|
HC HALO VEST APPLICATION
|
Facility
|
OP
|
$5,653.12
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,261.25 |
| Max. Negotiated Rate |
$5,653.12 |
| Rate for Payer: Aetna Commercial |
$5,087.81
|
| Rate for Payer: ASR ASR |
$5,483.53
|
| Rate for Payer: BCBS Complete |
$2,261.25
|
| Rate for Payer: BCBS Trust/PPO |
$4,382.86
|
| Rate for Payer: BCN Commercial |
$4,382.86
|
| Rate for Payer: Cash Price |
$4,522.50
|
| Rate for Payer: Cofinity Commercial |
$5,313.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,522.50
|
| Rate for Payer: Healthscope Commercial |
$5,653.12
|
| Rate for Payer: Healthscope Whirlpool |
$5,483.53
|
| Rate for Payer: Mclaren Commercial |
$5,087.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,805.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,957.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,144.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,013.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,974.75
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
IP
|
$5,653.12
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,957.18 |
| Max. Negotiated Rate |
$5,653.12 |
| Rate for Payer: Aetna Commercial |
$5,087.81
|
| Rate for Payer: ASR ASR |
$5,483.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,382.86
|
| Rate for Payer: BCN Commercial |
$4,382.86
|
| Rate for Payer: Cash Price |
$4,522.50
|
| Rate for Payer: Cofinity Commercial |
$5,313.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,522.50
|
| Rate for Payer: Healthscope Commercial |
$5,653.12
|
| Rate for Payer: Healthscope Whirlpool |
$5,483.53
|
| Rate for Payer: Mclaren Commercial |
$5,087.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,805.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,957.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,974.75
|
|
|
HC HAPTOGLOGIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.35
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
HC HAPTOGLOGIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Medicare |
$12.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$64.35
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.58
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Mclaren Medicaid |
$6.88
|
| Rate for Payer: Mclaren Medicare |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$7.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Medicare |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Medicaid |
$6.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.05
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health Narrow Network |
$32.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
| Rate for Payer: UHC Medicare Advantage |
$12.96
|
| Rate for Payer: VA VA |
$12.58
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$641.40 |
| Rate for Payer: Aetna Commercial |
$577.26
|
| Rate for Payer: Aetna Medicare |
$123.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.18
|
| Rate for Payer: ASR ASR |
$622.16
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: BCBS MAPPO |
$123.34
|
| Rate for Payer: BCBS Trust/PPO |
$497.28
|
| Rate for Payer: BCN Commercial |
$497.28
|
| Rate for Payer: BCN Medicare Advantage |
$123.34
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cofinity Commercial |
$602.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.34
|
| Rate for Payer: Healthscope Commercial |
$641.40
|
| Rate for Payer: Healthscope Whirlpool |
$622.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$123.34
|
| Rate for Payer: Mclaren Commercial |
$577.26
|
| Rate for Payer: Mclaren Medicaid |
$67.47
|
| Rate for Payer: Mclaren Medicare |
$123.34
|
| Rate for Payer: Meridian Medicaid |
$70.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$545.19
|
| Rate for Payer: PACE Medicare |
$117.17
|
| Rate for Payer: PACE SWMI |
$123.34
|
| Rate for Payer: PHP Commercial |
$135.67
|
| Rate for Payer: PHP Medicaid |
$67.47
|
| Rate for Payer: PHP Medicare Advantage |
$123.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$583.67
|
| Rate for Payer: Priority Health Medicare |
$123.34
|
| Rate for Payer: Priority Health Narrow Network |
$455.39
|
| Rate for Payer: Railroad Medicare Medicare |
$123.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.43
|
| Rate for Payer: UHC Medicare Advantage |
$127.04
|
| Rate for Payer: VA VA |
$123.34
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$448.98 |
| Max. Negotiated Rate |
$641.40 |
| Rate for Payer: Aetna Commercial |
$577.26
|
| Rate for Payer: ASR ASR |
$622.16
|
| Rate for Payer: BCBS Trust/PPO |
$497.28
|
| Rate for Payer: BCN Commercial |
$497.28
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cofinity Commercial |
$602.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.12
|
| Rate for Payer: Healthscope Commercial |
$641.40
|
| Rate for Payer: Healthscope Whirlpool |
