|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: ASR Commercial |
$726.08
|
| Rate for Payer: BCBS Trust/PPO |
$609.99
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: ASR Commercial |
$726.08
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS Trust/PPO |
$612.98
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.87
|
| Rate for Payer: Priority Health Narrow Network |
$524.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,251.27 |
| Max. Negotiated Rate |
$1,925.03 |
| Rate for Payer: Aetna Commercial |
$1,732.53
|
| Rate for Payer: ASR ASR |
$1,867.28
|
| Rate for Payer: ASR Commercial |
$1,867.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,568.71
|
| Rate for Payer: BCN Commercial |
$1,492.48
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,809.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Healthscope Commercial |
$1,925.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,867.28
|
| Rate for Payer: Mclaren Commercial |
$1,732.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: Nomi Health Commercial |
$1,578.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.03
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$770.01 |
| Max. Negotiated Rate |
$1,925.03 |
| Rate for Payer: Aetna Commercial |
$1,732.53
|
| Rate for Payer: Aetna Medicare |
$962.51
|
| Rate for Payer: ASR ASR |
$1,867.28
|
| Rate for Payer: ASR Commercial |
$1,867.28
|
| Rate for Payer: BCBS Complete |
$770.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.41
|
| Rate for Payer: BCN Commercial |
$1,492.48
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,809.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Healthscope Commercial |
$1,925.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,867.28
|
| Rate for Payer: Mclaren Commercial |
$1,732.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: Nomi Health Commercial |
$1,578.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.03
|
|
|
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 |
$32.99 |
| Max. Negotiated Rate |
$82.47 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Aetna Medicare |
$41.23
|
| Rate for Payer: ASR ASR |
$80.00
|
| Rate for Payer: ASR Commercial |
$80.00
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$67.53
|
| Rate for Payer: BCN Commercial |
$63.94
|
| 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 |
$82.47
|
| Rate for Payer: Healthscope Whirlpool |
$80.00
|
| 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: Priority Health Cigna Priority Health |
$53.61
|
| Rate for Payer: 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 1
|
Facility
|
IP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$82.47 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: ASR ASR |
$80.00
|
| Rate for Payer: ASR Commercial |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$67.20
|
| Rate for Payer: BCN Commercial |
$63.94
|
| 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 |
$82.47
|
| Rate for Payer: Healthscope Whirlpool |
$80.00
|
| 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: Priority Health Cigna Priority Health |
$53.61
|
| 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 |
$99.63 |
| Max. Negotiated Rate |
$249.07 |
| Rate for Payer: Aetna Commercial |
$224.16
|
| Rate for Payer: Aetna Medicare |
$124.53
|
| Rate for Payer: ASR ASR |
$241.60
|
| Rate for Payer: ASR Commercial |
$241.60
|
| Rate for Payer: BCBS Complete |
$99.63
|
| Rate for Payer: BCBS Trust/PPO |
$203.96
|
| Rate for Payer: BCN Commercial |
$193.10
|
| 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 |
$249.07
|
| Rate for Payer: Healthscope Whirlpool |
$241.60
|
| 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: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: 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 |
$161.90 |
| Max. Negotiated Rate |
$249.07 |
| Rate for Payer: Aetna Commercial |
$224.16
|
| Rate for Payer: ASR ASR |
$241.60
|
| Rate for Payer: ASR Commercial |
$241.60
|
| Rate for Payer: BCBS Trust/PPO |
$202.97
|
| Rate for Payer: BCN Commercial |
$193.10
|
| 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 |
$249.07
|
| Rate for Payer: Healthscope Whirlpool |
$241.60
|
| 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: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.18
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,189.23
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,275.69 |
| Max. Negotiated Rate |
$3,189.23 |
| Rate for Payer: Aetna Commercial |
$2,870.31
|
| Rate for Payer: Aetna Medicare |
$1,594.62
|
| Rate for Payer: ASR ASR |
$3,093.55
|
| Rate for Payer: ASR Commercial |
$3,093.55
|
| Rate for Payer: BCBS Complete |
