|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
OP
|
$47.59
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$47.59 |
| Rate for Payer: Aetna Commercial |
$42.83
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$46.16
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$36.90
|
| Rate for Payer: BCN Commercial |
$36.90
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$47.59
|
| Rate for Payer: Healthscope Whirlpool |
$46.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$42.83
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.45
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.31
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$33.79
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
IP
|
$47.59
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$47.59 |
| Rate for Payer: Aetna Commercial |
$42.83
|
| Rate for Payer: ASR ASR |
$46.16
|
| Rate for Payer: BCBS Trust/PPO |
$36.90
|
| Rate for Payer: BCN Commercial |
$36.90
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.07
|
| Rate for Payer: Healthscope Commercial |
$47.59
|
| Rate for Payer: Healthscope Whirlpool |
$46.16
|
| Rate for Payer: Mclaren Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.88
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$15.95
|
| Rate for Payer: ASR ASR |
$17.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.19
|
| Rate for Payer: Mclaren Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.59
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$15.95
|
| Rate for Payer: ASR ASR |
$17.19
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Whirlpool |
$17.19
|
| Rate for Payer: Mclaren Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.13
|
| Rate for Payer: Priority Health Narrow Network |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.59
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
OP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: ASR ASR |
$16.33
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.33
|
| Rate for Payer: Mclaren Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$11.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.81
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
IP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: ASR ASR |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.33
|
| Rate for Payer: Mclaren Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.81
|
|
|
HC HH WET ONES
|
Facility
|
OP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.61
|
| Rate for Payer: Priority Health Narrow Network |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
HC HH WET ONES
|
Facility
|
IP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Complete |
$7.41
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$7.06
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Medicaid |
$7.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: PHP Medicaid |
$7.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.60
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$50.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
| Rate for Payer: UHC Medicare Advantage |
$13.29
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: ASR ASR |
$40.10
|
| Rate for Payer: BCBS Trust/PPO |
$32.05
|
| Rate for Payer: BCN Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$38.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$41.34
|
| Rate for Payer: Healthscope Whirlpool |
$40.10
|
| Rate for Payer: Mclaren Commercial |
$37.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.38
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$41.34
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: ASR ASR |
$40.10
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$32.05
|
| Rate for Payer: BCN Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$38.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$41.34
|
| Rate for Payer: Healthscope Whirlpool |
$40.10
|
| Rate for Payer: Mclaren Commercial |
$37.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.62
|
| Rate for Payer: Priority Health Narrow Network |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.38
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$716.10 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: ASR ASR |
$992.31
|
| Rate for Payer: BCBS Trust/PPO |
$793.13
|
| Rate for Payer: BCN Commercial |
$793.13
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cofinity Commercial |
$961.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$818.40
|
| Rate for Payer: Healthscope Commercial |
$1,023.00
|
| Rate for Payer: Healthscope Whirlpool |
$992.31
|
| Rate for Payer: Mclaren Commercial |
$920.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$869.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$900.24
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$409.20 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: ASR ASR |
$992.31
|
| Rate for Payer: BCBS Complete |
$409.20
|
| Rate for Payer: BCBS Trust/PPO |
$793.13
|
| Rate for Payer: BCN Commercial |
$793.13
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cofinity Commercial |
$961.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$818.40
|
| Rate for Payer: Healthscope Commercial |
$1,023.00
|
| Rate for Payer: Healthscope Whirlpool |
$992.31
|
| Rate for Payer: Mclaren Commercial |
$920.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$869.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.93
|
| Rate for Payer: Priority Health Narrow Network |
$726.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$900.24
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
IP
|
$213.13
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.19 |
| Max. Negotiated Rate |
$213.13 |
| Rate for Payer: Aetna Commercial |
$191.82
|
| Rate for Payer: ASR ASR |
$206.74
|
| Rate for Payer: BCBS Trust/PPO |
$165.24
|
| Rate for Payer: BCN Commercial |
$165.24
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$200.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.50
|
| Rate for Payer: Healthscope Commercial |
$213.13
|
| Rate for Payer: Healthscope Whirlpool |
$206.74
|
| Rate for Payer: Mclaren Commercial |
$191.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.55
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
OP
|
$213.13
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$213.13 |
| Rate for Payer: Aetna Commercial |
$191.82
|
| Rate for Payer: ASR ASR |
$206.74
|
| Rate for Payer: BCBS Complete |
$85.25
|
| Rate for Payer: BCBS Trust/PPO |
$165.24
|
| Rate for Payer: BCN Commercial |
$165.24
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$200.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.50
|
| Rate for Payer: Healthscope Commercial |
$213.13
|
| Rate for Payer: Healthscope Whirlpool |
$206.74
|
| Rate for Payer: Mclaren Commercial |
$191.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.55
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
OP
|
$1,511.64
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,511.64 |
| Rate for Payer: Aetna Commercial |
$1,360.48
|
| Rate for Payer: ASR ASR |
$1,466.29
|
| Rate for Payer: BCBS Complete |
$604.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.97
|
| Rate for Payer: BCN Commercial |
$1,171.97
|
| Rate for Payer: Cash Price |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,420.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.31
|
| Rate for Payer: Healthscope Commercial |
$1,511.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,466.29
|
| Rate for Payer: Mclaren Commercial |
$1,360.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,284.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,375.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,073.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.24
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
IP
|
$1,511.64
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,058.15 |
| Max. Negotiated Rate |
$1,511.64 |
| Rate for Payer: Aetna Commercial |
$1,360.48
|
| Rate for Payer: ASR ASR |
$1,466.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.97
|
| Rate for Payer: BCN Commercial |
$1,171.97
|
| Rate for Payer: Cash Price |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,420.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.31
|
| Rate for Payer: Healthscope Commercial |
$1,511.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,466.29
|
| Rate for Payer: Mclaren Commercial |
$1,360.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,284.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.24
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
IP
|
$383.75
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.62 |
| Max. Negotiated Rate |
$383.75 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: ASR ASR |
$372.24
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$297.52
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cofinity Commercial |
$360.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.00
|
| Rate for Payer: Healthscope Commercial |
$383.75
|
| Rate for Payer: Healthscope Whirlpool |
$372.24
|
| Rate for Payer: Mclaren Commercial |
$345.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.70
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
OP
|
$383.75
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$383.75 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$372.24
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$297.52
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cofinity Commercial |
$360.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$383.75
|
| Rate for Payer: Healthscope Whirlpool |
$372.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$345.38
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.19
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.21
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$272.46
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.70
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
OP
|
$472.31
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$472.31 |
| Rate for Payer: Aetna Commercial |
$425.08
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$458.14
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$366.18
|
| Rate for Payer: BCN Commercial |
$366.18
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| 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 |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$472.31
|
| Rate for Payer: Healthscope Whirlpool |
$458.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$425.08
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| 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 |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$335.34
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.63
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
IP
|
$472.31
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| 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 HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
IP
|
$531.36
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| 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 HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
OP
|
$531.36
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$531.36 |
| Rate for Payer: Aetna Commercial |
$478.22
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$515.42
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$411.96
|
| Rate for Payer: BCN Commercial |
$411.96
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| 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 |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$531.36
|
| Rate for Payer: Healthscope Whirlpool |
$515.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$478.22
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| 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 |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$377.27
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.60
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
