|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,904.25
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,332.98 |
| Max. Negotiated Rate |
$1,904.25 |
| Rate for Payer: Aetna Commercial |
$1,713.82
|
| Rate for Payer: ASR ASR |
$1,847.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.37
|
| Rate for Payer: BCN Commercial |
$1,476.37
|
| Rate for Payer: Cash Price |
$1,523.40
|
| Rate for Payer: Cofinity Commercial |
$1,790.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.40
|
| Rate for Payer: Healthscope Commercial |
$1,904.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,847.12
|
| Rate for Payer: Mclaren Commercial |
$1,713.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,675.74
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,904.25
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$788.30 |
| Max. Negotiated Rate |
$1,904.25 |
| Rate for Payer: Aetna Commercial |
$1,713.82
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$1,847.12
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.37
|
| Rate for Payer: BCN Commercial |
$1,476.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$1,523.40
|
| Rate for Payer: Cash Price |
$1,523.40
|
| Rate for Payer: Cofinity Commercial |
$1,790.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$1,904.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,847.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$1,713.82
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.61
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.94
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,471.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,675.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,726.39
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,208.47 |
| Max. Negotiated Rate |
$1,726.39 |
| Rate for Payer: Aetna Commercial |
$1,553.75
|
| Rate for Payer: ASR ASR |
$1,674.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,338.47
|
| Rate for Payer: BCN Commercial |
$1,338.47
|
| Rate for Payer: Cash Price |
$1,381.11
|
| Rate for Payer: Cofinity Commercial |
$1,622.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,381.11
|
| Rate for Payer: Healthscope Commercial |
$1,726.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,674.60
|
| Rate for Payer: Mclaren Commercial |
$1,553.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,467.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,519.22
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,726.39
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$690.56 |
| Max. Negotiated Rate |
$1,726.39 |
| Rate for Payer: Aetna Commercial |
$1,553.75
|
| Rate for Payer: ASR ASR |
$1,674.60
|
| Rate for Payer: BCBS Complete |
$690.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,338.47
|
| Rate for Payer: BCN Commercial |
$1,338.47
|
| Rate for Payer: Cash Price |
$1,381.11
|
| Rate for Payer: Cofinity Commercial |
$1,622.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,381.11
|
| Rate for Payer: Healthscope Commercial |
$1,726.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,674.60
|
| Rate for Payer: Mclaren Commercial |
$1,553.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,467.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,571.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,225.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,519.22
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,018.44
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$807.38 |
| Max. Negotiated Rate |
$2,018.44 |
| Rate for Payer: Aetna Commercial |
$1,816.60
|
| Rate for Payer: ASR ASR |
$1,957.89
|
| Rate for Payer: BCBS Complete |
$807.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.90
|
| Rate for Payer: BCN Commercial |
$1,564.90
|
| Rate for Payer: Cash Price |
$1,614.75
|
| Rate for Payer: Cofinity Commercial |
$1,897.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,614.75
|
| Rate for Payer: Healthscope Commercial |
$2,018.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,957.89
|
| Rate for Payer: Mclaren Commercial |
$1,816.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,715.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,836.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,776.23
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,018.44
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,412.91 |
| Max. Negotiated Rate |
$2,018.44 |
| Rate for Payer: Aetna Commercial |
$1,816.60
|
| Rate for Payer: ASR ASR |
$1,957.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.90
|
| Rate for Payer: BCN Commercial |
$1,564.90
|
| Rate for Payer: Cash Price |
$1,614.75
|
| Rate for Payer: Cofinity Commercial |
$1,897.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,614.75
|
| Rate for Payer: Healthscope Commercial |
$2,018.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,957.89
|
| Rate for Payer: Mclaren Commercial |
$1,816.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,715.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,776.23
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,206.16
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$882.46 |
| Max. Negotiated Rate |
$2,206.16 |
| Rate for Payer: Aetna Commercial |
$1,985.54
|
| Rate for Payer: ASR ASR |
$2,139.98
|
| Rate for Payer: BCBS Complete |
$882.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.44
|
| Rate for Payer: BCN Commercial |
$1,710.44
|
| Rate for Payer: Cash Price |
$1,764.93
|
| Rate for Payer: Cofinity Commercial |
$2,073.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.93
|
| Rate for Payer: Healthscope Commercial |
$2,206.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,139.98
|
| Rate for Payer: Mclaren Commercial |
$1,985.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,875.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,007.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,566.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,941.42
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,206.16
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,544.31 |
| Max. Negotiated Rate |
$2,206.16 |
| Rate for Payer: Aetna Commercial |
$1,985.54
|
| Rate for Payer: ASR ASR |
$2,139.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.44
|
| Rate for Payer: BCN Commercial |
$1,710.44
|
| Rate for Payer: Cash Price |
$1,764.93
|
| Rate for Payer: Cofinity Commercial |
$2,073.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.93
|
| Rate for Payer: Healthscope Commercial |
$2,206.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,139.98
|
| Rate for Payer: Mclaren Commercial |
$1,985.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,875.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,941.42
