|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$1,828.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.61 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$1,645.20
|
| Rate for Payer: Aetna Commercial |
$1,950.05
|
| 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 |
$1,773.16
|
| Rate for Payer: ASR ASR |
$2,101.72
|
| 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 |
$1,679.86
|
| 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: BCN Medicare Advantage |
$637.31
|
| Rate for Payer: BCN Medicare Advantage |
$637.31
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| 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 |
$1,462.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,733.38
|
| 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 |
$2,166.72
|
| Rate for Payer: Healthscope Commercial |
$1,828.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,773.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,101.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.31
|
| Rate for Payer: Mclaren Commercial |
$1,645.20
|
| Rate for Payer: Mclaren Commercial |
$1,950.05
|
| 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 |
$1,553.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,841.71
|
| 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 |
$1,279.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,971.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,663.48
|
| Rate for Payer: Priority Health Medicare |
$637.31
|
| Rate for Payer: Priority Health Medicare |
$637.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,297.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,538.37
|
| 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 |
$1,608.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,906.71
|
| 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 IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$551.38
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.97 |
| Max. Negotiated Rate |
$551.38 |
| Rate for Payer: Aetna Commercial |
$496.24
|
| Rate for Payer: ASR ASR |
$534.84
|
| Rate for Payer: BCBS Trust/PPO |
$427.48
|
| Rate for Payer: BCN Commercial |
$427.48
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$518.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.10
|
| Rate for Payer: Healthscope Commercial |
$551.38
|
| Rate for Payer: Healthscope Whirlpool |
$534.84
|
| Rate for Payer: Mclaren Commercial |
$496.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.21
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$551.38
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.06 |
| Max. Negotiated Rate |
$551.38 |
| Rate for Payer: Aetna Commercial |
$496.24
|
| Rate for Payer: Aetna Medicare |
$323.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.62
|
| Rate for Payer: ASR ASR |
$534.84
|
| Rate for Payer: BCBS Complete |
$185.93
|
| Rate for Payer: BCBS MAPPO |
$323.70
|
| Rate for Payer: BCBS Trust/PPO |
$427.48
|
| Rate for Payer: BCN Commercial |
$427.48
|
| Rate for Payer: BCN Medicare Advantage |
$323.70
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$518.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.70
|
| Rate for Payer: Healthscope Commercial |
$551.38
|
| Rate for Payer: Healthscope Whirlpool |
$534.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$323.70
|
| Rate for Payer: Mclaren Commercial |
$496.24
|
| Rate for Payer: Mclaren Medicaid |
$177.06
|
| Rate for Payer: Mclaren Medicare |
$323.70
|
| Rate for Payer: Meridian Medicaid |
$185.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$339.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.67
|
| Rate for Payer: PACE Medicare |
$307.52
|
| Rate for Payer: PACE SWMI |
$323.70
|
| Rate for Payer: PHP Commercial |
$356.07
|
| Rate for Payer: PHP Medicaid |
$177.06
|
| Rate for Payer: PHP Medicare Advantage |
$323.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.76
|
| Rate for Payer: Priority Health Medicare |
$323.70
|
| Rate for Payer: Priority Health Narrow Network |
$391.48
|
| Rate for Payer: Railroad Medicare Medicare |
$323.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.21
|
| Rate for Payer: UHC Medicare Advantage |
$333.41
|
| Rate for Payer: VA VA |
$323.70
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,680.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.61 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: Aetna Commercial |
$2,412.00
|
| Rate for Payer: Aetna Commercial |
$2,151.96
|
| 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 |
$2,319.34
|
| Rate for Payer: ASR ASR |
$2,599.60
|
| 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 |
$1,853.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.80
|
| Rate for Payer: BCN Commercial |
$2,077.80
|
| Rate for Payer: BCN Commercial |
$1,853.80
|
| Rate for Payer: BCN Medicare Advantage |
$637.31
|
| Rate for Payer: BCN Medicare Advantage |
$637.31
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cofinity Commercial |
$2,519.20
|
| Rate for Payer: Cofinity Commercial |
$2,247.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,144.00
|
| 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 |
$2,391.07
|
| Rate for Payer: Healthscope Commercial |
