|
HC BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: ASR ASR |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Medicare |
$8.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: ASR ASR |
$27.56
|
| Rate for Payer: ASR Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Healthscope Whirlpool |
$27.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.17
|
| Rate for Payer: Mclaren Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$8.99
|
| Rate for Payer: PHP Medicaid |
$4.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.89
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$19.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.17
|
| Rate for Payer: UHC Exchange |
$12.66
|
| Rate for Payer: UHC Medicare Advantage |
$8.17
|
| Rate for Payer: UHCCP DNSP |
$8.17
|
| Rate for Payer: UHCCP Medicaid |
$4.38
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$612.78
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.31 |
| Max. Negotiated Rate |
$612.78 |
| Rate for Payer: Aetna Commercial |
$551.50
|
| Rate for Payer: ASR ASR |
$594.40
|
| Rate for Payer: ASR Commercial |
$594.40
|
| Rate for Payer: BCBS Trust/PPO |
$499.35
|
| Rate for Payer: BCN Commercial |
$475.09
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$576.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.22
|
| Rate for Payer: Healthscope Commercial |
$612.78
|
| Rate for Payer: Healthscope Whirlpool |
$594.40
|
| Rate for Payer: Mclaren Commercial |
$551.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.86
|
| Rate for Payer: Nomi Health Commercial |
$502.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.25
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$612.78
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$612.78 |
| Rate for Payer: Aetna Commercial |
$551.50
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$594.40
|
| Rate for Payer: ASR Commercial |
$594.40
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$501.81
|
| Rate for Payer: BCN Commercial |
$475.09
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cash Price |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$576.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$612.78
|
| Rate for Payer: Healthscope Whirlpool |
$594.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$551.50
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.86
|
| Rate for Payer: Nomi Health Commercial |
$502.48
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.92
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$429.56
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$738.48
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$738.48 |
| Rate for Payer: Aetna Commercial |
$664.63
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$716.33
|
| Rate for Payer: ASR Commercial |
$716.33
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$604.74
|
| Rate for Payer: BCN Commercial |
$572.54
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cofinity Commercial |
$694.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$738.48
|
| Rate for Payer: Healthscope Whirlpool |
$716.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$664.63
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.71
|
| Rate for Payer: Nomi Health Commercial |
$605.55
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$647.06
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$517.67
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$649.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$738.48
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.01 |
| Max. Negotiated Rate |
$738.48 |
| Rate for Payer: Aetna Commercial |
$664.63
|
| Rate for Payer: ASR ASR |
$716.33
|
| Rate for Payer: ASR Commercial |
$716.33
|
| Rate for Payer: BCBS Trust/PPO |
$601.79
|
| Rate for Payer: BCN Commercial |
$572.54
|
| Rate for Payer: Cash Price |
$590.78
|
| Rate for Payer: Cofinity Commercial |
$694.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.78
|
| Rate for Payer: Healthscope Commercial |
$738.48
|
| Rate for Payer: Healthscope Whirlpool |
$716.33
|
| Rate for Payer: Mclaren Commercial |
$664.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.71
|
| Rate for Payer: Nomi Health Commercial |
$605.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$649.86
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$116.88
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$116.88 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: Aetna Medicare |
$58.44
|
| Rate for Payer: ASR ASR |
$113.37
|
| Rate for Payer: ASR Commercial |
$113.37
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$95.71
|
| Rate for Payer: BCN Commercial |
$90.62
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cofinity Commercial |
$109.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.50
|
| Rate for Payer: Healthscope Commercial |
$116.88
|
| Rate for Payer: Healthscope Whirlpool |
$113.37
|
| Rate for Payer: Mclaren Commercial |
$105.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.35
|
| Rate for Payer: Nomi Health Commercial |
$95.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.41
|
| Rate for Payer: Priority Health Narrow Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.85
|
|
|
HC BILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$116.88
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$116.88 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: ASR ASR |
$113.37
|
| Rate for Payer: ASR Commercial |
$113.37
|
| Rate for Payer: BCBS Trust/PPO |
$95.25
|
| Rate for Payer: BCN Commercial |
$90.62
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cofinity Commercial |
$109.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.50
|
| Rate for Payer: Healthscope Commercial |
$116.88
|
| Rate for Payer: Healthscope Whirlpool |
$113.37
|
| Rate for Payer: Mclaren Commercial |
$105.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.35
|
| Rate for Payer: Nomi Health Commercial |
$95.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.85
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
OP
|
$456.96
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$456.96 |
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$443.25
|
| Rate for Payer: ASR Commercial |
$443.25
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$374.20
|
| Rate for Payer: BCN Commercial |
$354.28
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cofinity Commercial |