$622.16
|
| Rate for Payer: Mclaren Commercial |
$577.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$545.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.43
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
OP
|
$819.04
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$819.04 |
| Rate for Payer: Aetna Commercial |
$737.14
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$794.47
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$635.00
|
| Rate for Payer: BCN Commercial |
$635.00
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cofinity Commercial |
$769.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$819.04
|
| Rate for Payer: Healthscope Whirlpool |
$794.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$737.14
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.18
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.58
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$174.86
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.76
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
IP
|
$819.04
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$573.33 |
| Max. Negotiated Rate |
$819.04 |
| Rate for Payer: Aetna Commercial |
$737.14
|
| Rate for Payer: ASR ASR |
$794.47
|
| Rate for Payer: BCBS Trust/PPO |
$635.00
|
| Rate for Payer: BCN Commercial |
$635.00
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cofinity Commercial |
$769.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.23
|
| Rate for Payer: Healthscope Commercial |
$819.04
|
| Rate for Payer: Healthscope Whirlpool |
$794.47
|
| Rate for Payer: Mclaren Commercial |
$737.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.76
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
OP
|
$525.25
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$525.25 |
| Rate for Payer: Aetna Commercial |
$472.72
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$509.49
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$407.23
|
| Rate for Payer: BCN Commercial |
$407.23
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cofinity Commercial |
$493.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$525.25
|
| Rate for Payer: Healthscope Whirlpool |
$509.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$472.72
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.46
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.22
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
IP
|
$525.25
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$367.68 |
| Max. Negotiated Rate |
$525.25 |
| Rate for Payer: Aetna Commercial |
$472.72
|
| Rate for Payer: ASR ASR |
$509.49
|
| Rate for Payer: BCBS Trust/PPO |
$407.23
|
| Rate for Payer: BCN Commercial |
$407.23
|
| Rate for Payer: Cash Price |
$420.20
|
| Rate for Payer: Cofinity Commercial |
$493.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.20
|
| Rate for Payer: Healthscope Commercial |
$525.25
|
| Rate for Payer: Healthscope Whirlpool |
$509.49
|
| Rate for Payer: Mclaren Commercial |
$472.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.22
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
OP
|
$6,358.90
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,584.36 |
| Max. Negotiated Rate |
$6,358.90 |
| Rate for Payer: Aetna Commercial |
$5,723.01
|
| Rate for Payer: Aetna Medicare |
$2,896.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,620.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,620.58
|
| Rate for Payer: ASR ASR |
$6,168.13
|
| Rate for Payer: BCBS Complete |
$1,663.73
|
| Rate for Payer: BCBS MAPPO |
$2,896.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,930.06
|
| Rate for Payer: BCN Commercial |
$4,930.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,896.46
|
| Rate for Payer: Cash Price |
$5,087.12
|
| Rate for Payer: Cash Price |
$5,087.12
|
| Rate for Payer: Cofinity Commercial |
$5,977.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,087.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,896.46
|
| Rate for Payer: Healthscope Commercial |
$6,358.90
|
| Rate for Payer: Healthscope Whirlpool |
$6,168.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,896.46
|
| Rate for Payer: Mclaren Commercial |
$5,723.01
|
| Rate for Payer: Mclaren Medicaid |
$1,584.36
|
| Rate for Payer: Mclaren Medicare |
$2,896.46
|
| Rate for Payer: Meridian Medicaid |
$1,663.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,041.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,330.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,405.06
|
| Rate for Payer: PACE Medicare |
$2,751.64
|
| Rate for Payer: PACE SWMI |
$2,896.46
|
| Rate for Payer: PHP Commercial |
$3,186.11
|
| Rate for Payer: PHP Medicaid |
$1,584.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,896.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,451.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,786.60