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,888.04
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,321.63 |
| Max. Negotiated Rate |
$1,888.04 |
| Rate for Payer: Aetna Commercial |
$1,699.24
|
| Rate for Payer: ASR ASR |
$1,831.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.80
|
| Rate for Payer: BCN Commercial |
$1,463.80
|
| Rate for Payer: Cash Price |
$1,510.43
|
| Rate for Payer: Cofinity Commercial |
$1,774.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.43
|
| Rate for Payer: Healthscope Commercial |
$1,888.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,831.40
|
| Rate for Payer: Mclaren Commercial |
$1,699.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,661.48
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,888.04
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$755.22 |
| Max. Negotiated Rate |
$1,888.04 |
| Rate for Payer: Aetna Commercial |
$1,699.24
|
| Rate for Payer: ASR ASR |
$1,831.40
|
| Rate for Payer: BCBS Complete |
$755.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.80
|
| Rate for Payer: BCN Commercial |
$1,463.80
|
| Rate for Payer: Cash Price |
$1,510.43
|
| Rate for Payer: Cofinity Commercial |
$1,774.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.43
|
| Rate for Payer: Healthscope Commercial |
$1,888.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,831.40
|
| Rate for Payer: Mclaren Commercial |
$1,699.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,718.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,340.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,661.48
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$1,992.14
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$796.86 |
| Max. Negotiated Rate |
$1,992.14 |
| Rate for Payer: Aetna Commercial |
$1,792.93
|
| Rate for Payer: ASR ASR |
$1,932.38
|
| Rate for Payer: BCBS Complete |
$796.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.51
|
| Rate for Payer: BCN Commercial |
$1,544.51
|
| Rate for Payer: Cash Price |
$1,593.71
|
| Rate for Payer: Cofinity Commercial |
$1,872.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.71
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.38
|
| Rate for Payer: Mclaren Commercial |
$1,792.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,812.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,414.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.08
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$1,992.14
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,394.50 |
| Max. Negotiated Rate |
$1,992.14 |
| Rate for Payer: Aetna Commercial |
$1,792.93
|
| Rate for Payer: ASR ASR |
$1,932.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.51
|
| Rate for Payer: BCN Commercial |
$1,544.51
|
| Rate for Payer: Cash Price |
$1,593.71
|
| Rate for Payer: Cofinity Commercial |
$1,872.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.71
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.38
|
| Rate for Payer: Mclaren Commercial |
$1,792.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.08
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,324.18
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,626.93 |
| Max. Negotiated Rate |
$2,324.18 |
| Rate for Payer: Aetna Commercial |
$2,091.76
|
| Rate for Payer: ASR ASR |
$2,254.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.94
|
| Rate for Payer: BCN Commercial |
$1,801.94
|
| Rate for Payer: Cash Price |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$2,184.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.34
|
| Rate for Payer: Healthscope Commercial |
$2,324.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,254.45
|
| Rate for Payer: Mclaren Commercial |
$2,091.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,975.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,045.28
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,324.18
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.67 |
| Max. Negotiated Rate |
$2,324.18 |
| Rate for Payer: Aetna Commercial |
$2,091.76
|
| Rate for Payer: ASR ASR |
$2,254.45
|
| Rate for Payer: BCBS Complete |
$929.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.94
|
| Rate for Payer: BCN Commercial |
$1,801.94
|
| Rate for Payer: Cash Price |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$2,184.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.34
|
| Rate for Payer: Healthscope Commercial |
$2,324.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,254.45
|
| Rate for Payer: Mclaren Commercial |
$2,091.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,975.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,115.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,650.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,045.28
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$89.34
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$89.34 |
| Rate for Payer: Aetna Commercial |
$80.41
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$86.66
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$69.27
|
| Rate for Payer: BCN Commercial |
$69.27
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$89.34
|
| Rate for Payer: Healthscope Whirlpool |
$86.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$80.41
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.94
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.30
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$63.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.62
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$89.34
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$89.34 |
| Rate for Payer: Aetna Commercial |
$80.41
|
| Rate for Payer: ASR ASR |
$86.66
|
| Rate for Payer: BCBS Trust/PPO |
$69.27
|
| Rate for Payer: BCN Commercial |
$69.27
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.47
|
| Rate for Payer: Healthscope Commercial |
$89.34
|
| Rate for Payer: Healthscope Whirlpool |
$86.66
|
| Rate for Payer: Mclaren Commercial |
$80.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.62
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$134.70
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$94.29 |
| Max. Negotiated Rate |
$134.70 |
| Rate for Payer: Aetna Commercial |
$121.23
|
| Rate for Payer: ASR ASR |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$104.43
|
| Rate for Payer: BCN Commercial |
$104.43
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cofinity Commercial |
$126.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$134.70
|
| Rate for Payer: Healthscope Whirlpool |
$130.66
|
| Rate for Payer: Mclaren Commercial |
$121.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$134.70
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$134.70 |