$2,680.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,599.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,319.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$637.31
|
| Rate for Payer: Mclaren Commercial |
$2,412.00
|
| Rate for Payer: Mclaren Commercial |
$2,151.96
|
| 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 |
$2,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,032.41
|
| 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 |
$1,876.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,175.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,438.80
|
| Rate for Payer: Priority Health Medicare |
$637.31
|
| Rate for Payer: Priority Health Medicare |
$637.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,902.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,697.66
|
| 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 |
$2,104.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,358.40
|
| 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 OVER 12 CHANNELS
|
Facility
|
IP
|
$2,680.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,876.00 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: Aetna Commercial |
$2,412.00
|
| Rate for Payer: Aetna Commercial |
$2,151.96
|
| Rate for Payer: ASR ASR |
$2,599.60
|
| Rate for Payer: ASR ASR |
$2,319.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,853.80
|
| Rate for Payer: BCN Commercial |
$2,077.80
|
| Rate for Payer: BCN Commercial |
$1,853.80
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cofinity Commercial |
$2,519.20
|
| Rate for Payer: Cofinity Commercial |
$2,247.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,144.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.86
|
| Rate for Payer: Healthscope Commercial |
$2,680.00
|
| Rate for Payer: Healthscope Commercial |
$2,391.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,599.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,319.34
|
| Rate for Payer: Mclaren Commercial |
$2,151.96
|
| Rate for Payer: Mclaren Commercial |
$2,412.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,032.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,278.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,358.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,104.14
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$472.31
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.67 |
| Max. Negotiated Rate |
$472.31 |
| Rate for Payer: Aetna Commercial |
$425.08
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
| Rate for Payer: ASR ASR |
$458.14
|
| Rate for Payer: BCBS Complete |
$137.21
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$366.18
|
| Rate for Payer: BCN Commercial |
$366.18
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$443.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Healthscope Commercial |
$472.31
|
| Rate for Payer: Healthscope Whirlpool |
$458.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.88
|
| Rate for Payer: Mclaren Commercial |
$425.08
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Mclaren Medicare |
$238.88
|
| Rate for Payer: Meridian Medicaid |
$137.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Medicare |
$226.94
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Commercial |
$262.77
|
| Rate for Payer: PHP Medicaid |
$130.67
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.80
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow Network |
$335.34
|
| Rate for Payer: Railroad Medicare Medicare |
$238.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.63
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
| Rate for Payer: VA VA |
$238.88
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$472.31
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$330.62 |
| Max. Negotiated Rate |
$472.31 |
| Rate for Payer: Aetna Commercial |
$425.08
|
| Rate for Payer: ASR ASR |
$458.14
|
| Rate for Payer: BCBS Trust/PPO |
$366.18
|
| Rate for Payer: BCN Commercial |
$366.18
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$443.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Healthscope Commercial |
$472.31
|
| Rate for Payer: Healthscope Whirlpool |
$458.14
|
| Rate for Payer: Mclaren Commercial |
$425.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.63
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$531.36
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.67 |
| Max. Negotiated Rate |
$531.36 |
| Rate for Payer: Aetna Commercial |
$478.22
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
| Rate for Payer: ASR ASR |
$515.42
|
| Rate for Payer: BCBS Complete |
$137.21
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$411.96
|
| Rate for Payer: BCN Commercial |
$411.96
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$499.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Healthscope Commercial |
$531.36
|
| Rate for Payer: Healthscope Whirlpool |
$515.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.88
|
| Rate for Payer: Mclaren Commercial |
$478.22
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Mclaren Medicare |
$238.88
|
| Rate for Payer: Meridian Medicaid |
$137.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PACE Medicare |
$226.94
