|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: ASR ASR |
$128.04
|
| Rate for Payer: BCBS Trust/PPO |
$102.34
|
| Rate for Payer: BCN Commercial |
$102.34
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$124.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$132.00
|
| Rate for Payer: Healthscope Whirlpool |
$128.04
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: ASR ASR |
$43.65
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Healthscope Whirlpool |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.95
|
| Rate for Payer: Priority Health Narrow Network |
$31.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: ASR ASR |
$43.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Healthscope Whirlpool |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
|
HC COMPLEMENT C 3
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
|
|
HC COMPLEMENT C 3
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.56
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT C 4
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
|
|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.56
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$55.36
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$55.36
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.56
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: Aetna Medicare |
$20.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.40
|
| Rate for Payer: ASR ASR |
$37.60
|
| Rate for Payer: BCBS Complete |
$11.67
|
| Rate for Payer: BCBS MAPPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$30.05
|
| Rate for Payer: BCN Commercial |
$30.05
|
| Rate for Payer: BCN Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$36.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Healthscope Whirlpool |
$37.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.32
|
| Rate for Payer: Mclaren Commercial |
$34.88
|
| Rate for Payer: Mclaren Medicaid |
$11.12
|
| Rate for Payer: Mclaren Medicare |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Medicare |
$19.30
|
| Rate for Payer: PACE SWMI |
$20.32
|
| Rate for Payer: PHP Commercial |
$22.35
|
| Rate for Payer: PHP Medicaid |
$11.12
|
| Rate for Payer: PHP Medicare Advantage |
$20.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$20.32
|
| Rate for Payer: Priority Health Narrow Network |
$46.80
|
| Rate for Payer: Railroad Medicare Medicare |
$20.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.11
|
| Rate for Payer: UHC Medicare Advantage |
$20.93
|
| Rate for Payer: VA VA |
$20.32
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$38.76 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: ASR ASR |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$30.05
|
| Rate for Payer: BCN Commercial |
$30.05
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$36.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$38.76
|
| Rate for Payer: Healthscope Whirlpool |
$37.60
|
| Rate for Payer: Mclaren Commercial |
$34.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.11
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$389.48
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$389.48 |
| Rate for Payer: Aetna Commercial |
$350.53
|
| Rate for Payer: Aetna Medicare |
$219.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: ASR ASR |
$377.80
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$301.96
|
| Rate for Payer: BCN Commercial |
$301.96
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cofinity Commercial |
$366.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$389.48
|
| Rate for Payer: Healthscope Whirlpool |
$377.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$350.53
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.06
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$241.65
|
| Rate for Payer: PHP Medicaid |
$120.16
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.43
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$276.53
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.74
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$389.48
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$389.48 |
| Rate for Payer: Aetna Commercial |
$350.53
|
| Rate for Payer: ASR ASR |
$377.80
|
| Rate for Payer: BCBS Trust/PPO |
$301.96
|
| Rate for Payer: BCN Commercial |
$301.96
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cofinity Commercial |
$366.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.58
|
| Rate for Payer: Healthscope Commercial |
$389.48
|
| Rate for Payer: Healthscope Whirlpool |
$377.80
|
| Rate for Payer: Mclaren Commercial |
$350.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.74
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
OP
|
$859.86
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.14 |
| Max. Negotiated Rate |
$859.86 |
| Rate for Payer: Aetna Commercial |
$773.87
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: ASR ASR |
$834.06
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$666.65
|
| Rate for Payer: BCN Commercial |
$666.65
