|
HC CONNECTOR Y
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
27000048
|
|
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 CONSULT NUTRITIONAL
|
Facility
|
IP
|
$34.27
|
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$33.24
|
| Rate for Payer: BCBS Trust/PPO |
$26.57
|
| Rate for Payer: BCN Commercial |
$26.57
|
| Rate for Payer: Cash Price |
$27.42
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.42
|
| Rate for Payer: Healthscope Commercial |
$34.27
|
| Rate for Payer: Healthscope Whirlpool |
$33.24
|
| Rate for Payer: Mclaren Commercial |
$30.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.16
|
|
|
HC CONSULT NUTRITIONAL
|
Facility
|
OP
|
$34.27
|
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$33.24
|
| Rate for Payer: BCBS Complete |
$13.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.57
|
| Rate for Payer: BCN Commercial |
$26.57
|
| Rate for Payer: Cash Price |
$27.42
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.42
|
| Rate for Payer: Healthscope Commercial |
$34.27
|
| Rate for Payer: Healthscope Whirlpool |
$33.24
|
| Rate for Payer: Mclaren Commercial |
$30.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.19
|
| Rate for Payer: Priority Health Narrow Network |
$24.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.16
|
|
|
HC CONT GLUCOSE MONITOR OFFICE EQUIP
|
Facility
|
OP
|
$965.28
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$965.28 |
| Rate for Payer: Aetna Commercial |
$868.75
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$936.32
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$748.38
|
| Rate for Payer: BCN Commercial |
$748.38
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$907.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$965.28
|
| Rate for Payer: Healthscope Whirlpool |
$936.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$868.75
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.49
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.40
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$685.35
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.45
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC CONT GLUCOSE MONITOR OFFICE EQUIP
|
Facility
|
IP
|
$965.28
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$675.70 |
| Max. Negotiated Rate |
$965.28 |
| Rate for Payer: Aetna Commercial |
$868.75
|
| Rate for Payer: ASR ASR |
$936.32
|
| Rate for Payer: BCBS Trust/PPO |
$748.38
|
| Rate for Payer: BCN Commercial |
$748.38
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$907.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Healthscope Commercial |
$965.28
|
| Rate for Payer: Healthscope Whirlpool |
$936.32
|
| Rate for Payer: Mclaren Commercial |
$868.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.45
|
|
|
HC CONT GLUCOSE MONITOR PATIENT EQUIP
|
Facility
|
OP
|
$376.90
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
94200038
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$376.90 |
| Rate for Payer: Aetna Commercial |
$339.21
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$365.59
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$292.21
|
| Rate for Payer: BCN Commercial |
$292.21
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$301.52
|
| Rate for Payer: Cash Price |
$301.52
|
| Rate for Payer: Cofinity Commercial |
$354.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$376.90
|
| Rate for Payer: Healthscope Whirlpool |
$365.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$339.21
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.36
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.88
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$47.90
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.67
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC CONT GLUCOSE MONITOR PATIENT EQUIP
|
Facility
|
IP
|
$376.90
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
94200038
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$263.83 |
| Max. Negotiated Rate |
$376.90 |
| Rate for Payer: Aetna Commercial |
$339.21
|
| Rate for Payer: ASR ASR |
$365.59
|
| Rate for Payer: BCBS Trust/PPO |
$292.21
|
| Rate for Payer: BCN Commercial |
$292.21
|
| Rate for Payer: Cash Price |
$301.52
|
| Rate for Payer: Cofinity Commercial |
$354.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.52
|
| Rate for Payer: Healthscope Commercial |
$376.90
|
| Rate for Payer: Healthscope Whirlpool |
$365.59
|
| Rate for Payer: Mclaren Commercial |
$339.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.67
|
|
|
HC CONTINUOUS NEB SUBSEQUENT HR
|
Facility
|
IP
|
$102.48
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
41000007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$71.74 |
| Max. Negotiated Rate |
$102.48 |
| Rate for Payer: Aetna Commercial |
$92.23
|
| Rate for Payer: ASR ASR |
$99.41
|
| Rate for Payer: BCBS Trust/PPO |
$79.45
|
| Rate for Payer: BCN Commercial |
$79.45
|
| Rate for Payer: Cash Price |
$81.98
|
| Rate for Payer: Cofinity Commercial |