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Commercial |
$262.77
|
| Rate for Payer: PHP Medicaid |
$130.67
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.54
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow Network |
$377.27
|
| Rate for Payer: Railroad Medicare Medicare |
$238.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.60
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
| Rate for Payer: VA VA |
$238.88
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$531.36
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$371.95 |
| Max. Negotiated Rate |
$531.36 |
| Rate for Payer: Aetna Commercial |
$478.22
|
| Rate for Payer: ASR ASR |
$515.42
|
| Rate for Payer: BCBS Trust/PPO |
$411.96
|
| Rate for Payer: BCN Commercial |
$411.96
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$499.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.09
|
| Rate for Payer: Healthscope Commercial |
$531.36
|
| Rate for Payer: Healthscope Whirlpool |
$515.42
|
| Rate for Payer: Mclaren Commercial |
$478.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.60
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$120.36 |
| Rate for Payer: Aetna Commercial |
$108.32
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.04
|
| Rate for Payer: ASR ASR |
$116.75
|
| Rate for Payer: BCBS Complete |
$45.51
|
| Rate for Payer: BCBS MAPPO |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$93.32
|
| Rate for Payer: BCN Commercial |
$93.32
|
| Rate for Payer: BCN Medicare Advantage |
$79.23
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$120.36
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$79.23
|
| Rate for Payer: Mclaren Commercial |
$108.32
|
| Rate for Payer: Mclaren Medicaid |
$43.34
|
| Rate for Payer: Mclaren Medicare |
$79.23
|
| Rate for Payer: Meridian Medicaid |
$45.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PACE Medicare |
$75.27
|
| Rate for Payer: PACE SWMI |
$79.23
|
| Rate for Payer: PHP Commercial |
$87.15
|
| Rate for Payer: PHP Medicaid |
$43.34
|
| Rate for Payer: PHP Medicare Advantage |
$79.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.03
|
| Rate for Payer: Priority Health Medicare |
$79.23
|
| Rate for Payer: Priority Health Narrow Network |
$67.22
|
| Rate for Payer: Railroad Medicare Medicare |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.92
|
| Rate for Payer: UHC Medicare Advantage |
$81.61
|
| Rate for Payer: VA VA |
$79.23
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.25 |
| Max. Negotiated Rate |
$120.36 |
| Rate for Payer: Aetna Commercial |
$108.32
|
| Rate for Payer: ASR ASR |
$116.75
|
| Rate for Payer: BCBS Trust/PPO |
$93.32
|
| Rate for Payer: BCN Commercial |
$93.32
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$120.36
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Mclaren Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.92
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$18.22 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: ASR ASR |
$58.37
|
| Rate for Payer: BCBS Complete |
$24.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.66
|
| Rate for Payer: BCN Commercial |
$46.66
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$60.18
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Mclaren Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.78
|
| Rate for Payer: Priority Health Narrow Network |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: ASR ASR |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$46.66
|
| Rate for Payer: BCN Commercial |
$46.66
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$60.18
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Mclaren Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.25 |
| Max. Negotiated Rate |
$120.36 |
| Rate for Payer: Aetna Commercial |
$108.32
|
| Rate for Payer: ASR ASR |
$116.75
|
| Rate for Payer: BCBS Trust/PPO |
$93.32
|
| Rate for Payer: BCN Commercial |
$93.32
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$120.36
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Mclaren Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.92
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$177.15 |
| Rate for Payer: Aetna Commercial |
$108.32
|
| Rate for Payer: Aetna Medicare |
$141.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.15
|
| Rate for Payer: ASR ASR |
$116.75
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS MAPPO |
$141.72
|
| Rate for Payer: BCBS Trust/PPO |
$93.32
|
| Rate for Payer: BCN Commercial |
$93.32
|
| Rate for Payer: BCN Medicare Advantage |
$141.72
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.72
|
| Rate for Payer: Healthscope Commercial |
$120.36
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$141.72
|
| Rate for Payer: Mclaren Commercial |
$108.32
|
| Rate for Payer: Mclaren Medicaid |
$77.52
|
| Rate for Payer: Mclaren Medicare |
$141.72
|
| Rate for Payer: Meridian Medicaid |
$81.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PACE Medicare |
$134.63
|
| Rate for Payer: PACE SWMI |
$141.72
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: PHP Medicaid |
$77.52
|
| Rate for Payer: PHP Medicare Advantage |
$141.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.03
|
| Rate for Payer: Priority Health Medicare |
