|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
IP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.03 |
| Max. Negotiated Rate |
$529.37 |
| Rate for Payer: Aetna Commercial |
$476.43
|
| Rate for Payer: ASR ASR |
$513.49
|
| Rate for Payer: BCBS Trust/PPO |
$434.72
|
| Rate for Payer: BCN Commercial |
$434.72
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$497.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$513.49
|
| Rate for Payer: Healthscope Whirlpool |
$529.37
|
| Rate for Payer: Mclaren Commercial |
$476.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.85
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
IP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$557.68 |
| Max. Negotiated Rate |
$743.57 |
| Rate for Payer: Aetna Commercial |
$669.21
|
| Rate for Payer: ASR ASR |
$721.26
|
| Rate for Payer: BCBS Trust/PPO |
$610.62
|
| Rate for Payer: BCN Commercial |
$610.62
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$698.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$721.26
|
| Rate for Payer: Healthscope Whirlpool |
$743.57
|
| Rate for Payer: Mclaren Commercial |
$669.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.34
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
OP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$743.57 |
| Rate for Payer: Aetna Commercial |
$669.21
|
| Rate for Payer: Aetna Medicare |
$275.12
|
| Rate for Payer: ASR ASR |
$721.26
|
| Rate for Payer: BCBS Complete |
$297.43
|
| Rate for Payer: BCBS Trust/PPO |
$613.07
|
| Rate for Payer: BCN Commercial |
$613.07
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$698.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$721.26
|
| Rate for Payer: Healthscope Whirlpool |
$743.57
|
| Rate for Payer: Mclaren Commercial |
$669.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$594.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$651.52
|
| Rate for Payer: Priority Health Narrow Network |
$521.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.34
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
OP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.52 |
| Max. Negotiated Rate |
$793.31 |
| Rate for Payer: Aetna Commercial |
$713.98
|
| Rate for Payer: Aetna Medicare |
$293.52
|
| Rate for Payer: ASR ASR |
$769.51
|
| Rate for Payer: BCBS Complete |
$317.32
|
| Rate for Payer: BCBS Trust/PPO |
$654.08
|
| Rate for Payer: BCN Commercial |
$654.08
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$745.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$769.51
|
| Rate for Payer: Healthscope Whirlpool |
$793.31
|
| Rate for Payer: Mclaren Commercial |
$713.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$695.10
|
| Rate for Payer: Priority Health Narrow Network |
$556.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.11
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
IP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.98 |
| Max. Negotiated Rate |
$793.31 |
| Rate for Payer: Aetna Commercial |
$713.98
|
| Rate for Payer: ASR ASR |
$769.51
|
| Rate for Payer: BCBS Trust/PPO |
$651.47
|
| Rate for Payer: BCN Commercial |
$651.47
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$745.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$769.51
|
| Rate for Payer: Healthscope Whirlpool |
$793.31
|
| Rate for Payer: Mclaren Commercial |
$713.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.11
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
IP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$850.67 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: ASR ASR |
$825.15
|
| Rate for Payer: BCBS Trust/PPO |
$698.57
|
| Rate for Payer: BCN Commercial |
$698.57
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$799.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$825.15
|
| Rate for Payer: Healthscope Whirlpool |
$850.67
|
| Rate for Payer: Mclaren Commercial |
$765.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.59
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
OP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.75 |
| Max. Negotiated Rate |
$850.67 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: Aetna Medicare |
$314.75
|
| Rate for Payer: ASR ASR |
$825.15
|
| Rate for Payer: BCBS Complete |
$340.27
|
| Rate for Payer: BCBS Trust/PPO |
$701.38
|
| Rate for Payer: BCN Commercial |
$701.38
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$799.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$825.15
|
| Rate for Payer: Healthscope Whirlpool |
$850.67
|
| Rate for Payer: Mclaren Commercial |
$765.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$680.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$745.36
|
| Rate for Payer: Priority Health Narrow Network |
$596.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.59
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
IP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.33 |
| Max. Negotiated Rate |
$957.77 |
| Rate for Payer: Aetna Commercial |
$861.99
|
| Rate for Payer: ASR ASR |
$929.04
|
| Rate for Payer: BCBS Trust/PPO |
$786.52
|
| Rate for Payer: BCN Commercial |
$786.52
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$900.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$929.04
|
| Rate for Payer: Healthscope Whirlpool |
$957.77
|
| Rate for Payer: Mclaren Commercial |
$861.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.84
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
OP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.37 |
| Max. Negotiated Rate |
$957.77 |
| Rate for Payer: Aetna Commercial |
$861.99
|
| Rate for Payer: Aetna Medicare |
$354.37
|
| Rate for Payer: ASR ASR |
$929.04
|
| Rate for Payer: BCBS Complete |
$383.11
|
| Rate for Payer: BCBS Trust/PPO |
$789.68
|
| Rate for Payer: BCN Commercial |
$789.68
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$900.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$929.04
|
| Rate for Payer: Healthscope Whirlpool |
$957.77
|
| Rate for Payer: Mclaren Commercial |
$861.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$766.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$839.20
|
| Rate for Payer: Priority Health Narrow Network |
$671.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.84
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$404.49
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$149.66 |
| Max. Negotiated Rate |
$404.49 |
| Rate for Payer: Aetna Commercial |
$364.04
|
| Rate for Payer: Aetna Medicare |
$149.66
|
| Rate for Payer: ASR ASR |
$392.36
|