$96.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.98
|
| Rate for Payer: Healthscope Commercial |
$102.48
|
| Rate for Payer: Healthscope Whirlpool |
$99.41
|
| Rate for Payer: Mclaren Commercial |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.18
|
|
|
HC CONTINUOUS NEB SUBSEQUENT HR
|
Facility
|
OP
|
$102.48
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
41000007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.99 |
| Max. Negotiated Rate |
$108.78 |
| Rate for Payer: Aetna Commercial |
$92.23
|
| Rate for Payer: ASR ASR |
$99.41
|
| Rate for Payer: BCBS Complete |
$40.99
|
| Rate for Payer: BCBS Trust/PPO |
$79.45
|
| Rate for Payer: BCN Commercial |
$79.45
|
| Rate for Payer: Cash Price |
$81.98
|
| Rate for Payer: Cash Price |
$81.98
|
| Rate for Payer: Cofinity Commercial |
$96.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.98
|
| Rate for Payer: Healthscope Commercial |
$102.48
|
| Rate for Payer: Healthscope Whirlpool |
$99.41
|
| Rate for Payer: Mclaren Commercial |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.78
|
| Rate for Payer: Priority Health Narrow Network |
$87.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.18
|
|
|
HC CONTINUOUS NEB TX INITIAL HOUR
|
Facility
|
IP
|
$368.06
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
41000006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$257.64 |
| Max. Negotiated Rate |
$368.06 |
| Rate for Payer: Aetna Commercial |
$331.25
|
| Rate for Payer: ASR ASR |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$285.36
|
| Rate for Payer: BCN Commercial |
$285.36
|
| Rate for Payer: Cash Price |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$345.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.45
|
| Rate for Payer: Healthscope Commercial |
$368.06
|
| Rate for Payer: Healthscope Whirlpool |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$331.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.89
|
|
|
HC CONTINUOUS NEB TX INITIAL HOUR
|
Facility
|
OP
|
$368.06
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
41000006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$368.06 |
| Rate for Payer: Aetna Commercial |
$331.25
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$357.02
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$285.36
|
| Rate for Payer: BCN Commercial |
$285.36
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$294.45
|
| Rate for Payer: Cash Price |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$345.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$368.06
|
| Rate for Payer: Healthscope Whirlpool |
$357.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$331.25
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.85
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.78
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$212.62
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.89
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC CONT PHYSICS CONSULT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$462.70 |
| Max. Negotiated Rate |
$661.00 |
| Rate for Payer: Aetna Commercial |
$594.90
|
| Rate for Payer: Aetna Commercial |
$515.92
|
| Rate for Payer: ASR ASR |
$641.17
|
| Rate for Payer: ASR ASR |
$556.04
|
| Rate for Payer: BCBS Trust/PPO |
$444.43
|
| Rate for Payer: BCBS Trust/PPO |
$512.47
|
| Rate for Payer: BCN Commercial |
$444.43
|
| Rate for Payer: BCN Commercial |
$512.47
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Commercial |
$621.34
|
| Rate for Payer: Cofinity Commercial |
$538.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.80
|
| Rate for Payer: Healthscope Commercial |
$661.00
|
| Rate for Payer: Healthscope Commercial |
$573.24
|
| Rate for Payer: Healthscope Whirlpool |
$641.17
|
| Rate for Payer: Healthscope Whirlpool |
$556.04
|
| Rate for Payer: Mclaren Commercial |
$515.92
|
| Rate for Payer: Mclaren Commercial |
$594.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$581.68
|
|
|
HC CONT PHYSICS CONSULT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$661.00 |
| Rate for Payer: Aetna Commercial |
$594.90
|
| Rate for Payer: Aetna Commercial |
$515.92
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$641.17
|
| Rate for Payer: ASR ASR |
$556.04
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$444.43
|
| Rate for Payer: BCBS Trust/PPO |
$512.47
|
| Rate for Payer: BCN Commercial |
$512.47
|
| Rate for Payer: BCN Commercial |
$444.43
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Commercial |
$538.85
|
| Rate for Payer: Cofinity Commercial |
$621.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$661.00
|
| Rate for Payer: Healthscope Commercial |
$573.24
|
| Rate for Payer: Healthscope Whirlpool |
$556.04
|
| Rate for Payer: Healthscope Whirlpool |
$641.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$594.90
|
| Rate for Payer: Mclaren Commercial |
$515.92
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.85
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.51
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$469.31
|
