|
HC CONT GLUCOSE MONITOR PATIENT EQUIP
|
Facility
|
OP
|
$384.44
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
94200038
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$384.44 |
| Rate for Payer: Aetna Commercial |
$346.00
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$372.91
|
| Rate for Payer: ASR Commercial |
$372.91
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$314.82
|
| Rate for Payer: BCN Commercial |
$298.06
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$307.55
|
| Rate for Payer: Cash Price |
$307.55
|
| Rate for Payer: Cofinity Commercial |
$361.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$384.44
|
| Rate for Payer: Healthscope Whirlpool |
$372.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$346.00
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.77
|
| Rate for Payer: Nomi Health Commercial |
$315.24
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.07
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$51.26
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC CONTINUOUS NEB SUBSEQUENT HR
|
Facility
|
OP
|
$104.53
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
41000007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$41.81 |
| Max. Negotiated Rate |
$116.39 |
| Rate for Payer: Aetna Commercial |
$94.08
|
| Rate for Payer: Aetna Medicare |
$52.26
|
| Rate for Payer: ASR ASR |
$101.39
|
| Rate for Payer: ASR Commercial |
$101.39
|
| Rate for Payer: BCBS Complete |
$41.81
|
| Rate for Payer: BCBS Trust/PPO |
$85.60
|
| Rate for Payer: BCN Commercial |
$81.04
|
| Rate for Payer: Cash Price |
$83.62
|
| Rate for Payer: Cash Price |
$83.62
|
| Rate for Payer: Cofinity Commercial |
$98.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.62
|
| Rate for Payer: Healthscope Commercial |
$104.53
|
| Rate for Payer: Healthscope Whirlpool |
$101.39
|
| Rate for Payer: Mclaren Commercial |
$94.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.85
|
| Rate for Payer: Nomi Health Commercial |
$85.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.39
|
| Rate for Payer: Priority Health Narrow Network |
$93.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.99
|
|
|
HC CONTINUOUS NEB SUBSEQUENT HR
|
Facility
|
IP
|
$104.53
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
41000007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.94 |
| Max. Negotiated Rate |
$104.53 |
| Rate for Payer: Aetna Commercial |
$94.08
|
| Rate for Payer: ASR ASR |
$101.39
|
| Rate for Payer: ASR Commercial |
$101.39
|
| Rate for Payer: BCBS Trust/PPO |
$85.18
|
| Rate for Payer: BCN Commercial |
$81.04
|
| Rate for Payer: Cash Price |
$83.62
|
| Rate for Payer: Cofinity Commercial |
$98.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.62
|
| Rate for Payer: Healthscope Commercial |
$104.53
|
| Rate for Payer: Healthscope Whirlpool |
$101.39
|
| Rate for Payer: Mclaren Commercial |
$94.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.85
|
| Rate for Payer: Nomi Health Commercial |
$85.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.99
|
|
|
HC CONTINUOUS NEB TX INITIAL HOUR
|
Facility
|
OP
|
$375.42
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
41000006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$375.42 |
| Rate for Payer: Aetna Commercial |
$337.88
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$364.16
|
| Rate for Payer: ASR Commercial |
$364.16
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$307.43
|
| Rate for Payer: BCN Commercial |
$291.06
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$300.34
|
| Rate for Payer: Cash Price |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$352.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$375.42
|
| Rate for Payer: Healthscope Whirlpool |
$364.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$337.88
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.11
|
| Rate for Payer: Nomi Health Commercial |
$307.84
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.38
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$227.50
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC CONTINUOUS NEB TX INITIAL HOUR
|
Facility
|
IP
|
$375.42
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
41000006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$244.02 |
| Max. Negotiated Rate |
$375.42 |
| Rate for Payer: Aetna Commercial |
$337.88
|
| Rate for Payer: ASR ASR |
$364.16
|
| Rate for Payer: ASR Commercial |
$364.16
|
| Rate for Payer: BCBS Trust/PPO |
$305.93
|
| Rate for Payer: BCN Commercial |
$291.06
|
| Rate for Payer: Cash Price |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$352.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.34
|
| Rate for Payer: Healthscope Commercial |
$375.42
|
| Rate for Payer: Healthscope Whirlpool |
$364.16
|
| Rate for Payer: Mclaren Commercial |
$337.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.11
|
| Rate for Payer: Nomi Health Commercial |
$307.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.37
|
|
|
HC CONT PHYSICS CONSULT
|
Facility
|
IP
|
$584.70
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$380.06 |
| Max. Negotiated Rate |
$584.70 |
| Rate for Payer: Aetna Commercial |
$526.23
|
| Rate for Payer: ASR ASR |
$567.16
|
| Rate for Payer: ASR Commercial |
$567.16
|
| Rate for Payer: BCBS Trust/PPO |
$476.47
|
| Rate for Payer: BCN Commercial |
$453.32