$141.72
|
| Rate for Payer: Priority Health Narrow Network |
$67.22
|
| Rate for Payer: Railroad Medicare Medicare |
$141.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.92
|
| Rate for Payer: UHC Medicare Advantage |
$145.97
|
| Rate for Payer: VA VA |
$141.72
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$46.52
|
| Rate for Payer: BCN Commercial |
$46.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$60.00
|
| Rate for Payer: Healthscope Whirlpool |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.52
|
| Rate for Payer: BCN Commercial |
$46.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$60.00
|
| Rate for Payer: Healthscope Whirlpool |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.60
|
| Rate for Payer: Priority Health Narrow Network |
$42.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.09
|
| Rate for Payer: BCN Commercial |
$41.09
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$53.00
|
| Rate for Payer: Healthscope Whirlpool |
$51.41
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$41.09
|
| Rate for Payer: BCN Commercial |
$41.09
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$53.00
|
| Rate for Payer: Healthscope Whirlpool |
$51.41
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.23
|
| Rate for Payer: Priority Health Narrow Network |
$37.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: ASR ASR |
$115.43
|
| Rate for Payer: BCBS Trust/PPO |
$92.26
|
| Rate for Payer: BCN Commercial |
$92.26
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.20
|
| Rate for Payer: Healthscope Commercial |
$119.00
|
| Rate for Payer: Healthscope Whirlpool |
$115.43
|
| Rate for Payer: Mclaren Commercial |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.72
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: ASR ASR |
$115.43
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$92.26
|
| Rate for Payer: BCN Commercial |
$92.26
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.20
|
| Rate for Payer: Healthscope Commercial |
$119.00
|
| Rate for Payer: Healthscope Whirlpool |
$115.43
|
| Rate for Payer: Mclaren Commercial |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.29
|
| Rate for Payer: Priority Health Narrow Network |
$84.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.72
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: ASR ASR |
$105.73
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$84.51
|
| Rate for Payer: BCN Commercial |
$84.51
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$105.73
|
| Rate for Payer: Mclaren Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.19
|
| Rate for Payer: Priority Health Narrow Network |
$77.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: ASR ASR |
$105.73
|
| Rate for Payer: BCBS Trust/PPO |
$84.51
|
| Rate for Payer: BCN Commercial |
$84.51
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$105.73
|
| Rate for Payer: Mclaren Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
HC HEART CATH CORONARIES CABG'S
|
Facility
|
OP
|
$11,972.93
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,584.36 |
| Max. Negotiated Rate |
$11,972.93 |
| Rate for Payer: Aetna Commercial |
$10,775.64
|
| 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 |
$11,613.74
|
| Rate for Payer: BCBS Complete |
$1,663.73
|
| Rate for Payer: BCBS MAPPO |
$2,896.46
|
| Rate for Payer: BCBS Trust/PPO |
$9,282.61
|
| Rate for Payer: BCN Commercial |
$9,282.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,896.46
|
| Rate for Payer: Cash Price |
$9,578.34
|
| Rate for Payer: Cash Price |
$9,578.34
|
| Rate for Payer: Cofinity Commercial |
$11,254.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,896.46
|
| Rate for Payer: Healthscope Commercial |
$11,972.93
|
| Rate for Payer: Healthscope Whirlpool |
$11,613.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,896.46
|
| Rate for Payer: Mclaren Commercial |
$10,775.64
|
| 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 |
$10,176.99
|
| 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 |
$8,381.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,895.37
|
| Rate for Payer: Priority Health Medicare |
$2,896.46
|
| Rate for Payer: Priority Health Narrow Network |
$8,500.78
|
| Rate for Payer: Railroad Medicare Medicare |
$2,896.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,536.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.35
|
| Rate for Payer: VA VA |
$2,896.46
|
|
|
HC HEART CATH CORONARIES CABG'S
|
Facility
|
IP
|
$11,972.93
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,381.05 |
| Max. Negotiated Rate |
$11,972.93 |
| Rate for Payer: Aetna Commercial |
$10,775.64
|
| Rate for Payer: ASR ASR |
$11,613.74
|
| Rate for Payer: BCBS Trust/PPO |
$9,282.61
|
| Rate for Payer: BCN Commercial |
$9,282.61
|
| Rate for Payer: Cash Price |
$9,578.34
|
| Rate for Payer: Cofinity Commercial |
$11,254.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.34
|
| Rate for Payer: Healthscope Commercial |
$11,972.93
|
| Rate for Payer: Healthscope Whirlpool |
$11,613.74
|
| Rate for Payer: Mclaren Commercial |
$10,775.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,176.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,536.18
|
|