| Rate for Payer: Priority Health Narrow Network |
$407.00
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$581.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.45
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
IP
|
$103.70
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.59 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Aetna Commercial |
$93.33
|
| Rate for Payer: ASR ASR |
$100.59
|
| Rate for Payer: BCBS Trust/PPO |
$80.40
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$82.96
|
| Rate for Payer: Cofinity Commercial |
$97.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.96
|
| Rate for Payer: Healthscope Commercial |
$103.70
|
| Rate for Payer: Healthscope Whirlpool |
$100.59
|
| Rate for Payer: Mclaren Commercial |
$93.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.26
|
|
|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
OP
|
$103.70
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Aetna Commercial |
$93.33
|
| Rate for Payer: ASR ASR |
$100.59
|
| Rate for Payer: BCBS Complete |
$41.48
|
| Rate for Payer: BCBS Trust/PPO |
$80.40
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$82.96
|
| Rate for Payer: Cash Price |
$82.96
|
| Rate for Payer: Cofinity Commercial |
$97.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.96
|
| Rate for Payer: Healthscope Commercial |
$103.70
|
| Rate for Payer: Healthscope Whirlpool |
$100.59
|
| Rate for Payer: Mclaren Commercial |
$93.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.84
|
| Rate for Payer: Priority Health Narrow Network |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.26
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
OP
|
$406.51
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$406.51 |
| Rate for Payer: Aetna Commercial |
$365.86
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$394.31
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$315.17
|
| Rate for Payer: BCN Commercial |
$315.17
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$325.21
|
| Rate for Payer: Cash Price |
$325.21
|
| Rate for Payer: Cofinity Commercial |
$382.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$406.51
|
| Rate for Payer: Healthscope Whirlpool |
$394.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$365.86
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.53
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.86
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$160.69
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.73
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
IP
|
$406.51
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.56 |
| Max. Negotiated Rate |
$406.51 |
| Rate for Payer: Aetna Commercial |
$365.86
|
| Rate for Payer: ASR ASR |
$394.31
|
| Rate for Payer: BCBS Trust/PPO |
$315.17
|
| Rate for Payer: BCN Commercial |
$315.17
|
| Rate for Payer: Cash Price |
$325.21
|
| Rate for Payer: Cofinity Commercial |
$382.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.21
|
| Rate for Payer: Healthscope Commercial |
$406.51
|
| Rate for Payer: Healthscope Whirlpool |
$394.31
|
| Rate for Payer: Mclaren Commercial |
$365.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.73
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
IP
|
$738.99
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$517.29 |
| Max. Negotiated Rate |
$738.99 |
| Rate for Payer: Aetna Commercial |
$665.09
|
| Rate for Payer: ASR ASR |
$716.82
|
| Rate for Payer: BCBS Trust/PPO |
$572.94
|
| Rate for Payer: BCN Commercial |
$572.94
|
| Rate for Payer: Cash Price |
$591.19
|
| Rate for Payer: Cofinity Commercial |
$694.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$591.19
|
| Rate for Payer: Healthscope Commercial |
$738.99
|
| Rate for Payer: Healthscope Whirlpool |
$716.82
|
| Rate for Payer: Mclaren Commercial |
$665.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$628.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$650.31
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
OP
|
$738.99
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.52 |
| Max. Negotiated Rate |
$738.99 |
| Rate for Payer: Aetna Commercial |
$665.09
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: ASR ASR |
$716.82
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$572.94
|
| Rate for Payer: BCN Commercial |
$572.94
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Cash Price |
$591.19
|
| Rate for Payer: Cash Price |
$591.19
|
| Rate for Payer: Cofinity Commercial |
$694.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$591.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Healthscope Commercial |
$738.99
|
| Rate for Payer: Healthscope Whirlpool |
$716.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$489.06
|
| Rate for Payer: Mclaren Commercial |
$665.09
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$628.14
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Commercial |
$537.97
|
| Rate for Payer: PHP Medicaid |
$267.52
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.48