|
| Rate for Payer: Cash Price |
$467.76
|
| Rate for Payer: Cofinity Commercial |
$549.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.76
|
| Rate for Payer: Healthscope Commercial |
$584.70
|
| Rate for Payer: Healthscope Whirlpool |
$567.16
|
| Rate for Payer: Mclaren Commercial |
$526.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.00
|
| Rate for Payer: Nomi Health Commercial |
$479.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.54
|
|
|
HC CONT PHYSICS CONSULT
|
Facility
|
OP
|
$584.70
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$584.70 |
| Rate for Payer: Aetna Commercial |
$526.23
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$567.16
|
| Rate for Payer: ASR Commercial |
$567.16
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$478.81
|
| Rate for Payer: BCN Commercial |
$453.32
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$467.76
|
| Rate for Payer: Cash Price |
$467.76
|
| Rate for Payer: Cofinity Commercial |
$549.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$584.70
|
| Rate for Payer: Healthscope Whirlpool |
$567.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$526.23
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.00
|
| Rate for Payer: Nomi Health Commercial |
$479.45
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.31
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$409.87
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
IP
|
$105.77
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna Commercial |
$95.19
|
| Rate for Payer: ASR ASR |
$102.60
|
| Rate for Payer: ASR Commercial |
$102.60
|
| Rate for Payer: BCBS Trust/PPO |
$86.19
|
| Rate for Payer: BCN Commercial |
$82.00
|
| Rate for Payer: Cash Price |
$84.62
|
| Rate for Payer: Cofinity Commercial |
$99.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.62
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Healthscope Whirlpool |
$102.60
|
| Rate for Payer: Mclaren Commercial |
$95.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.90
|
| Rate for Payer: Nomi Health Commercial |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.08
|
|
|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
OP
|
$105.77
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna Commercial |
$95.19
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: ASR ASR |
$102.60
|
| Rate for Payer: ASR Commercial |
$102.60
|
| Rate for Payer: BCBS Complete |
$42.31
|
| Rate for Payer: BCBS Trust/PPO |
$86.62
|
| Rate for Payer: BCN Commercial |
$82.00
|
| Rate for Payer: Cash Price |
$84.62
|
| Rate for Payer: Cash Price |
$84.62
|
| Rate for Payer: Cofinity Commercial |
$99.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.62
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Healthscope Whirlpool |
$102.60
|
| Rate for Payer: Mclaren Commercial |
$95.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.90
|
| Rate for Payer: Nomi Health Commercial |
$86.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.14
|
| Rate for Payer: Priority Health Narrow Network |
$28.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.08
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
IP
|
$414.64
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.52 |
| Max. Negotiated Rate |
$414.64 |
| Rate for Payer: Aetna Commercial |
$373.18
|
| Rate for Payer: ASR ASR |
$402.20
|
| Rate for Payer: ASR Commercial |
$402.20
|
| Rate for Payer: BCBS Trust/PPO |
$337.89
|
| Rate for Payer: BCN Commercial |
$321.47
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cofinity Commercial |
$389.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.71
|
| Rate for Payer: Healthscope Commercial |
$414.64
|
| Rate for Payer: Healthscope Whirlpool |
$402.20
|
| Rate for Payer: Mclaren Commercial |
$373.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.44
|
| Rate for Payer: Nomi Health Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.88
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
OP
|
$414.64
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$414.64 |
| Rate for Payer: Aetna Commercial |
$373.18
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$402.20
|
| Rate for Payer: ASR Commercial |
$402.20
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$339.55
|
| Rate for Payer: BCN Commercial |
$321.47
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cofinity Commercial |
$389.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$414.64
|
| Rate for Payer: Healthscope Whirlpool |
$402.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$373.18
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.44
|
| Rate for Payer: Nomi Health Commercial |
$340.00
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.92
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$171.94
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
IP
|
$753.77
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$489.95 |
| Max. Negotiated Rate |
$753.77 |
| Rate for Payer: Aetna Commercial |
$678.39
|
| Rate for Payer: ASR ASR |
$731.16
|
| Rate for Payer: ASR Commercial |
$731.16
|
| Rate for Payer: BCBS Trust/PPO |
$614.25
|
| Rate for Payer: BCN Commercial |
$584.40
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cofinity Commercial |
$708.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$603.02
|
| Rate for Payer: Healthscope Commercial |
$753.77
|
