|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,203.27 |
| Max. Negotiated Rate |
$6,937.70 |
| Rate for Payer: Aetna Commercial |
$6,243.93
|
| Rate for Payer: ASR ASR |
$6,729.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,697.24
|
| Rate for Payer: BCN Commercial |
$5,697.24
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$6,521.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,729.57
|
| Rate for Payer: Healthscope Whirlpool |
$6,937.70
|
| Rate for Payer: Mclaren Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,203.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,105.18
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,566.95 |
| Max. Negotiated Rate |
$6,937.70 |
| Rate for Payer: Aetna Commercial |
$6,243.93
|
| Rate for Payer: Aetna Medicare |
$2,566.95
|
| Rate for Payer: ASR ASR |
$6,729.57
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,720.13
|
| Rate for Payer: BCN Commercial |
$5,720.13
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$6,521.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,729.57
|
| Rate for Payer: Healthscope Whirlpool |
$6,937.70
|
| Rate for Payer: Mclaren Commercial |
$6,243.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,550.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,203.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,078.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,863.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,105.18
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$660.96
|
| Rate for Payer: ASR ASR |
$712.37
|
| Rate for Payer: BCBS Trust/PPO |
$603.09
|
| Rate for Payer: BCN Commercial |
$603.09
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$690.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$712.37
|
| Rate for Payer: Healthscope Whirlpool |
$734.40
|
| Rate for Payer: Mclaren Commercial |
$660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$646.27
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.73 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$660.96
|
| Rate for Payer: Aetna Medicare |
$271.73
|
| Rate for Payer: ASR ASR |
$712.37
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$605.51
|
| Rate for Payer: BCN Commercial |
$605.51
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$690.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$712.37
|
| Rate for Payer: Healthscope Whirlpool |
$734.40
|
| Rate for Payer: Mclaren Commercial |
$660.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$587.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$643.48
|
| Rate for Payer: Priority Health Narrow Network |
$514.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$646.27
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.09 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$798.11
|
| Rate for Payer: ASR ASR |
$860.19
|
| Rate for Payer: BCBS Trust/PPO |
$728.23
|
| Rate for Payer: BCN Commercial |
$728.23
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$833.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$860.19
|
| Rate for Payer: Healthscope Whirlpool |
$886.79
|
| Rate for Payer: Mclaren Commercial |
$798.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$665.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.38
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.11 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$798.11
|
| Rate for Payer: Aetna Medicare |
$328.11
|
| Rate for Payer: ASR ASR |
$860.19
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS Trust/PPO |
$731.16
|
| Rate for Payer: BCN Commercial |
$731.16
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$833.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$860.19
|
| Rate for Payer: Healthscope Whirlpool |
$886.79
|
| Rate for Payer: Mclaren Commercial |
$798.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$709.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$665.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$777.01
|
| Rate for Payer: Priority Health Narrow Network |
$621.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.38
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$763.51
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.63 |
| Max. Negotiated Rate |
$763.51 |
| Rate for Payer: Aetna Commercial |
$687.16
|
| Rate for Payer: ASR ASR |
$740.60
|
| Rate for Payer: BCBS Trust/PPO |
$626.99
|
| Rate for Payer: BCN Commercial |
$626.99
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Commercial |
$717.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$740.60
|
| Rate for Payer: Healthscope Whirlpool |
$763.51
|
| Rate for Payer: Mclaren Commercial |
$687.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Nomi Health Commercial |
$626.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.89
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$763.51
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.50 |
| Max. Negotiated Rate |
$763.51 |
| Rate for Payer: Aetna Commercial |
$687.16
|
| Rate for Payer: Aetna Medicare |
$282.50
|
| Rate for Payer: ASR ASR |
$740.60
|
| Rate for Payer: BCBS Complete |
$305.40
|
| Rate for Payer: BCBS Trust/PPO |
$629.51
|
| Rate for Payer: BCN Commercial |
$629.51
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Commercial |