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$524.68
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$650.31
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: VA VA |
$489.06
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.52 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$1,184.40
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: ASR ASR |
$1,276.52
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.29
|
| Rate for Payer: BCN Commercial |
$1,020.29
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,237.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Healthscope Commercial |
$1,316.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,276.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$489.06
|
| Rate for Payer: Mclaren Commercial |
$1,184.40
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Commercial |
$537.97
|
| Rate for Payer: PHP Medicaid |
$267.52
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,197.56
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$934.36
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.08
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: VA VA |
$489.06
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.20 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$1,184.40
|
| Rate for Payer: ASR ASR |
$1,276.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.29
|
| Rate for Payer: BCN Commercial |
$1,020.29
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,237.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Healthscope Commercial |
$1,316.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,276.52
|
| Rate for Payer: Mclaren Commercial |
$1,184.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.08
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,610.82
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,527.57 |
| Max. Negotiated Rate |
$3,610.82 |
| Rate for Payer: Aetna Commercial |
$3,249.74
|
| Rate for Payer: ASR ASR |
$3,502.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,799.47
|
| Rate for Payer: BCN Commercial |
$2,799.47
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$3,394.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.66
|
| Rate for Payer: Healthscope Commercial |
$3,610.82
|
| Rate for Payer: Healthscope Whirlpool |
$3,502.50
|
| Rate for Payer: Mclaren Commercial |
$3,249.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,177.52
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,610.82
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,682.15 |
| Max. Negotiated Rate |
$3,844.02 |
| Rate for Payer: Aetna Commercial |
$3,249.74
|
| Rate for Payer: Aetna Medicare |
$3,075.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: ASR ASR |
$3,502.50
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,799.47
|
| Rate for Payer: BCN Commercial |
$2,799.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$3,394.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,888.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$3,610.82
|
| Rate for Payer: Healthscope Whirlpool |
$3,502.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,075.22
|
| Rate for Payer: Mclaren Commercial |
$3,249.74
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$3,382.74
|
| Rate for Payer: PHP Medicaid |
$1,682.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,285.85
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,563.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,177.52
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
IP
|
$1,180.78
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$826.55 |
| Max. Negotiated Rate |
$1,180.78 |
| Rate for Payer: Aetna Commercial |
$1,062.70
|
| Rate for Payer: ASR ASR |
$1,145.36
|
| Rate for Payer: BCBS Trust/PPO |
$915.46
|
| Rate for Payer: BCN Commercial |
$915.46
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,109.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Healthscope Commercial |
$1,180.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.36
|
| Rate for Payer: Mclaren Commercial |
$1,062.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.09
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
OP
|
$1,180.78
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$826.55 |
| Max. Negotiated Rate |
$2,263.10 |
| Rate for Payer: Aetna Commercial |
$1,062.70
|
| Rate for Payer: Aetna Medicare |
$1,810.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: ASR ASR |
$1,145.36
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$915.46
|
| Rate for Payer: BCN Commercial |
$915.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,109.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$1,180.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,810.48
|
| Rate for Payer: Mclaren Commercial |
$1,062.70
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$1,991.53
|
| Rate for Payer: PHP Medicaid |
$990.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,074.51
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$838.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
