$72.04
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$74.34
|
| Rate for Payer: Cash Price |
$74.34
|
| Rate for Payer: Cofinity Commercial |
$87.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: Healthscope Whirlpool |
$90.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$83.63
|
| Rate for Payer: Mclaren Medicaid |
$7.51
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.98
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: PHP Medicaid |
$7.51
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.56
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$65.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.77
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC BASIC RAD DOSIMETRY
|
Facility
|
IP
|
$423.30
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$296.31 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: Aetna Commercial |
$380.97
|
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: ASR ASR |
$410.60
|
| Rate for Payer: ASR ASR |
$277.42
|
| Rate for Payer: BCBS Trust/PPO |
$221.74
|
| Rate for Payer: BCBS Trust/PPO |
$328.18
|
| Rate for Payer: BCN Commercial |
$221.74
|
| Rate for Payer: BCN Commercial |
$328.18
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$397.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.64
|
| Rate for Payer: Healthscope Commercial |
$423.30
|
| Rate for Payer: Healthscope Commercial |
$286.00
|
| Rate for Payer: Healthscope Whirlpool |
$277.42
|
| Rate for Payer: Healthscope Whirlpool |
$410.60
|
| Rate for Payer: Mclaren Commercial |
$380.97
|
| Rate for Payer: Mclaren Commercial |
$257.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.50
|
|
|
HC BASIC RAD DOSIMETRY
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Commercial |
$380.97
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$410.60
|
| Rate for Payer: ASR ASR |
$277.42
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$221.74
|
| Rate for Payer: BCBS Trust/PPO |
$328.18
|
| Rate for Payer: BCN Commercial |
$328.18
|
| Rate for Payer: BCN Commercial |
$221.74
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$397.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$286.00
|
| Rate for Payer: Healthscope Commercial |
$423.30
|
| Rate for Payer: Healthscope Whirlpool |
$410.60
|
| Rate for Payer: Healthscope Whirlpool |
$277.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$380.97
|
| Rate for Payer: Mclaren Commercial |
$257.40
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.80
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.20
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$203.06
|
| Rate for Payer: Priority Health Narrow Network |
$300.54
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.68
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC BB-COMP-FRESH-FROZEN PLASMA EA
|
Facility
|
OP
|
$219.81
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
39000041
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$219.81 |
| Rate for Payer: Aetna Commercial |
$197.83
|
| Rate for Payer: Aetna Medicare |
$67.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.62
|
| Rate for Payer: ASR ASR |
$213.22
|
| Rate for Payer: BCBS Complete |
$38.89
|
| Rate for Payer: BCBS MAPPO |
$67.70
|
| Rate for Payer: BCBS Trust/PPO |
$170.42
|
| Rate for Payer: BCN Commercial |
$170.42
|
| Rate for Payer: BCN Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cofinity Commercial |
$206.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.70
|
| Rate for Payer: Healthscope Commercial |
$219.81
|
| Rate for Payer: Healthscope Whirlpool |
$213.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$67.70
|
| Rate for Payer: Mclaren Commercial |
$197.83
|
| Rate for Payer: Mclaren Medicaid |
$37.03
|
| Rate for Payer: Mclaren Medicare |
$67.70
|
| Rate for Payer: Meridian Medicaid |
$38.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: PACE Medicare |
$64.32
|
| Rate for Payer: PACE SWMI |
$67.70
|
| Rate for Payer: PHP Commercial |
$74.47
|
| Rate for Payer: PHP Medicaid |
$37.03
|
| Rate for Payer: PHP Medicare Advantage |
$67.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.20
|
| Rate for Payer: Priority Health Medicare |
$67.70
|
| Rate for Payer: Priority Health Narrow Network |
$124.16
|
| Rate for Payer: Railroad Medicare Medicare |
$67.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.43
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: VA VA |
$67.70
|
|
|
HC BB-COMP-FRESH-FROZEN PLASMA EA
|
Facility
|
IP
|
$219.81
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
39000041
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$153.87 |
| Max. Negotiated Rate |
$219.81 |
| Rate for Payer: Aetna Commercial |
$197.83
|
| Rate for Payer: ASR ASR |
$213.22
|
| Rate for Payer: BCBS Trust/PPO |
$170.42
|
| Rate for Payer: BCN Commercial |
$170.42
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cofinity Commercial |
$206.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.85
|
| Rate for Payer: Healthscope Commercial |
$219.81
|
| Rate for Payer: Healthscope Whirlpool |
$213.22
|
| Rate for Payer: Mclaren Commercial |
$197.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.43
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$92.82
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Aetna Commercial |
$83.54
|
| Rate for Payer: ASR ASR |
$90.04
|
| Rate for Payer: BCBS Trust/PPO |
$71.96
|
| Rate for Payer: BCN Commercial |
$71.96
|
| Rate for Payer: Cash Price |
$74.26
|
| Rate for Payer: Cofinity Commercial |
$87.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.26
|
| Rate for Payer: Healthscope Commercial |
$92.82
|
| Rate for Payer: Healthscope Whirlpool |
$90.04
|
| Rate for Payer: Mclaren Commercial |
$83.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.68
|
|