$717.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$740.60
|
| Rate for Payer: Healthscope Whirlpool |
$763.51
|
| Rate for Payer: Mclaren Commercial |
$687.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$610.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Nomi Health Commercial |
$626.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$668.99
|
| Rate for Payer: Priority Health Narrow Network |
$535.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.89
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,963.53
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$726.51 |
| Max. Negotiated Rate |
$1,963.53 |
| Rate for Payer: Aetna Commercial |
$1,767.18
|
| Rate for Payer: Aetna Medicare |
$726.51
|
| Rate for Payer: ASR ASR |
$1,904.62
|
| Rate for Payer: BCBS Complete |
$785.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,618.93
|
| Rate for Payer: BCN Commercial |
$1,618.93
|
| Rate for Payer: Cash Price |
$1,570.82
|
| Rate for Payer: Cofinity Commercial |
$1,845.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Commercial |
$1,904.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,963.53
|
| Rate for Payer: Mclaren Commercial |
$1,767.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,570.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.00
|
| Rate for Payer: Nomi Health Commercial |
$1,610.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,720.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.91
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,963.53
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,472.65 |
| Max. Negotiated Rate |
$1,963.53 |
| Rate for Payer: Aetna Commercial |
$1,767.18
|
| Rate for Payer: ASR ASR |
$1,904.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.45
|
| Rate for Payer: BCN Commercial |
$1,612.45
|
| Rate for Payer: Cash Price |
$1,570.82
|
| Rate for Payer: Cofinity Commercial |
$1,845.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Commercial |
$1,904.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,963.53
|
| Rate for Payer: Mclaren Commercial |
$1,767.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.00
|
| Rate for Payer: Nomi Health Commercial |
$1,610.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,472.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,727.91
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.85 |
| Max. Negotiated Rate |
$82.47 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: ASR ASR |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$67.72
|
| Rate for Payer: BCN Commercial |
$67.72
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$77.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$80.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.47
|
| Rate for Payer: Mclaren Commercial |
$74.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Nomi Health Commercial |
$67.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.57
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$82.47 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Aetna Medicare |
$30.51
|
| Rate for Payer: ASR ASR |
$80.00
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$68.00
|
| Rate for Payer: BCN Commercial |
$68.00
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$77.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$80.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.47
|
| Rate for Payer: Mclaren Commercial |
$74.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Nomi Health Commercial |
$67.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.26
|
| Rate for Payer: Priority Health Narrow Network |
$57.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.57
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.16 |
| Max. Negotiated Rate |
$249.07 |
| Rate for Payer: Aetna Commercial |
$224.16
|
| Rate for Payer: Aetna Medicare |
$92.16
|
| Rate for Payer: ASR ASR |
$241.60
|
| Rate for Payer: BCBS Complete |
$99.63
|
| Rate for Payer: BCBS Trust/PPO |
$205.36
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$234.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$241.60
|
| Rate for Payer: Healthscope Whirlpool |
$249.07
|
| Rate for Payer: Mclaren Commercial |
$224.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: Nomi Health Commercial |
$204.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.24
|
| Rate for Payer: Priority Health Narrow Network |
$174.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.18
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$249.07 |
| Rate for Payer: Aetna Commercial |
$224.16
|
| Rate for Payer: ASR ASR |
$241.60
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$204.54
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$234.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$241.60
|
| Rate for Payer: Healthscope Whirlpool |
$249.07
|
| Rate for Payer: Mclaren Commercial |
$224.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: Nomi Health Commercial |
$204.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.18
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,253.01
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,439.76 |
| Max. Negotiated Rate |
$3,253.01 |
| Rate for Payer: Aetna Commercial |
$2,927.71
|
| Rate for Payer: ASR ASR |