$1,275.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,611.66
|
| Rate for Payer: BCN Commercial |
$2,472.61
|
| Rate for Payer: Cash Price |
$2,551.38
|
| Rate for Payer: Cofinity Commercial |
$2,997.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,551.38
|
| Rate for Payer: Healthscope Commercial |
$3,189.23
|
| Rate for Payer: Healthscope Whirlpool |
$3,093.55
|
| Rate for Payer: Mclaren Commercial |
$2,870.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.85
|
| Rate for Payer: Nomi Health Commercial |
$2,615.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,794.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,235.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,806.52
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,189.23
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,073.00 |
| Max. Negotiated Rate |
$3,189.23 |
| Rate for Payer: Aetna Commercial |
$2,870.31
|
| Rate for Payer: ASR ASR |
$3,093.55
|
| Rate for Payer: ASR Commercial |
$3,093.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,598.90
|
| Rate for Payer: BCN Commercial |
$2,472.61
|
| Rate for Payer: Cash Price |
$2,551.38
|
| Rate for Payer: Cofinity Commercial |
$2,997.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,551.38
|
| Rate for Payer: Healthscope Commercial |
$3,189.23
|
| Rate for Payer: Healthscope Whirlpool |
$3,093.55
|
| Rate for Payer: Mclaren Commercial |
$2,870.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.85
|
| Rate for Payer: Nomi Health Commercial |
$2,615.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,806.52
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.69
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: ASR ASR |
$13.28
|
| Rate for Payer: ASR Commercial |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.16
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Healthscope Whirlpool |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: Nomi Health Commercial |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.05
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.69
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: ASR ASR |
$13.28
|
| Rate for Payer: ASR Commercial |
$13.28
|
| Rate for Payer: BCBS Complete |
$5.48
|
| Rate for Payer: BCBS Trust/PPO |
$11.21
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$12.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Healthscope Whirlpool |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: Nomi Health Commercial |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$9.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.05
|
|
|
HC BANDING
|
Facility
|
OP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.26 |
| Max. Negotiated Rate |
$965.64 |
| Rate for Payer: Aetna Commercial |
$869.08
|
| Rate for Payer: Aetna Medicare |
$482.82
|
| Rate for Payer: ASR ASR |
$936.67
|
| Rate for Payer: ASR Commercial |
$936.67
|
| Rate for Payer: BCBS Complete |
$386.26
|
| Rate for Payer: BCBS Trust/PPO |
$790.76
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$907.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Healthscope Commercial |
$965.64
|
| Rate for Payer: Healthscope Whirlpool |
$936.67
|
| Rate for Payer: Mclaren Commercial |
$869.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: Nomi Health Commercial |
$791.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$846.09
|
| Rate for Payer: Priority Health Narrow Network |
$676.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.76
|
|
|
HC BANDING
|
Facility
|
IP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$627.67 |
| Max. Negotiated Rate |
$965.64 |
| Rate for Payer: Aetna Commercial |
$869.08
|
| Rate for Payer: ASR ASR |
$936.67
|
| Rate for Payer: ASR Commercial |
$936.67
|
| Rate for Payer: BCBS Trust/PPO |
$786.90
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$907.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Healthscope Commercial |
$965.64
|
| Rate for Payer: Healthscope Whirlpool |
$936.67
|
| Rate for Payer: Mclaren Commercial |
$869.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: Nomi Health Commercial |
$791.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.76
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| 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 |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| 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 |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Trust/PPO |
$82.84
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.53
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC BARRIER ADHESION
|
Facility
|
OP
|
$589.96
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$235.98 |
| Max. Negotiated Rate |