| Rate for Payer: BCBS Complete |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$333.50
|
| Rate for Payer: BCN Commercial |
$333.50
|
| Rate for Payer: Cash Price |
$323.59
|
| Rate for Payer: Cash Price |
$323.59
|
| Rate for Payer: Cofinity Commercial |
$380.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.59
|
| Rate for Payer: Healthscope Commercial |
$392.36
|
| Rate for Payer: Healthscope Whirlpool |
$404.49
|
| Rate for Payer: Mclaren Commercial |
$364.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Nomi Health Commercial |
$331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$237.27
|
| Rate for Payer: Priority Health Narrow Network |
$189.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.95
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$404.49
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$303.37 |
| Max. Negotiated Rate |
$404.49 |
| Rate for Payer: Aetna Commercial |
$364.04
|
| Rate for Payer: ASR ASR |
$392.36
|
| Rate for Payer: BCBS Trust/PPO |
$332.17
|
| Rate for Payer: BCN Commercial |
$332.17
|
| Rate for Payer: Cash Price |
$323.59
|
| Rate for Payer: Cofinity Commercial |
$380.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.59
|
| Rate for Payer: Healthscope Commercial |
$392.36
|
| Rate for Payer: Healthscope Whirlpool |
$404.49
|
| Rate for Payer: Mclaren Commercial |
$364.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Nomi Health Commercial |
$331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.95
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$172.71
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$172.71 |
| Rate for Payer: Aetna Commercial |
$155.44
|
| Rate for Payer: Aetna Medicare |
$34.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: ASR ASR |
$167.53
|
| Rate for Payer: BCBS Complete |
$19.12
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$142.40
|
| Rate for Payer: BCN Commercial |
$142.40
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$162.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$167.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$34.81
|
| Rate for Payer: Mclaren Commercial |
$155.44
|
| Rate for Payer: Mclaren Medicaid |
$34.81
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: Meridian Medicaid |
$19.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$38.29
|
| Rate for Payer: PHP Medicaid |
$18.66
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.33
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$121.07
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.81
|
| Rate for Payer: UHC Exchange |
$53.96
|
| Rate for Payer: UHC Medicaid |
$18.21
|
| Rate for Payer: UHCCP DNSP |
$34.81
|
| Rate for Payer: UHCCP Medicaid |
$18.21
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$129.53 |
| Max. Negotiated Rate |
$172.71 |
| Rate for Payer: Aetna Commercial |
$155.44
|
| Rate for Payer: ASR ASR |
$167.53
|
| Rate for Payer: BCBS Trust/PPO |
$141.83
|
| Rate for Payer: BCN Commercial |
$141.83
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$162.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$167.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.71
|
| Rate for Payer: Mclaren Commercial |
$155.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.98
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$93.71
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$93.71 |
| Rate for Payer: Aetna Commercial |
$84.34
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: ASR ASR |
$90.90
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$77.26
|
| Rate for Payer: BCN Commercial |
$77.26
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$88.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$84.34
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Meridian Medicaid |
$7.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$76.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$14.61
|
| Rate for Payer: PHP Medicaid |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.02
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow Network |
$57.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.28
|
| Rate for Payer: UHC Exchange |
$20.58
|
| Rate for Payer: UHC Medicaid |
$6.95
|
| Rate for Payer: UHCCP DNSP |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$6.95
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$93.71
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$93.71 |
| Rate for Payer: Aetna Commercial |
$84.34
|
| Rate for Payer: ASR ASR |
$90.90
|
| Rate for Payer: BCBS Trust/PPO |
$76.95
|
| Rate for Payer: BCN Commercial |
$76.95
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$88.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.71
|
| Rate for Payer: Mclaren Commercial |
$84.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$76.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.46
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$85.95 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$30.62
|
| Rate for Payer: BCN Commercial |
$30.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$13.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.95
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$68.76
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$107.78
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$107.78 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: ASR ASR |
$104.55
|
| Rate for Payer: BCBS Trust/PPO |
$88.51
|
| Rate for Payer: BCN Commercial |
$88.51
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$104.55
|
| Rate for Payer: Healthscope Whirlpool |
$107.78
|
| Rate for Payer: Mclaren Commercial |
$97.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.85
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$107.78
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$107.78 |
| Rate for Payer: Aetna Commercial |
$97.00
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: ASR ASR |
$104.55
|
| Rate for Payer: BCBS Complete |
$7.56
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$88.86
|
| Rate for Payer: BCN Commercial |
$88.86
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$101.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$104.55
|
| Rate for Payer: Healthscope Whirlpool |
$107.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.76
|
| Rate for Payer: Mclaren Commercial |
$97.00
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: Meridian Medicaid |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$15.14
|
| Rate for Payer: PHP Medicaid |
$7.38
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.59