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Cash Price |
$687.89
|
| Rate for Payer: Cash Price |
$687.89
|
| Rate for Payer: Cofinity Commercial |
$808.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Healthscope Commercial |
$859.86
|
| Rate for Payer: Healthscope Whirlpool |
$834.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$607.20
|
| Rate for Payer: Mclaren Commercial |
$773.87
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.88
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Commercial |
$667.92
|
| Rate for Payer: PHP Medicaid |
$332.14
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.47
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$610.50
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$756.68
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
IP
|
$859.86
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.90 |
| Max. Negotiated Rate |
$859.86 |
| Rate for Payer: Aetna Commercial |
$773.87
|
| Rate for Payer: ASR ASR |
$834.06
|
| Rate for Payer: BCBS Trust/PPO |
$666.65
|
| Rate for Payer: BCN Commercial |
$666.65
|
| Rate for Payer: Cash Price |
$687.89
|
| Rate for Payer: Cofinity Commercial |
$808.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.89
|
| Rate for Payer: Healthscope Commercial |
$859.86
|
| Rate for Payer: Healthscope Whirlpool |
$834.06
|
| Rate for Payer: Mclaren Commercial |
$773.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$756.68
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
IP
|
$860.25
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.18 |
| Max. Negotiated Rate |
$860.25 |
| Rate for Payer: Aetna Commercial |
$774.22
|
| Rate for Payer: ASR ASR |
$834.44
|
| Rate for Payer: BCBS Trust/PPO |
$666.95
|
| Rate for Payer: BCN Commercial |
$666.95
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$808.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$860.25
|
| Rate for Payer: Healthscope Whirlpool |
$834.44
|
| Rate for Payer: Mclaren Commercial |
$774.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.02
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
OP
|
$860.25
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.14 |
| Max. Negotiated Rate |
$860.25 |
| Rate for Payer: Aetna Commercial |
$774.22
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: ASR ASR |
$834.44
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$666.95
|
| Rate for Payer: BCN Commercial |
$666.95
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$808.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Healthscope Commercial |
$860.25
|
| Rate for Payer: Healthscope Whirlpool |
$834.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$607.20
|
| Rate for Payer: Mclaren Commercial |
$774.22
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.21
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Commercial |
$667.92
|
| Rate for Payer: PHP Medicaid |
$332.14
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.83
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$610.78
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.02
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$715.50
|
| Rate for Payer: ASR ASR |
$771.15
|
| Rate for Payer: BCBS Trust/PPO |
$616.36
|
| Rate for Payer: BCN Commercial |
$616.36
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cofinity Commercial |
$747.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.00
|
| Rate for Payer: Healthscope Commercial |
$795.00
|
| Rate for Payer: Healthscope Whirlpool |
$771.15
|
| Rate for Payer: Mclaren Commercial |
$715.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$675.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$699.60
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.61 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$715.50
|
| Rate for Payer: Aetna Medicare |
$140.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.08
|
| Rate for Payer: ASR ASR |
$771.15
|
| Rate for Payer: BCBS Complete |
$80.45
|
| Rate for Payer: BCBS MAPPO |
$140.06
|
| Rate for Payer: BCBS Trust/PPO |
$616.36
|
| Rate for Payer: BCN Commercial |
$616.36
|
| Rate for Payer: BCN Medicare Advantage |
$140.06
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cofinity Commercial |
$747.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.06
|
| Rate for Payer: Healthscope Commercial |
$795.00
|
| Rate for Payer: Healthscope Whirlpool |
$771.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$140.06
|
| Rate for Payer: Mclaren Commercial |
$715.50
|
| Rate for Payer: Mclaren Medicaid |
$76.61
|
| Rate for Payer: Mclaren Medicare |
$140.06
|
| Rate for Payer: Meridian Medicaid |
$80.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$675.75
|
| Rate for Payer: PACE Medicare |
$133.06
|
| Rate for Payer: PACE SWMI |
$140.06
|
| Rate for Payer: PHP Commercial |
$154.07
|
| Rate for Payer: PHP Medicaid |
$76.61
|
| Rate for Payer: PHP Medicare Advantage |
$140.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$723.45
|
| Rate for Payer: Priority Health Medicare |
$140.06
|
| Rate for Payer: Priority Health Narrow Network |
