|
HC CONNECTOR REDUCER
|
Facility
|
IP
|
$5.36
|
|
| Hospital Charge Code |
27000651
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$4.82
|
| Rate for Payer: ASR ASR |
$5.20
|
| Rate for Payer: ASR Commercial |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.72
|
|
|
HC CONNECTOR REDUCER
|
Facility
|
OP
|
$5.36
|
|
| Hospital Charge Code |
27000651
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$4.82
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: ASR ASR |
$5.20
|
| Rate for Payer: ASR Commercial |
$5.20
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$4.39
|
| Rate for Payer: BCN Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.70
|
| Rate for Payer: Priority Health Narrow Network |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.72
|
|
|
HC CONNECTOR ST 1/2 X 1/2
|
Facility
|
OP
|
$7.65
|
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$6.88
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: ASR ASR |
$7.42
|
| Rate for Payer: ASR Commercial |
$7.42
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.26
|
| Rate for Payer: BCN Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Healthscope Whirlpool |
$7.42
|
| Rate for Payer: Mclaren Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.73
|
|
|
HC CONNECTOR ST 1/2 X 1/2
|
Facility
|
IP
|
$7.65
|
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$6.88
|
| Rate for Payer: ASR ASR |
$7.42
|
| Rate for Payer: ASR Commercial |
$7.42
|
| Rate for Payer: BCBS Trust/PPO |
$6.23
|
| Rate for Payer: BCN Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Healthscope Whirlpool |
$7.42
|
| Rate for Payer: Mclaren Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.73
|
|
|
HC CONNECTOR ST 3/8 OR 1/4
|
Facility
|
OP
|
$5.36
|
|
| Hospital Charge Code |
27000685
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$4.82
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: ASR ASR |
$5.20
|
| Rate for Payer: ASR Commercial |
$5.20
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$4.39
|
| Rate for Payer: BCN Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.70
|
| Rate for Payer: Priority Health Narrow Network |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.72
|
|
|
HC CONNECTOR ST 3/8 OR 1/4
|
Facility
|
IP
|
$5.36
|
|
| Hospital Charge Code |
27000685
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$4.82
|
| Rate for Payer: ASR ASR |
$5.20
|
| Rate for Payer: ASR Commercial |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.72
|
|
|
HC CONNECTOR V
|
Facility
|
IP
|
$7.65
|
|
| Hospital Charge Code |
27000678
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$6.88
|
| Rate for Payer: ASR ASR |
$7.42
|
| Rate for Payer: ASR Commercial |
$7.42
|
| Rate for Payer: BCBS Trust/PPO |
$6.23
|
| Rate for Payer: BCN Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Healthscope Whirlpool |
$7.42
|
| Rate for Payer: Mclaren Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.73
|
|
|
HC CONNECTOR V
|
Facility
|
OP
|
$7.65
|
|
| Hospital Charge Code |
27000678
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$6.88
|
| Rate for Payer: Aetna Medicare |
$3.83
|
| Rate for Payer: ASR ASR |
$7.42
|
| Rate for Payer: ASR Commercial |
$7.42
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.26
|
| Rate for Payer: BCN Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Healthscope Whirlpool |
$7.42
|
| Rate for Payer: Mclaren Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.73
|
|
|
HC CONNECTOR Y
|
Facility
|
IP
|
$5.36
|
|
| Hospital Charge Code |
27000048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$4.82
|
| Rate for Payer: ASR ASR |
$5.20
|
| Rate for Payer: ASR Commercial |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.72
|
|
|
HC CONNECTOR Y
|
Facility
|
OP
|
$5.36
|
|
| Hospital Charge Code |
27000048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$4.82
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: ASR ASR |
$5.20
|
| Rate for Payer: ASR Commercial |
$5.20
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$4.39
|
| Rate for Payer: BCN Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.70
|
| Rate for Payer: Priority Health Narrow Network |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.72
|
|
|
HC CONSULT NUTRITIONAL
|
Facility
|
IP
|
$34.96
|
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$31.46
|
| Rate for Payer: ASR ASR |
$33.91
|
| Rate for Payer: ASR Commercial |
$33.91
|
| Rate for Payer: BCBS Trust/PPO |
$28.49
|
| Rate for Payer: BCN Commercial |
$27.10
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$32.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.97
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Whirlpool |
$33.91
|
| Rate for Payer: Mclaren Commercial |
$31.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.72
|
| Rate for Payer: Nomi Health Commercial |
$28.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.76
|
|
|
HC CONSULT NUTRITIONAL
|
Facility
|
OP
|
$34.96
|
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$31.46
|
| Rate for Payer: Aetna Medicare |
$17.48
|
| Rate for Payer: ASR ASR |
$33.91
|
| Rate for Payer: ASR Commercial |
$33.91
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCN Commercial |
$27.10
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$32.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.97
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Whirlpool |
$33.91
|
| Rate for Payer: Mclaren Commercial |
$31.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.72
|
| Rate for Payer: Nomi Health Commercial |
$28.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.63
|
| Rate for Payer: Priority Health Narrow Network |
$24.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.76
|
|
|
HC CONT GLUCOSE MONITOR OFFICE EQUIP
|
Facility
|
OP
|
$984.59
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$984.59 |
| Rate for Payer: Aetna Commercial |
$886.13
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$955.05
|
| Rate for Payer: ASR Commercial |
$955.05
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$806.28
|
| Rate for Payer: BCN Commercial |
$763.35
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$787.67
|
| Rate for Payer: Cash Price |