$589.96 |
| Rate for Payer: Aetna Commercial |
$530.96
|
| Rate for Payer: Aetna Medicare |
$294.98
|
| Rate for Payer: ASR ASR |
$572.26
|
| Rate for Payer: ASR Commercial |
$572.26
|
| Rate for Payer: BCBS Complete |
$235.98
|
| Rate for Payer: BCBS Trust/PPO |
$483.12
|
| Rate for Payer: BCN Commercial |
$457.40
|
| Rate for Payer: Cash Price |
$471.97
|
| Rate for Payer: Cofinity Commercial |
$554.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.97
|
| Rate for Payer: Healthscope Commercial |
$589.96
|
| Rate for Payer: Healthscope Whirlpool |
$572.26
|
| Rate for Payer: Mclaren Commercial |
$530.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.47
|
| Rate for Payer: Nomi Health Commercial |
$483.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.92
|
| Rate for Payer: Priority Health Narrow Network |
$413.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.16
|
|
|
HC BARRIER ADHESION
|
Facility
|
IP
|
$589.96
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$383.47 |
| Max. Negotiated Rate |
$589.96 |
| Rate for Payer: Aetna Commercial |
$530.96
|
| Rate for Payer: ASR ASR |
$572.26
|
| Rate for Payer: ASR Commercial |
$572.26
|
| Rate for Payer: BCBS Trust/PPO |
$480.76
|
| Rate for Payer: BCN Commercial |
$457.40
|
| Rate for Payer: Cash Price |
$471.97
|
| Rate for Payer: Cofinity Commercial |
$554.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.97
|
| Rate for Payer: Healthscope Commercial |
$589.96
|
| Rate for Payer: Healthscope Whirlpool |
$572.26
|
| Rate for Payer: Mclaren Commercial |
$530.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.47
|
| Rate for Payer: Nomi Health Commercial |
$483.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.16
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
OP
|
$5,720.86
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,288.34 |
| Max. Negotiated Rate |
$5,720.86 |
| Rate for Payer: Aetna Commercial |
$5,148.77
|
| Rate for Payer: Aetna Medicare |
$2,860.43
|
| Rate for Payer: ASR ASR |
$5,549.23
|
| Rate for Payer: ASR Commercial |
$5,549.23
|
| Rate for Payer: BCBS Complete |
$2,288.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,684.81
|
| Rate for Payer: BCN Commercial |
$4,435.38
|
| Rate for Payer: Cash Price |
$4,576.69
|
| Rate for Payer: Cofinity Commercial |
$5,377.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,576.69
|
| Rate for Payer: Healthscope Commercial |
$5,720.86
|
| Rate for Payer: Healthscope Whirlpool |
$5,549.23
|
| Rate for Payer: Mclaren Commercial |
$5,148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,862.73
|
| Rate for Payer: Nomi Health Commercial |
$4,691.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,718.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,012.62
|
| Rate for Payer: Priority Health Narrow Network |
$4,010.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,034.36
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
IP
|
$5,720.86
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,718.56 |
| Max. Negotiated Rate |
$5,720.86 |
| Rate for Payer: Aetna Commercial |
$5,148.77
|
| Rate for Payer: ASR ASR |
$5,549.23
|
| Rate for Payer: ASR Commercial |
$5,549.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,661.93
|
| Rate for Payer: BCN Commercial |
$4,435.38
|
| Rate for Payer: Cash Price |
$4,576.69
|
| Rate for Payer: Cofinity Commercial |
$5,377.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,576.69
|
| Rate for Payer: Healthscope Commercial |
$5,720.86
|
| Rate for Payer: Healthscope Whirlpool |
$5,549.23
|
| Rate for Payer: Mclaren Commercial |
$5,148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,862.73
|
| Rate for Payer: Nomi Health Commercial |
$4,691.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,718.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,034.36
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,350.88
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,828.07 |
| Max. Negotiated Rate |
$4,350.88 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: ASR ASR |
$4,220.35
|
| Rate for Payer: ASR Commercial |
$4,220.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,545.53
|
| Rate for Payer: BCN Commercial |
$3,373.24
|
| Rate for Payer: Cash Price |
$3,480.70
|
| Rate for Payer: Cofinity Commercial |
$4,089.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.70
|
| Rate for Payer: Healthscope Commercial |
$4,350.88
|
| Rate for Payer: Healthscope Whirlpool |
$4,220.35
|
| Rate for Payer: Mclaren Commercial |
$3,915.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,698.25
|
| Rate for Payer: Nomi Health Commercial |
$3,567.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,828.77
|
|