$564.45
|
| Rate for Payer: Railroad Medicare Medicare |
$140.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$699.60
|
| Rate for Payer: UHC Medicare Advantage |
$144.26
|
| Rate for Payer: VA VA |
$140.06
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$228.81
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.17 |
| Max. Negotiated Rate |
$228.81 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: ASR ASR |
$221.95
|
| Rate for Payer: BCBS Trust/PPO |
$177.40
|
| Rate for Payer: BCN Commercial |
$177.40
|
| Rate for Payer: Cash Price |
$183.05
|
| Rate for Payer: Cofinity Commercial |
$215.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.05
|
| Rate for Payer: Healthscope Commercial |
$228.81
|
| Rate for Payer: Healthscope Whirlpool |
$221.95
|
| Rate for Payer: Mclaren Commercial |
$205.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.35
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$228.81
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$221.95
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$177.40
|
| Rate for Payer: BCN Commercial |
$177.40
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$183.05
|
| Rate for Payer: Cash Price |
$183.05
|
| Rate for Payer: Cofinity Commercial |
$215.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$228.81
|
| Rate for Payer: Healthscope Whirlpool |
$221.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$205.93
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.49
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.22
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$162.46
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.35
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$72.86 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: Aetna Medicare |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.20
|
| Rate for Payer: ASR ASR |
$37.25
|
| Rate for Payer: BCBS Complete |
$6.07
|
| Rate for Payer: BCBS MAPPO |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$29.77
|
| Rate for Payer: BCN Commercial |
$29.77
|
| Rate for Payer: BCN Medicare Advantage |
$10.56
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cofinity Commercial |
$36.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$38.40
|
| Rate for Payer: Healthscope Whirlpool |
$37.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.56
|
| Rate for Payer: Mclaren Commercial |
$34.56
|
| Rate for Payer: Mclaren Medicaid |
$5.78
|
| Rate for Payer: Mclaren Medicare |
$10.56
|
| Rate for Payer: Meridian Medicaid |
$6.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.64
|
| Rate for Payer: PACE Medicare |
$10.03
|
| Rate for Payer: PACE SWMI |
$10.56
|
| Rate for Payer: PHP Commercial |
$11.62
|
| Rate for Payer: PHP Medicaid |
$5.78
|
| Rate for Payer: PHP Medicare Advantage |
$10.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.86
|
| Rate for Payer: Priority Health Medicare |
$10.56
|
| Rate for Payer: Priority Health Narrow Network |
$58.29
|
| Rate for Payer: Railroad Medicare Medicare |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.79
|
| Rate for Payer: UHC Medicare Advantage |
$10.88
|
| Rate for Payer: VA VA |
$10.56
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$34.56
|
| Rate for Payer: ASR ASR |
$37.25
|
| Rate for Payer: BCBS Trust/PPO |
$29.77
|
| Rate for Payer: BCN Commercial |
$29.77
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cofinity Commercial |
$36.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.72
|
| Rate for Payer: Healthscope Commercial |
$38.40
|
| Rate for Payer: Healthscope Whirlpool |
$37.25
|
| Rate for Payer: Mclaren Commercial |
$34.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.79
|
|
|
HC COMPONENT POOLING
|
Facility
|
OP
|
$121.70
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$109.53
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$118.05
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$94.35
|
| Rate for Payer: BCN Commercial |
$94.35
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$114.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$121.70
|
| Rate for Payer: Healthscope Whirlpool |
$118.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$109.53
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.44
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.75
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$86.41
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.10
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC COMPONENT POOLING
|
Facility
|
IP
|
$121.70
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.19 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$109.53
|
| Rate for Payer: ASR ASR |
$118.05
|
| Rate for Payer: BCBS Trust/PPO |
$94.35
|
| Rate for Payer: BCN Commercial |
$94.35
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$114.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Healthscope Commercial |
$121.70
|
| Rate for Payer: Healthscope Whirlpool |
$118.05
|
| Rate for Payer: Mclaren Commercial |
$109.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.10
|
|