|
| Rate for Payer: Priority Health Medicare |
$2,896.46
|
| Rate for Payer: Priority Health Narrow Network |
$4,514.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,896.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,595.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.35
|
| Rate for Payer: VA VA |
$2,896.46
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
IP
|
$6,358.90
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,451.23 |
| Max. Negotiated Rate |
$6,358.90 |
| Rate for Payer: Aetna Commercial |
$5,723.01
|
| Rate for Payer: ASR ASR |
$6,168.13
|
| Rate for Payer: BCBS Trust/PPO |
$4,930.06
|
| Rate for Payer: BCN Commercial |
$4,930.06
|
| Rate for Payer: Cash Price |
$5,087.12
|
| Rate for Payer: Cofinity Commercial |
$5,977.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,087.12
|
| Rate for Payer: Healthscope Commercial |
$6,358.90
|
| Rate for Payer: Healthscope Whirlpool |
$6,168.13
|
| Rate for Payer: Mclaren Commercial |
$5,723.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,405.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,451.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,595.83
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$48.24
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$401.24 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$48.24
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.89
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Medicaid |
$8.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$401.24
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$320.99
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$395.58
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$743.98 |
| Rate for Payer: Aetna Commercial |
$356.02
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: ASR ASR |
$383.71
|
| Rate for Payer: BCBS Complete |
$147.88
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$306.69
|
| Rate for Payer: BCN Commercial |
$306.69
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$316.46
|
| Rate for Payer: Cash Price |
$316.46
|
| Rate for Payer: Cofinity Commercial |
$371.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$395.58
|
| Rate for Payer: Healthscope Whirlpool |
$383.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$356.02
|
| Rate for Payer: Mclaren Medicaid |
$140.83
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Medicaid |
$147.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.24
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.20
|
| Rate for Payer: PHP Medicaid |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.98
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$595.18
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.11
|
| Rate for Payer: UHC Medicare Advantage |
$265.17
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$395.58
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$276.91 |
| Max. Negotiated Rate |
$395.58 |
| Rate for Payer: Aetna Commercial |
$356.02
|
| Rate for Payer: ASR ASR |
$383.71
|
| Rate for Payer: BCBS Trust/PPO |
$306.69
|
| Rate for Payer: BCN Commercial |
$306.69
|
| Rate for Payer: Cash Price |
$316.46
|
| Rate for Payer: Cofinity Commercial |
$371.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.46
|
| Rate for Payer: Healthscope Commercial |
$395.58
|
| Rate for Payer: Healthscope Whirlpool |
$383.71
|
| Rate for Payer: Mclaren Commercial |
$356.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.11
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.84
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$26.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.84
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$26.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$1,950.65
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.61 |
| Max. Negotiated Rate |
$1,950.65 |
| Rate for Payer: Aetna Commercial |
$1,755.58
|
| Rate for Payer: Aetna Commercial |
$479.70
|
| Rate for Payer: Aetna Medicare |
$637.31
|
| Rate for Payer: Aetna Medicare |
$637.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$796.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$796.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$796.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$796.64
|
| Rate for Payer: ASR ASR |
$517.01
|
| Rate for Payer: ASR ASR |
$1,892.13
|
| Rate for Payer: BCBS Complete |
$366.07
|
| Rate for Payer: BCBS Complete |
$366.07
|
| Rate for Payer: BCBS MAPPO |
$637.31
|
| Rate for Payer: BCBS MAPPO |
$637.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.34
|
| Rate for Payer: BCBS Trust/PPO |
$413.23
|
| Rate for Payer: BCN Commercial |
$413.23
|
| Rate for Payer: BCN Commercial |
$1,512.34
|
| Rate for Payer: BCN Medicare Advantage |
$637.31
|
| Rate for Payer: BCN Medicare Advantage |
