|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$1,964.25
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$785.70 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Aetna Commercial |
$1,767.82
|
| Rate for Payer: ASR ASR |
$1,905.32
|
| Rate for Payer: BCBS Complete |
$785.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.88
|
| Rate for Payer: BCN Commercial |
$1,522.88
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cofinity Commercial |
$1,846.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.40
|
| Rate for Payer: Healthscope Commercial |
$1,964.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,905.32
|
| Rate for Payer: Mclaren Commercial |
$1,767.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,787.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,394.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.54
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$1,964.25
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,374.98 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Aetna Commercial |
$1,767.82
|
| Rate for Payer: ASR ASR |
$1,905.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.88
|
| Rate for Payer: BCN Commercial |
$1,522.88
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cofinity Commercial |
$1,846.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.40
|
| Rate for Payer: Healthscope Commercial |
$1,964.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,905.32
|
| Rate for Payer: Mclaren Commercial |
$1,767.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.54
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: BCBS Trust/PPO |
$36.44
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: ASR ASR |
$45.59
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.44
|
| Rate for Payer: BCN Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$44.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Healthscope Whirlpool |
$45.59
|
| Rate for Payer: Mclaren Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.77
|
| Rate for Payer: Priority Health Narrow Network |
$33.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.36
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$35.44
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna Commercial |
$31.90
|
| Rate for Payer: ASR ASR |
$34.38
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Commercial |
$27.48
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$33.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.35
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Healthscope Whirlpool |
$34.38
|
| Rate for Payer: Mclaren Commercial |
$31.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.19
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$35.44
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna Commercial |
$31.90
|
| Rate for Payer: ASR ASR |
$34.38
|
| Rate for Payer: BCBS Complete |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Commercial |
$27.48
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$33.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.35
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Healthscope Whirlpool |
$34.38
|
| Rate for Payer: Mclaren Commercial |
$31.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.25
|
| Rate for Payer: Priority Health Narrow Network |
$25.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.19
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$144.63
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$144.63 |
| Rate for Payer: Aetna Commercial |
$130.17
|
| Rate for Payer: ASR ASR |
$140.29
|
| Rate for Payer: BCBS Complete |
$57.85
|
| Rate for Payer: BCBS Trust/PPO |
$112.13
|
| Rate for Payer: BCN Commercial |
$112.13
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$135.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Healthscope Commercial |
$144.63
|
| Rate for Payer: Healthscope Whirlpool |
$140.29
|
| Rate for Payer: Mclaren Commercial |
$130.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.61
|
| Rate for Payer: Priority Health Narrow Network |
$102.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.27
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$144.63
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.24 |
| Max. Negotiated Rate |
$144.63 |
| Rate for Payer: Aetna Commercial |
$130.17
|
| Rate for Payer: ASR ASR |
$140.29
|
| Rate for Payer: BCBS Trust/PPO |
$112.13
|
| Rate for Payer: BCN Commercial |
$112.13
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$135.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Healthscope Commercial |
$144.63
|
| Rate for Payer: Healthscope Whirlpool |
$140.29
|
| Rate for Payer: Mclaren Commercial |
$130.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.27
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$332.52
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.76 |
| Max. Negotiated Rate |
$332.52 |
| Rate for Payer: Aetna Commercial |
$299.27
|
| Rate for Payer: ASR ASR |
$322.54
|
| Rate for Payer: BCBS Trust/PPO |
$257.80
|
| Rate for Payer: BCN Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cofinity Commercial |
$312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.02
|
| Rate for Payer: Healthscope Commercial |
$332.52
|
| Rate for Payer: Healthscope Whirlpool |
$322.54
|
| Rate for Payer: Mclaren Commercial |
$299.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.62
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$332.52
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$332.52 |
| Rate for Payer: Aetna Commercial |
$299.27