| Rate for Payer: Healthscope Whirlpool |
$731.16
|
| Rate for Payer: Mclaren Commercial |
$678.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.70
|
| Rate for Payer: Nomi Health Commercial |
$618.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.32
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
OP
|
$753.77
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$773.37 |
| Rate for Payer: Aetna Commercial |
$678.39
|
| Rate for Payer: Aetna Medicare |
$498.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: ASR ASR |
$731.16
|
| Rate for Payer: ASR Commercial |
$731.16
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$617.26
|
| Rate for Payer: BCN Commercial |
$584.40
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cofinity Commercial |
$708.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$603.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$753.77
|
| Rate for Payer: Healthscope Whirlpool |
$731.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$498.95
|
| Rate for Payer: Mclaren Commercial |
$678.39
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.70
|
| Rate for Payer: Nomi Health Commercial |
$618.09
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$548.84
|
| Rate for Payer: PHP Medicaid |
$267.44
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$660.45
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$528.39
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$773.37
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP DNSP |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,342.32
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.51 |
| Max. Negotiated Rate |
$1,342.32 |
| Rate for Payer: Aetna Commercial |
$1,208.09
|
| Rate for Payer: ASR ASR |
$1,302.05
|
| Rate for Payer: ASR Commercial |
$1,302.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.86
|
| Rate for Payer: BCN Commercial |
$1,040.70
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Healthscope Commercial |
$1,342.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.05
|
| Rate for Payer: Mclaren Commercial |
$1,208.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.24
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,342.32
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$1,342.32 |
| Rate for Payer: Aetna Commercial |
$1,208.09
|
| Rate for Payer: Aetna Medicare |
$498.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: ASR ASR |
$1,302.05
|
| Rate for Payer: ASR Commercial |
$1,302.05
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.23
|
| Rate for Payer: BCN Commercial |
$1,040.70
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$1,342.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$498.95
|
| Rate for Payer: Mclaren Commercial |
$1,208.09
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$548.84
|
| Rate for Payer: PHP Medicaid |
$267.44
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,176.14
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$940.97
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$773.37
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP DNSP |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,683.04
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,393.98 |
| Max. Negotiated Rate |
$3,683.04 |
| Rate for Payer: Aetna Commercial |
$3,314.74
|
| Rate for Payer: ASR ASR |
$3,572.55
|
| Rate for Payer: ASR Commercial |
$3,572.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,001.31
|
| Rate for Payer: BCN Commercial |
$2,855.46
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$3,462.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Healthscope Commercial |
$3,683.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,572.55
|
| Rate for Payer: Mclaren Commercial |
$3,314.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: Nomi Health Commercial |
$3,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,241.08
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,683.04
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,853.33 |
| Max. Negotiated Rate |
$5,359.44 |
| Rate for Payer: Aetna Commercial |
$3,314.74
|
| Rate for Payer: Aetna Medicare |
$3,457.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: ASR ASR |
$3,572.55
|
| Rate for Payer: ASR Commercial |
$3,572.55
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,016.04
|
| Rate for Payer: BCN Commercial |
$2,855.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$3,462.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$3,683.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,572.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,457.70
|
| Rate for Payer: Mclaren Commercial |
$3,314.74
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: Nomi Health Commercial |
$3,020.09
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$3,803.47
|
| Rate for Payer: PHP Medicaid |
$1,853.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,227.08
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$2,581.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,241.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$5,359.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP DNSP |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
OP
|
$1,204.40
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.86 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$1,083.96
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$1,168.27