$3,155.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,671.37
|
| Rate for Payer: BCN Commercial |
$2,671.37
|
| Rate for Payer: Cash Price |
$2,602.41
|
| Rate for Payer: Cofinity Commercial |
$3,057.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,602.41
|
| Rate for Payer: Healthscope Commercial |
$3,155.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,253.01
|
| Rate for Payer: Mclaren Commercial |
$2,927.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,765.06
|
| Rate for Payer: Nomi Health Commercial |
$2,667.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,439.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,862.65
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,253.01
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,203.61 |
| Max. Negotiated Rate |
$3,253.01 |
| Rate for Payer: Aetna Commercial |
$2,927.71
|
| Rate for Payer: Aetna Medicare |
$1,203.61
|
| Rate for Payer: ASR ASR |
$3,155.42
|
| Rate for Payer: BCBS Complete |
$1,301.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,682.11
|
| Rate for Payer: BCN Commercial |
$2,682.11
|
| Rate for Payer: Cash Price |
$2,602.41
|
| Rate for Payer: Cofinity Commercial |
$3,057.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,602.41
|
| Rate for Payer: Healthscope Commercial |
$3,155.42
|
| Rate for Payer: Healthscope Whirlpool |
$3,253.01
|
| Rate for Payer: Mclaren Commercial |
$2,927.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,602.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,765.06
|
| Rate for Payer: Nomi Health Commercial |
$2,667.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,439.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,850.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,280.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,862.65
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.96
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna Commercial |
$12.56
|
| Rate for Payer: ASR ASR |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.46
|
| Rate for Payer: BCN Commercial |
$11.46
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Healthscope Whirlpool |
$13.96
|
| Rate for Payer: Mclaren Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.87
|
| Rate for Payer: Nomi Health Commercial |
$11.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.96
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna Commercial |
$12.56
|
| Rate for Payer: Aetna Medicare |
$5.17
|
| Rate for Payer: ASR ASR |
$13.54
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.51
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Healthscope Whirlpool |
$13.96
|
| Rate for Payer: Mclaren Commercial |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.87
|
| Rate for Payer: Nomi Health Commercial |
$11.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.23
|
| Rate for Payer: Priority Health Narrow Network |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
|
|
HC BANDING
|
Facility
|
IP
|
$984.95
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$738.71 |
| Max. Negotiated Rate |
$984.95 |
| Rate for Payer: Aetna Commercial |
$886.46
|
| Rate for Payer: ASR ASR |
$955.40
|
| Rate for Payer: BCBS Trust/PPO |
$808.84
|
| Rate for Payer: BCN Commercial |
$808.84
|
| Rate for Payer: Cash Price |
$787.96
|
| Rate for Payer: Cofinity Commercial |
$925.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.96
|
| Rate for Payer: Healthscope Commercial |
$955.40
|
| Rate for Payer: Healthscope Whirlpool |
$984.95
|
| Rate for Payer: Mclaren Commercial |
$886.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$837.21
|
| Rate for Payer: Nomi Health Commercial |
$807.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$866.76
|
|
|
HC BANDING
|
Facility
|
OP
|
$984.95
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.43 |
| Max. Negotiated Rate |
$984.95 |
| Rate for Payer: Aetna Commercial |
$886.46
|
| Rate for Payer: Aetna Medicare |
$364.43
|
| Rate for Payer: ASR ASR |
$955.40
|
| Rate for Payer: BCBS Complete |
$393.98
|
| Rate for Payer: BCBS Trust/PPO |
$812.09
|
| Rate for Payer: BCN Commercial |
$812.09
|
| Rate for Payer: Cash Price |
$787.96
|
| Rate for Payer: Cofinity Commercial |
$925.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.96
|
| Rate for Payer: Healthscope Commercial |
$955.40
|
| Rate for Payer: Healthscope Whirlpool |
$984.95
|
| Rate for Payer: Mclaren Commercial |
$886.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$787.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$837.21
|
| Rate for Payer: Nomi Health Commercial |
$807.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$863.01
|
| Rate for Payer: Priority Health Narrow Network |
$690.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$866.76
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| 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 |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$53.18
|
| Rate for Payer: BCN Commercial |
$53.18
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$62.56
|
| Rate for Payer: Healthscope Whirlpool |
$64.50
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.51
|
| Rate for Payer: Priority Health Narrow Network |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