|
| Rate for Payer: ASR ASR |
$322.54
|
| Rate for Payer: BCBS Complete |
$133.01
|
| Rate for Payer: BCBS Trust/PPO |
$257.80
|
| Rate for Payer: BCN Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cofinity Commercial |
$312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.02
|
| Rate for Payer: Healthscope Commercial |
$332.52
|
| Rate for Payer: Healthscope Whirlpool |
$322.54
|
| Rate for Payer: Mclaren Commercial |
$299.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.59
|
| Rate for Payer: Priority Health Narrow Network |
$236.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.62
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$473.28
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.30 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$425.95
|
| Rate for Payer: ASR ASR |
$459.08
|
| Rate for Payer: BCBS Trust/PPO |
$366.93
|
| Rate for Payer: BCN Commercial |
$366.93
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cofinity Commercial |
$444.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.62
|
| Rate for Payer: Healthscope Commercial |
$473.28
|
| Rate for Payer: Healthscope Whirlpool |
$459.08
|
| Rate for Payer: Mclaren Commercial |
$425.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.49
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$473.28
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.31 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$425.95
|
| Rate for Payer: ASR ASR |
$459.08
|
| Rate for Payer: BCBS Complete |
$189.31
|
| Rate for Payer: BCBS Trust/PPO |
$366.93
|
| Rate for Payer: BCN Commercial |
$366.93
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cofinity Commercial |
$444.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.62
|
| Rate for Payer: Healthscope Commercial |
$473.28
|
| Rate for Payer: Healthscope Whirlpool |
$459.08
|
| Rate for Payer: Mclaren Commercial |
$425.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.68
|
| Rate for Payer: Priority Health Narrow Network |
$336.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.49
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$132.19
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: ASR ASR |
$128.22
|
| Rate for Payer: BCBS Complete |
$52.88
|
| Rate for Payer: BCBS Trust/PPO |
$102.49
|
| Rate for Payer: BCN Commercial |
$102.49
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$124.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.75
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Healthscope Whirlpool |
$128.22
|
| Rate for Payer: Mclaren Commercial |
$118.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.29
|
| Rate for Payer: Priority Health Narrow Network |
$93.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.33
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$132.19
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$118.97
|
| Rate for Payer: ASR ASR |
$128.22
|
| Rate for Payer: BCBS Trust/PPO |
$102.49
|
| Rate for Payer: BCN Commercial |
$102.49
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$124.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.75
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Healthscope Whirlpool |
$128.22
|
| Rate for Payer: Mclaren Commercial |
$118.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.33
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$219.81
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| 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 BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$219.81
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$219.81 |
| Rate for Payer: Aetna Commercial |
$197.83
|
| Rate for Payer: Aetna Medicare |
$32.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.76
|
| Rate for Payer: ASR ASR |
$213.22
|
| Rate for Payer: BCBS Complete |
$18.73
|
| Rate for Payer: BCBS MAPPO |
$32.61
|
| Rate for Payer: BCBS Trust/PPO |
$170.42
|
| Rate for Payer: BCN Commercial |
$170.42
|
| Rate for Payer: BCN Medicare Advantage |
$32.61
|
| 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 |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$219.81
|
| Rate for Payer: Healthscope Whirlpool |
$213.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$32.61
|
| Rate for Payer: Mclaren Commercial |
$197.83
|
| Rate for Payer: Mclaren Medicaid |
$17.84
|
| Rate for Payer: Mclaren Medicare |
$32.61
|
| Rate for Payer: Meridian Medicaid |
$18.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: PACE Medicare |
$30.98
|
| Rate for Payer: PACE SWMI |
$32.61
|
| Rate for Payer: PHP Commercial |
$35.87
|
| Rate for Payer: PHP Medicaid |
$17.84
|
| Rate for Payer: PHP Medicare Advantage |
$32.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.03
|
| Rate for Payer: Priority Health Medicare |
$32.61
|
| Rate for Payer: Priority Health Narrow Network |
$156.07
|
| Rate for Payer: Railroad Medicare Medicare |
$32.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.43
|
| Rate for Payer: UHC Medicare Advantage |
$33.59
|
| Rate for Payer: VA VA |
$32.61
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,751.81
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,226.27 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna Commercial |
$1,576.63
|
| Rate for Payer: ASR ASR |
$1,699.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,358.18
|
| Rate for Payer: BCN Commercial |
$1,358.18
|
| Rate for Payer: Cash Price |
$1,401.45
|
| Rate for Payer: Cofinity Commercial |
$1,646.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.45
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,699.26