| Rate for Payer: Aetna Commercial |
$121.23
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$130.66
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$104.43
|
| Rate for Payer: BCN Commercial |
$104.43
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cofinity Commercial |
$126.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$134.70
|
| Rate for Payer: Healthscope Whirlpool |
$130.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$121.23
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.58
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$95.64
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$565.13
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$395.59 |
| Max. Negotiated Rate |
$565.13 |
| Rate for Payer: Aetna Commercial |
$508.62
|
| Rate for Payer: ASR ASR |
$548.18
|
| Rate for Payer: BCBS Trust/PPO |
$438.15
|
| Rate for Payer: BCN Commercial |
$438.15
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.10
|
| Rate for Payer: Healthscope Commercial |
$565.13
|
| Rate for Payer: Healthscope Whirlpool |
$548.18
|
| Rate for Payer: Mclaren Commercial |
$508.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.31
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$565.13
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.44 |
| Max. Negotiated Rate |
$723.12 |
| Rate for Payer: Aetna Commercial |
$508.62
|
| Rate for Payer: Aetna Medicare |
$578.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.12
|
| Rate for Payer: ASR ASR |
$548.18
|
| Rate for Payer: BCBS Complete |
$332.29
|
| Rate for Payer: BCBS MAPPO |
$578.50
|
| Rate for Payer: BCBS Trust/PPO |
$438.15
|
| Rate for Payer: BCN Commercial |
$438.15
|
| Rate for Payer: BCN Medicare Advantage |
$578.50
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.50
|
| Rate for Payer: Healthscope Commercial |
$565.13
|
| Rate for Payer: Healthscope Whirlpool |
$548.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$578.50
|
| Rate for Payer: Mclaren Commercial |
$508.62
|
| Rate for Payer: Mclaren Medicaid |
$316.44
|
| Rate for Payer: Mclaren Medicare |
$578.50
|
| Rate for Payer: Meridian Medicaid |
$332.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$607.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.36
|
| Rate for Payer: PACE Medicare |
$549.58
|
| Rate for Payer: PACE SWMI |
$578.50
|
| Rate for Payer: PHP Commercial |
$636.35
|
| Rate for Payer: PHP Medicaid |
$316.44
|
| Rate for Payer: PHP Medicare Advantage |
$578.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$514.27
|
| Rate for Payer: Priority Health Medicare |
$578.50
|
| Rate for Payer: Priority Health Narrow Network |
$401.24
|
| Rate for Payer: Railroad Medicare Medicare |
$578.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.31
|
| Rate for Payer: UHC Medicare Advantage |
$595.86
|
| Rate for Payer: VA VA |
$578.50
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,782.67
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,947.87 |
| Max. Negotiated Rate |
$2,782.67 |
| Rate for Payer: Aetna Commercial |
$2,504.40
|
| Rate for Payer: ASR ASR |
$2,699.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,157.40
|
| Rate for Payer: BCN Commercial |
$2,157.40
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cofinity Commercial |
$2,615.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,226.14
|
| Rate for Payer: Healthscope Commercial |
$2,782.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,699.19
|
| Rate for Payer: Mclaren Commercial |
$2,504.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,365.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,448.75
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,782.67
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,520.09 |
| Max. Negotiated Rate |
$3,473.69 |
| Rate for Payer: Aetna Commercial |
$2,504.40
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: ASR ASR |
$2,699.19
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,157.40
|
| Rate for Payer: BCN Commercial |
$2,157.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cofinity Commercial |
$2,615.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,226.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$2,782.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,699.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$2,504.40
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,365.27
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,448.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$383.03
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.12 |
| Max. Negotiated Rate |
$383.03 |
| Rate for Payer: Aetna Commercial |
$344.73
|
| Rate for Payer: ASR ASR |
$371.54
|
| Rate for Payer: BCBS Trust/PPO |
$296.96
|
| Rate for Payer: BCN Commercial |
$296.96
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$360.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.42
|
| Rate for Payer: Healthscope Commercial |
$383.03
|
| Rate for Payer: Healthscope Whirlpool |
$371.54
|
| Rate for Payer: Mclaren Commercial |
$344.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.07
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$383.03
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.52 |
| Max. Negotiated Rate |
$611.32 |
| Rate for Payer: Aetna Commercial |
$344.73
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: ASR ASR |
$371.54
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$296.96
|
| Rate for Payer: BCN Commercial |
$296.96
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$360.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Healthscope Commercial |
$383.03
|
| Rate for Payer: Healthscope Whirlpool |
$371.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$489.06
|
| Rate for Payer: Mclaren Commercial |
$344.73
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Commercial |
$537.97
|
| Rate for Payer: PHP Medicaid |
$267.52
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.56
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$271.95
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.07
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: VA VA |
$489.06
|
|
|
HC EZPAP SUPPLY
|
Facility
|
IP
|
$125.48
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$125.48 |
| Rate for Payer: Aetna Commercial |
$112.93
|
| Rate for Payer: ASR ASR |
$121.72
|
| Rate for Payer: BCBS Trust/PPO |
$97.28
|
| Rate for Payer: BCN Commercial |
$97.28
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Commercial |
$117.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Healthscope Commercial |
$125.48
|
| Rate for Payer: Healthscope Whirlpool |
$121.72
|
| Rate for Payer: Mclaren Commercial |
$112.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.42
|
|