$429.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$456.96
|
| Rate for Payer: Healthscope Whirlpool |
$443.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$411.26
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.71
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.39
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$320.33
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC BILATERAL UNNA BOOT
|
Facility
|
IP
|
$456.96
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$456.96 |
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: ASR ASR |
$443.25
|
| Rate for Payer: ASR Commercial |
$443.25
|
| Rate for Payer: BCBS Trust/PPO |
$372.38
|
| Rate for Payer: BCN Commercial |
$354.28
|
| Rate for Payer: Cash Price |
$365.57
|
| Rate for Payer: Cofinity Commercial |
$429.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.57
|
| Rate for Payer: Healthscope Commercial |
$456.96
|
| Rate for Payer: Healthscope Whirlpool |
$443.25
|
| Rate for Payer: Mclaren Commercial |
$411.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.12
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$14,483.45
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9,414.24 |
| Max. Negotiated Rate |
$14,483.45 |
| Rate for Payer: Aetna Commercial |
$13,035.10
|
| Rate for Payer: ASR ASR |
$14,048.95
|
| Rate for Payer: ASR Commercial |
$14,048.95
|
| Rate for Payer: BCBS Trust/PPO |
$11,802.56
|
| Rate for Payer: BCN Commercial |
$11,229.02
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cofinity Commercial |
$13,614.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,586.76
|
| Rate for Payer: Healthscope Commercial |
$14,483.45
|
| Rate for Payer: Healthscope Whirlpool |
$14,048.95
|
| Rate for Payer: Mclaren Commercial |
$13,035.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,310.93
|
| Rate for Payer: Nomi Health Commercial |
$11,876.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,414.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,745.44
|
|
|
HC BILAT PERC IMPLANT NEUROSTIM ELTRD,SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$14,483.45
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,430.76 |
| Max. Negotiated Rate |
$14,483.45 |
| Rate for Payer: Aetna Commercial |
$13,035.10
|
| Rate for Payer: Aetna Medicare |
$6,400.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,000.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,000.84
|
| Rate for Payer: ASR ASR |
$14,048.95
|
| Rate for Payer: ASR Commercial |
$14,048.95
|
| Rate for Payer: BCBS Complete |
$3,602.30
|
| Rate for Payer: BCBS MAPPO |
$6,400.67
|
| Rate for Payer: BCBS Trust/PPO |
$11,860.50
|
| Rate for Payer: BCN Commercial |
$11,229.02
|
| Rate for Payer: BCN Medicare Advantage |
$6,400.67
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cash Price |
$11,586.76
|
| Rate for Payer: Cofinity Commercial |
$13,614.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,586.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,400.67
|
| Rate for Payer: Healthscope Commercial |
$14,483.45
|
| Rate for Payer: Healthscope Whirlpool |
$14,048.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,400.67
|
| Rate for Payer: Mclaren Commercial |
$13,035.10
|
| Rate for Payer: Mclaren Medicaid |
$3,430.76
|
| Rate for Payer: Mclaren Medicare |
$6,400.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,720.70
|
| Rate for Payer: Meridian Medicaid |
$3,602.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,360.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,310.93
|
| Rate for Payer: Nomi Health Commercial |
$11,876.43
|
| Rate for Payer: PACE Medicare |
$6,080.64
|
| Rate for Payer: PACE SWMI |
$6,400.67
|
| Rate for Payer: PHP Commercial |
$7,040.74
|
| Rate for Payer: PHP Medicaid |
$3,430.76
|
| Rate for Payer: PHP Medicare Advantage |
$6,400.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,430.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,414.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,690.40
|
| Rate for Payer: Priority Health Medicare |
$6,400.67
|
| Rate for Payer: Priority Health Narrow Network |
$10,152.90
|
| Rate for Payer: Railroad Medicare Medicare |
$6,400.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,745.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,400.67
|
| Rate for Payer: UHC Exchange |
$9,921.04
|
| Rate for Payer: UHC Medicare Advantage |
$6,400.67
|
| Rate for Payer: UHCCP DNSP |
$6,400.67
|
| Rate for Payer: UHCCP Medicaid |
$3,430.76
|
| Rate for Payer: VA VA |
$6,400.67
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$907.80
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Aetna Commercial |
$817.02
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$880.57
|
| Rate for Payer: ASR Commercial |
$880.57
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$743.40
|
| Rate for Payer: BCN Commercial |
$703.82
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$853.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$907.80
|
| Rate for Payer: Healthscope Whirlpool |
$880.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$817.02
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$771.63
|
| Rate for Payer: Nomi Health Commercial |
$744.40
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$795.41
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$636.37
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$798.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC BIL COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$907.80
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$590.07 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Aetna Commercial |
$817.02
|
| Rate for Payer: ASR ASR |
$880.57
|
| Rate for Payer: ASR Commercial |
$880.57
|
| Rate for Payer: BCBS Trust/PPO |
$739.77
|
| Rate for Payer: BCN Commercial |
$703.82
|
| Rate for Payer: Cash Price |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$853.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.24
|
| Rate for Payer: Healthscope Commercial |
$907.80
|
| Rate for Payer: Healthscope Whirlpool |
$880.57
|
| Rate for Payer: Mclaren Commercial |
$817.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$771.63
|
| Rate for Payer: Nomi Health Commercial |
$744.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$798.86
|
|
|
HC BIL DIAG BONE MARROW ASP
|
Facility
|
OP
|
$3,251.25
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$3,251.25 |
| Rate for Payer: Aetna Commercial |