|
| Rate for Payer: Mclaren Commercial |
$1,576.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,489.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,541.59
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,751.81
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.72 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna Commercial |
$1,576.63
|
| Rate for Payer: ASR ASR |
$1,699.26
|
| Rate for Payer: BCBS Complete |
$700.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,358.18
|
| Rate for Payer: BCN Commercial |
$1,358.18
|
| Rate for Payer: Cash Price |
$1,401.45
|
| Rate for Payer: Cofinity Commercial |
$1,646.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.45
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,699.26
|
| Rate for Payer: Mclaren Commercial |
$1,576.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,489.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,594.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,243.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,541.59
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,077.67
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.49 |
| Max. Negotiated Rate |
$5,077.67 |
| Rate for Payer: Aetna Commercial |
$4,569.90
|
| Rate for Payer: ASR ASR |
$4,925.34
|
| Rate for Payer: BCBS Complete |
$2,031.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,936.72
|
| Rate for Payer: BCCCP Commercial |
$613.86
|
| Rate for Payer: BCN Commercial |
$3,936.72
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cofinity Commercial |
$4,773.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,062.14
|
| Rate for Payer: Healthscope Commercial |
$5,077.67
|
| Rate for Payer: Healthscope Whirlpool |
$4,925.34
|
| Rate for Payer: Mclaren Commercial |
$4,569.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,554.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.36
|
| Rate for Payer: Priority Health Narrow Network |
$195.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,468.35
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,077.67
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,554.37 |
| Max. Negotiated Rate |
$5,077.67 |
| Rate for Payer: Aetna Commercial |
$4,569.90
|
| Rate for Payer: ASR ASR |
$4,925.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,936.72
|
| Rate for Payer: BCN Commercial |
$3,936.72
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cofinity Commercial |
$4,773.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,062.14
|
| Rate for Payer: Healthscope Commercial |
$5,077.67
|
| Rate for Payer: Healthscope Whirlpool |
$4,925.34
|
| Rate for Payer: Mclaren Commercial |
$4,569.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,554.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,468.35
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,598.37
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,518.86 |
| Max. Negotiated Rate |
$3,598.37 |
| Rate for Payer: Aetna Commercial |
$3,238.53
|
| Rate for Payer: ASR ASR |
$3,490.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,789.82
|
| Rate for Payer: BCN Commercial |
$2,789.82
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cofinity Commercial |
$3,382.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,878.70
|
| Rate for Payer: Healthscope Commercial |
$3,598.37
|
| Rate for Payer: Healthscope Whirlpool |
$3,490.42
|
| Rate for Payer: Mclaren Commercial |
$3,238.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,058.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,166.57
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,598.37
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.89 |
| Max. Negotiated Rate |
$3,598.37 |
| Rate for Payer: Aetna Commercial |
$3,238.53
|
| Rate for Payer: ASR ASR |
$3,490.42
|
| Rate for Payer: BCBS Complete |
$1,439.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,789.82
|
| Rate for Payer: BCCCP Commercial |
$400.24
|
| Rate for Payer: BCN Commercial |
$2,789.82
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cofinity Commercial |
$3,382.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,878.70
|
| Rate for Payer: Healthscope Commercial |
$3,598.37
|
| Rate for Payer: Healthscope Whirlpool |
$3,490.42
|
| Rate for Payer: Mclaren Commercial |
$3,238.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,058.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.61
|
| Rate for Payer: Priority Health Narrow Network |
$190.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,166.57
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
OP
|
$3,966.57
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$3,966.57 |
| Rate for Payer: Aetna Commercial |
$3,569.91
|
| Rate for Payer: ASR ASR |
$3,847.57
|
| Rate for Payer: BCBS Complete |
$1,586.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,075.28
|
| Rate for Payer: BCCCP Commercial |
$394.27
|
| Rate for Payer: BCN Commercial |
$3,075.28
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cofinity Commercial |
$3,728.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.26
|
| Rate for Payer: Healthscope Commercial |
$3,966.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,847.57
|
| Rate for Payer: Mclaren Commercial |
$3,569.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,371.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,776.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.23
|
| Rate for Payer: Priority Health Narrow Network |
$179.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,490.58
|
|
