|
HC COMPONENT THAWING
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| 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 |
$102.82
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$82.18
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$95.40
|
| 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 |
$90.10
|
| 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 |
$74.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$24.62
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.28
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC COMPONENT THAWING
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: ASR ASR |
$102.82
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$99.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.80
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.82
|
| Rate for Payer: Mclaren Commercial |
$95.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.28
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$145.61 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: ASR ASR |
$201.77
|
| Rate for Payer: BCBS Trust/PPO |
$161.27
|
| Rate for Payer: BCN Commercial |
$161.27
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$195.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Healthscope Whirlpool |
$201.77
|
| Rate for Payer: Mclaren Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.05
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$201.77
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$161.27
|
| Rate for Payer: BCN Commercial |
$161.27
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$195.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Healthscope Whirlpool |
$201.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$187.21
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.29
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$147.69
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.05
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC COMPRESS BURN GARM GAUNTLET-EL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: ASR ASR |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$66.68
|
| Rate for Payer: BCN Commercial |
$66.68
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Healthscope Commercial |
$86.00
|
| Rate for Payer: Healthscope Whirlpool |
$83.42
|
| Rate for Payer: Mclaren Commercial |
$77.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.68
|
|
|
HC COMPRESS BURN GARM GAUNTLET-EL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: ASR ASR |
$83.42
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS Trust/PPO |
$66.68
|
| Rate for Payer: BCN Commercial |
$66.68
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Healthscope Commercial |
$86.00
|
| Rate for Payer: Healthscope Whirlpool |
$83.42
|
| Rate for Payer: Mclaren Commercial |
$77.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.26
|
| Rate for Payer: Priority Health Narrow Network |
$61.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.68
|
|
|
HC CONDITIONING PLAY AUDIOMETRY
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$141.62
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$113.19
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$146.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.86
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$103.66
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC CONDITIONING PLAY AUDIOMETRY
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: ASR ASR |
$141.62
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$113.19
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.80
|
| Rate for Payer: Healthscope Commercial |
$146.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.62
|
| Rate for Payer: Mclaren Commercial |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
|
|
HC CONFIRMED DRUG ABUSE PANEL 9 U
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100643
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC CONFIRMED DRUG ABUSE PANEL 9 U
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100643
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.82
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.42
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC CONIZ CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.14 |
| Max. Negotiated Rate |
$7,789.74 |
| Rate for Payer: Aetna Commercial |
$7,010.77
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: ASR ASR |
$7,556.05
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$6,039.39
|
| Rate for Payer: BCCCP Commercial |
$322.14
|
| Rate for Payer: BCN Commercial |
$6,039.39
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$7,322.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$7,789.74
|
| Rate for Payer: Healthscope Whirlpool |
$7,556.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$7,010.77
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,088.66
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$5,530.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,854.97
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
HC CONIZ CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,452.82 |
| Max. Negotiated Rate |
$7,789.74 |
| Rate for Payer: Aetna Commercial |
$7,010.77
|
| Rate for Payer: ASR ASR |
$7,556.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,039.39
|
| Rate for Payer: BCN Commercial |
$6,039.39
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$7,322.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Healthscope Commercial |
$7,789.74
|
| Rate for Payer: Healthscope Whirlpool |
$7,556.05
|
| Rate for Payer: Mclaren Commercial |
$7,010.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,854.97
|
|
|
HC CONNECTIVE TISSUE CASCADE ANA & CCP
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
30200156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$138.53 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$24.20
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$7.08
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.53
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$14.24
|
| Rate for Payer: PHP Medicaid |
$7.08
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.53
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health Narrow Network |
$110.82
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Medicare Advantage |
$13.34
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CONNECTIVE TISSUE CASCADE ANA & CCP
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
30200156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$24.20
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC CONNECTOR 3/8 W/ LL
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
27000448
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
HC CONNECTOR 3/8 W/ LL
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
27000448
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.78
|
| Rate for Payer: Priority Health Narrow Network |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
HC CONNECTOR REDUCER
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
27000651
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
HC CONNECTOR REDUCER
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
27000651
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.78
|
| Rate for Payer: Priority Health Narrow Network |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
HC CONNECTOR ST 1/2 X 1/2
|
Facility
|
IP
|
$7.50
|
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: ASR ASR |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$5.81
|
| Rate for Payer: BCN Commercial |
$5.81
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Healthscope Whirlpool |
$7.28
|
| Rate for Payer: Mclaren Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.60
|
|
|
HC CONNECTOR ST 1/2 X 1/2
|
Facility
|
OP
|
$7.50
|
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: ASR ASR |
$7.28
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.81
|
| Rate for Payer: BCN Commercial |
$5.81
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Healthscope Whirlpool |
$7.28
|
| Rate for Payer: Mclaren Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.82
|
| Rate for Payer: Priority Health Narrow Network |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.60
|
|
|
HC CONNECTOR ST 3/8 OR 1/4
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
27000685
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.78
|
| Rate for Payer: Priority Health Narrow Network |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
HC CONNECTOR ST 3/8 OR 1/4
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
27000685
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
HC CONNECTOR V
|
Facility
|
OP
|
$7.50
|
|
| Hospital Charge Code |
27000678
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: ASR ASR |
$7.28
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.81
|
| Rate for Payer: BCN Commercial |
$5.81
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Healthscope Whirlpool |
$7.28
|
| Rate for Payer: Mclaren Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.82
|
| Rate for Payer: Priority Health Narrow Network |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.60
|
|
|
HC CONNECTOR V
|
Facility
|
IP
|
$7.50
|
|
| Hospital Charge Code |
27000678
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: ASR ASR |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$5.81
|
| Rate for Payer: BCN Commercial |
$5.81
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Healthscope Whirlpool |
$7.28
|
| Rate for Payer: Mclaren Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.60
|
|
|
HC CONNECTOR Y
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
27000048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