|
| Rate for Payer: ASR Commercial |
$1,168.27
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$986.28
|
| Rate for Payer: BCN Commercial |
$933.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$1,083.96
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: Nomi Health Commercial |
$987.61
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,055.30
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$844.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
IP
|
$1,204.40
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.86 |
| Max. Negotiated Rate |
$1,204.40 |
| Rate for Payer: Aetna Commercial |
$1,083.96
|
| Rate for Payer: ASR ASR |
$1,168.27
|
| Rate for Payer: ASR Commercial |
$1,168.27
|
| Rate for Payer: BCBS Trust/PPO |
$981.47
|
| Rate for Payer: BCN Commercial |
$933.77
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Healthscope Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.27
|
| Rate for Payer: Mclaren Commercial |
$1,083.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: Nomi Health Commercial |
$987.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.87
|
|
|
HC CONVEX WAFER
|
Facility
|
OP
|
$57.04
|
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: ASR ASR |
$55.33
|
| Rate for Payer: ASR Commercial |
$55.33
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$46.71
|
| Rate for Payer: BCN Commercial |
$44.22
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$53.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$57.04
|
| Rate for Payer: Healthscope Whirlpool |
$55.33
|
| Rate for Payer: Mclaren Commercial |
$51.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: Nomi Health Commercial |
$46.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.98
|
| Rate for Payer: Priority Health Narrow Network |
$39.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.20
|
|
|
HC CONVEX WAFER
|
Facility
|
IP
|
$57.04
|
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.08 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: ASR ASR |
$55.33
|
| Rate for Payer: ASR Commercial |
$55.33
|
| Rate for Payer: BCBS Trust/PPO |
$46.48
|
| Rate for Payer: BCN Commercial |
$44.22
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$53.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$57.04
|
| Rate for Payer: Healthscope Whirlpool |
$55.33
|
| Rate for Payer: Mclaren Commercial |
$51.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: Nomi Health Commercial |
$46.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.20
|
|
|
HC COOK GUIDEWIRE
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: Aetna Medicare |
$23.94
|
| Rate for Payer: ASR ASR |
$46.43
|
| Rate for Payer: ASR Commercial |
$46.43
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: BCBS Trust/PPO |
$39.20
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Whirlpool |
$46.43
|
| Rate for Payer: Mclaren Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.94
|
| Rate for Payer: Priority Health Narrow Network |
$33.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.13
|
|
|
HC COOK GUIDEWIRE
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Aetna Commercial |
$43.08
|
| Rate for Payer: ASR ASR |
$46.43
|
| Rate for Payer: ASR Commercial |
$46.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.01
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Whirlpool |
$46.43
|
| Rate for Payer: Mclaren Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.13
|
|
|
HC COOK PIGTAIL
|
Facility
|
OP
|
$468.32
|
|
| Hospital Charge Code |
27200233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.33 |
| Max. Negotiated Rate |
$468.32 |
| Rate for Payer: Aetna Commercial |
$421.49
|
| Rate for Payer: Aetna Medicare |
$234.16
|
| Rate for Payer: ASR ASR |
$454.27
|
| Rate for Payer: ASR Commercial |
$454.27
|
| Rate for Payer: BCBS Complete |
$187.33
|
| Rate for Payer: BCBS Trust/PPO |
$383.51
|
| Rate for Payer: BCN Commercial |
$363.09
|
| Rate for Payer: Cash Price |
$374.66
|
| Rate for Payer: Cofinity Commercial |
$440.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.66
|
| Rate for Payer: Healthscope Commercial |
$468.32
|
| Rate for Payer: Healthscope Whirlpool |
$454.27
|
| Rate for Payer: Mclaren Commercial |
$421.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.07
|
| Rate for Payer: Nomi Health Commercial |
$384.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.34
|
| Rate for Payer: Priority Health Narrow Network |
$328.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.12
|
|
|
HC COOK PIGTAIL
|
Facility
|
IP
|
$468.32
|
|
| Hospital Charge Code |
27200233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.41 |
| Max. Negotiated Rate |
$468.32 |
| Rate for Payer: Aetna Commercial |
$421.49
|
| Rate for Payer: ASR ASR |
$454.27
|
| Rate for Payer: ASR Commercial |
$454.27
|
| Rate for Payer: BCBS Trust/PPO |
$381.63
|
| Rate for Payer: BCN Commercial |
$363.09
|
| Rate for Payer: Cash Price |
$374.66
|
| Rate for Payer: Cofinity Commercial |
$440.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.66
|
| Rate for Payer: Healthscope Commercial |
$468.32
|
| Rate for Payer: Healthscope Whirlpool |
$454.27
|
| Rate for Payer: Mclaren Commercial |
$421.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.07
|
| Rate for Payer: Nomi Health Commercial |
$384.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.12
|
|