$637.31
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$1,560.52
|
| Rate for Payer: Cash Price |
$1,560.52
|
| Rate for Payer: Cofinity Commercial |
$501.02
|
| Rate for Payer: Cofinity Commercial |
$1,833.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,560.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.31
|
| Rate for Payer: Healthscope Commercial |
$533.00
|
| Rate for Payer: Healthscope Commercial |
$1,950.65
|
| Rate for Payer: Healthscope Whirlpool |
$517.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,892.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.31
|
| Rate for Payer: Mclaren Commercial |
$1,755.58
|
| Rate for Payer: Mclaren Commercial |
$479.70
|
| Rate for Payer: Mclaren Medicaid |
$348.61
|
| Rate for Payer: Mclaren Medicaid |
$348.61
|
| Rate for Payer: Mclaren Medicare |
$637.31
|
| Rate for Payer: Mclaren Medicare |
$637.31
|
| Rate for Payer: Meridian Medicaid |
$366.07
|
| Rate for Payer: Meridian Medicaid |
$366.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$732.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$732.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,658.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$453.05
|
| Rate for Payer: PACE Medicare |
$605.44
|
| Rate for Payer: PACE Medicare |
$605.44
|
| Rate for Payer: PACE SWMI |
$637.31
|
| Rate for Payer: PACE SWMI |
$637.31
|
| Rate for Payer: PHP Commercial |
$701.04
|
| Rate for Payer: PHP Commercial |
$701.04
|
| Rate for Payer: PHP Medicaid |
$348.61
|
| Rate for Payer: PHP Medicaid |
$348.61
|
| Rate for Payer: PHP Medicare Advantage |
$637.31
|
| Rate for Payer: PHP Medicare Advantage |
$637.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,775.09
|
| Rate for Payer: Priority Health Medicare |
$637.31
|
| Rate for Payer: Priority Health Medicare |
$637.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,384.96
|
| Rate for Payer: Priority Health Narrow Network |
$378.43
|
| Rate for Payer: Railroad Medicare Medicare |
$637.31
|
| Rate for Payer: Railroad Medicare Medicare |
$637.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,716.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.04
|
| Rate for Payer: UHC Medicare Advantage |
$656.43
|
| Rate for Payer: UHC Medicare Advantage |
$656.43
|
| Rate for Payer: VA VA |
$637.31
|
| Rate for Payer: VA VA |
$637.31
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$373.10 |
| Max. Negotiated Rate |
$533.00 |
| Rate for Payer: Aetna Commercial |
$479.70
|
| Rate for Payer: Aetna Commercial |
$1,755.58
|
| Rate for Payer: ASR ASR |
$1,892.13
|
| Rate for Payer: ASR ASR |
$517.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.34
|
| Rate for Payer: BCBS Trust/PPO |
$413.23
|
| Rate for Payer: BCN Commercial |
$1,512.34
|
| Rate for Payer: BCN Commercial |
$413.23
|
| Rate for Payer: Cash Price |
$1,560.52
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cofinity Commercial |
$1,833.61
|
| Rate for Payer: Cofinity Commercial |
$501.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,560.52
|
| Rate for Payer: Healthscope Commercial |
$1,950.65
|
| Rate for Payer: Healthscope Commercial |
$533.00
|
| Rate for Payer: Healthscope Whirlpool |
$517.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,892.13
|
| Rate for Payer: Mclaren Commercial |
$479.70
|
| Rate for Payer: Mclaren Commercial |
$1,755.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$453.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,658.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,716.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.04
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,166.72
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,516.70 |
| Max. Negotiated Rate |
$2,166.72 |
| Rate for Payer: Aetna Commercial |
$1,950.05
|
| Rate for Payer: Aetna Commercial |
$1,645.20
|
| Rate for Payer: ASR ASR |
$2,101.72
|
| Rate for Payer: ASR ASR |
$1,773.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,417.25
|
| Rate for Payer: BCN Commercial |
$1,679.86
|
| Rate for Payer: BCN Commercial |
$1,417.25
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cofinity Commercial |
$1,718.32
|
| Rate for Payer: Cofinity Commercial |
$2,036.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,733.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.40
|
| Rate for Payer: Healthscope Commercial |
$1,828.00
|
| Rate for Payer: Healthscope Commercial |
$2,166.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,101.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,773.16
|
| Rate for Payer: Mclaren Commercial |
$1,950.05
|
| Rate for Payer: Mclaren Commercial |
$1,645.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,841.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,608.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,906.71
|
|