$787.67
|
| Rate for Payer: Cofinity Commercial |
$925.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$984.59
|
| Rate for Payer: Healthscope Whirlpool |
$955.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$886.13
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.90
|
| Rate for Payer: Nomi Health Commercial |
$807.36
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.70
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$690.20
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$866.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
HC CONT GLUCOSE MONITOR OFFICE EQUIP
|
Facility
|
IP
|
$984.59
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$639.98 |
| Max. Negotiated Rate |
$984.59 |
| Rate for Payer: Aetna Commercial |
$886.13
|
| Rate for Payer: ASR ASR |
$955.05
|
| Rate for Payer: ASR Commercial |
$955.05
|
| Rate for Payer: BCBS Trust/PPO |
$802.34
|
| Rate for Payer: BCN Commercial |
$763.35
|
| Rate for Payer: Cash Price |
$787.67
|
| Rate for Payer: Cofinity Commercial |
$925.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.67
|
| Rate for Payer: Healthscope Commercial |
$984.59
|
| Rate for Payer: Healthscope Whirlpool |
$955.05
|
| Rate for Payer: Mclaren Commercial |
$886.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.90
|
| Rate for Payer: Nomi Health Commercial |
$807.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$866.44
|
|
|
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 |
$31.05 |
| Max. Negotiated Rate |
$384.44 |
| Rate for Payer: Aetna Commercial |
$346.00
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$372.91
|
| Rate for Payer: ASR Commercial |
$372.91
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$314.82
|
| Rate for Payer: BCN Commercial |
$298.06
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| 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 |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$384.44
|
| Rate for Payer: Healthscope Whirlpool |
$372.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$346.00
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.77
|
| Rate for Payer: Nomi Health Commercial |
$315.24
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.85
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$269.49
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC CONT GLUCOSE MONITOR PATIENT EQUIP
|
Facility
|
IP
|
$384.44
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
94200038
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$249.89 |
| Max. Negotiated Rate |
$384.44 |
| Rate for Payer: Aetna Commercial |
$346.00
|
| Rate for Payer: ASR ASR |
$372.91
|
| Rate for Payer: ASR Commercial |
$372.91
|
| Rate for Payer: BCBS Trust/PPO |
$313.28
|
| Rate for Payer: BCN Commercial |
$298.06
|
| 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: Healthscope Commercial |
$384.44
|
| Rate for Payer: Healthscope Whirlpool |
$372.91
|
| Rate for Payer: Mclaren Commercial |
$346.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.77
|
| Rate for Payer: Nomi Health Commercial |
$315.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.31
|
|
|
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 |
$104.53 |
| Rate for Payer: Aetna Commercial |
$94.08
|
| Rate for Payer: Aetna Medicare |
$52.27
|
| 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: 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 |
$91.59
|
| Rate for Payer: Priority Health Narrow Network |
$73.28
|
| 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 |
$67.38 |
| Max. Negotiated Rate |
$375.42 |
| Rate for Payer: Aetna Commercial |
$337.88
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$364.16
|
| Rate for Payer: ASR Commercial |
$364.16
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$307.43
|
| Rate for Payer: BCN Commercial |
$291.06
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| 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 |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$375.42
|
| Rate for Payer: Healthscope Whirlpool |
$364.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$337.88
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.11
|
| Rate for Payer: Nomi Health Commercial |
$307.84
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.94
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$263.17
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
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 |
$69.41 |
| Max. Negotiated Rate |
$584.70 |
| Rate for Payer: Aetna Commercial |
$526.23
|
| Rate for Payer: Aetna Medicare |
$129.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: ASR ASR |
$567.16
|
| Rate for Payer: ASR Commercial |
$567.16
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCBS Trust/PPO |
$478.81
|
| Rate for Payer: BCN Commercial |
$453.32
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| 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 |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$584.70
|
| Rate for Payer: Healthscope Whirlpool |
$567.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$129.49
|
| Rate for Payer: Mclaren Commercial |
$526.23
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.00
|
| Rate for Payer: Nomi Health Commercial |
$479.45
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$142.44
|
| Rate for Payer: PHP Medicaid |
$69.41
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| 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 |
$129.49
|
| Rate for Payer: Priority Health Narrow Network |
$409.87
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$200.71
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP DNSP |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$69.41
|
| Rate for Payer: VA VA |
$129.49
|
|
|
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 |
$42.31 |
| 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: 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 |
$92.68
|
| Rate for Payer: Priority Health Narrow Network |
$74.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.08
|
|
|
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 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
|
|