$2,926.12
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$3,153.71
|
| Rate for Payer: ASR Commercial |
$3,153.71
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,662.45
|
| Rate for Payer: BCN Commercial |
$2,520.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$3,056.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$3,251.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,153.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$2,926.12
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$2,666.03
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,848.75
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,279.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,861.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC BIL DIAG BONE MARROW ASP
|
Facility
|
IP
|
$3,251.25
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,113.31 |
| Max. Negotiated Rate |
$3,251.25 |
| Rate for Payer: Aetna Commercial |
$2,926.12
|
| Rate for Payer: ASR ASR |
$3,153.71
|
| Rate for Payer: ASR Commercial |
$3,153.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,649.44
|
| Rate for Payer: BCN Commercial |
$2,520.69
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$3,056.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$3,251.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,153.71
|
| Rate for Payer: Mclaren Commercial |
$2,926.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$2,666.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,113.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,861.10
|
|
|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
OP
|
$3,096.23
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$2,786.61
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$3,003.34
|
| Rate for Payer: ASR Commercial |
$3,003.34
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,535.50
|
| Rate for Payer: BCN Commercial |
$2,400.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,910.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$3,096.23
|
| Rate for Payer: Healthscope Whirlpool |
$3,003.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$2,786.61
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: Nomi Health Commercial |
$2,538.91
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,712.92
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,170.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,724.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
IP
|
$3,096.23
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,012.55 |
| Max. Negotiated Rate |
$3,096.23 |
| Rate for Payer: Aetna Commercial |
$2,786.61
|
| Rate for Payer: ASR ASR |
$3,003.34
|
| Rate for Payer: ASR Commercial |
$3,003.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,523.12
|
| Rate for Payer: BCN Commercial |
$2,400.51
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,910.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Healthscope Commercial |
$3,096.23
|
| Rate for Payer: Healthscope Whirlpool |
$3,003.34
|
| Rate for Payer: Mclaren Commercial |
$2,786.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: Nomi Health Commercial |
$2,538.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,724.68
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
IP
|
$3,096.23
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,012.55 |
| Max. Negotiated Rate |
$3,096.23 |
| Rate for Payer: Aetna Commercial |
$2,786.61
|
| Rate for Payer: ASR ASR |
$3,003.34
|
| Rate for Payer: ASR Commercial |
$3,003.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,523.12
|
| Rate for Payer: BCN Commercial |
$2,400.51
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,910.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Healthscope Commercial |
$3,096.23
|
| Rate for Payer: Healthscope Whirlpool |
$3,003.34
|
| Rate for Payer: Mclaren Commercial |
$2,786.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: Nomi Health Commercial |
$2,538.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,724.68
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
OP
|
$3,096.23
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$3,096.23 |
| Rate for Payer: Aetna Commercial |
$2,786.61
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$3,003.34
|
| Rate for Payer: ASR Commercial |
$3,003.34
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,535.50
|
| Rate for Payer: BCN Commercial |
$2,400.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cash Price |
$2,476.98
|
| Rate for Payer: Cofinity Commercial |
$2,910.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,476.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$3,096.23
|
| Rate for Payer: Healthscope Whirlpool |
$3,003.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$2,786.61
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,631.80
|
| Rate for Payer: Nomi Health Commercial |
$2,538.91
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,712.92
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,170.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,724.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$17.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.40
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$17.12
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.12
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$9.18
|
| Rate for Payer: Mclaren Medicare |
$17.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$16.26
|
| Rate for Payer: PACE SWMI |
$17.12
|
| Rate for Payer: PHP Commercial |
$18.83
|
| Rate for Payer: PHP Medicaid |
$9.18
|
| Rate for Payer: PHP Medicare Advantage |
$17.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$17.12
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.12
|
| Rate for Payer: UHC Exchange |
$26.54
|
| Rate for Payer: UHC Medicare Advantage |
$17.12
|
| Rate for Payer: UHCCP DNSP |
$17.12
|
| Rate for Payer: UHCCP Medicaid |
$9.18
|
| Rate for Payer: VA VA |
$17.12
|
|
|
HC BILE BODY FLUID
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700007
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$31.66
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.16
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.36
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.16
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC BILE BODY FLUID
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700007
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
|