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow Network |
$71.67
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.76
|
| Rate for Payer: UHC Exchange |
$21.33
|
| Rate for Payer: UHC Medicaid |
$7.20
|
| Rate for Payer: UHCCP DNSP |
$13.76
|
| Rate for Payer: UHCCP Medicaid |
$7.20
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$173.51
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$156.16
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$168.30
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$143.06
|
| Rate for Payer: BCN Commercial |
$143.06
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cofinity Commercial |
$163.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$173.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$156.16
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.48
|
| Rate for Payer: Nomi Health Commercial |
$142.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.13
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.03
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$121.63
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$173.51
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.13 |
| Max. Negotiated Rate |
$173.51 |
| Rate for Payer: Aetna Commercial |
$156.16
|
| Rate for Payer: ASR ASR |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$142.49
|
| Rate for Payer: BCN Commercial |
$142.49
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cofinity Commercial |
$163.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.81
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$173.51
|
| Rate for Payer: Mclaren Commercial |
$156.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.48
|
| Rate for Payer: Nomi Health Commercial |
$142.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.69
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$675.66
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.99 |
| Max. Negotiated Rate |
$675.66 |
| Rate for Payer: Aetna Commercial |
$608.09
|
| Rate for Payer: Aetna Medicare |
$249.99
|
| Rate for Payer: ASR ASR |
$655.39
|
| Rate for Payer: BCBS Complete |
$270.26
|
| Rate for Payer: BCBS Trust/PPO |
$557.08
|
| Rate for Payer: BCN Commercial |
$557.08
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cofinity Commercial |
$635.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.53
|
| Rate for Payer: Healthscope Commercial |
$655.39
|
| Rate for Payer: Healthscope Whirlpool |
$675.66
|
| Rate for Payer: Mclaren Commercial |
$608.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$540.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.31
|
| Rate for Payer: Nomi Health Commercial |
$554.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$592.01
|
| Rate for Payer: Priority Health Narrow Network |
$473.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.58
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$675.66
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.75 |
| Max. Negotiated Rate |
$675.66 |
| Rate for Payer: Aetna Commercial |
$608.09
|
| Rate for Payer: ASR ASR |
$655.39
|
| Rate for Payer: BCBS Trust/PPO |
$554.85
|
| Rate for Payer: BCN Commercial |
$554.85
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cofinity Commercial |
$635.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.53
|
| Rate for Payer: Healthscope Commercial |
$655.39
|
| Rate for Payer: Healthscope Whirlpool |
$675.66
|
| Rate for Payer: Mclaren Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.31
|
| Rate for Payer: Nomi Health Commercial |
$554.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.58
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,736.26
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,802.20 |
| Max. Negotiated Rate |
$3,736.26 |
| Rate for Payer: Aetna Commercial |
$3,362.63
|
| Rate for Payer: ASR ASR |
$3,624.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,068.22
|
| Rate for Payer: BCN Commercial |
$3,068.22
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cofinity Commercial |
$3,512.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,989.01
|
| Rate for Payer: Healthscope Commercial |
$3,624.17
|
| Rate for Payer: Healthscope Whirlpool |
$3,736.26
|
| Rate for Payer: Mclaren Commercial |
$3,362.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,175.82
|
| Rate for Payer: Nomi Health Commercial |
$3,063.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,802.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,287.91
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,736.26
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,619.12 |
| Max. Negotiated Rate |
$16,417.00 |
| Rate for Payer: Aetna Commercial |
$3,362.63
|
| Rate for Payer: Aetna Medicare |
$10,591.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.51
|
| Rate for Payer: ASR ASR |
$3,624.17
|
| Rate for Payer: BCBS Complete |
$5,816.91
|
| Rate for Payer: BCBS MAPPO |
$10,591.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,080.55
|
| Rate for Payer: BCN Commercial |
$3,080.55
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.61
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cofinity Commercial |
$3,512.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,989.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.61
|
| Rate for Payer: Healthscope Commercial |
$3,624.17
|
| Rate for Payer: Healthscope Whirlpool |
$3,736.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,591.61
|
| Rate for Payer: Mclaren Commercial |
$3,362.63
|
| Rate for Payer: Mclaren Medicaid |
$10,591.61
|
| Rate for Payer: Mclaren Medicare |
$10,591.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.19
|
| Rate for Payer: Meridian Medicaid |
$5,816.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,175.82
|
| Rate for Payer: Nomi Health Commercial |
$3,063.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,802.20
|
| Rate for Payer: PACE Medicare |
$10,062.03
|
| Rate for Payer: PACE SWMI |
$10,591.61
|
| Rate for Payer: PHP Commercial |
$11,650.77
|
| Rate for Payer: PHP Medicaid |
$5,677.10
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,273.71
|
| Rate for Payer: Priority Health Medicare |
$10,591.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,619.12
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,287.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.61
|
| Rate for Payer: UHC Exchange |
$16,417.00
|
| Rate for Payer: UHC Medicaid |
$5,539.41
|
| Rate for Payer: UHCCP DNSP |
$10,591.61
|
| Rate for Payer: UHCCP Medicaid |
$5,539.41
|
| Rate for Payer: VA VA |
$10,591.61
|
|
