|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,487.25 |
| Max. Negotiated Rate |
$1,983.00 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: ASR ASR |
$1,923.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.44
|
| Rate for Payer: BCN Commercial |
$1,628.44
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$1,864.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.40
|
| Rate for Payer: Healthscope Commercial |
$1,923.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,983.00
|
| Rate for Payer: Mclaren Commercial |
$1,784.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,685.55
|
| Rate for Payer: Nomi Health Commercial |
$1,626.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,745.04
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,390.08 |
| Max. Negotiated Rate |
$9,998.34 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Aetna Medicare |
$6,450.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: ASR ASR |
$1,923.51
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,634.98
|
| Rate for Payer: BCN Commercial |
$1,634.98
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$1,864.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Healthscope Commercial |
$1,923.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,983.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,450.54
|
| Rate for Payer: Mclaren Commercial |
$1,784.70
|
| Rate for Payer: Mclaren Medicaid |
$6,450.54
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$3,542.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,685.55
|
| Rate for Payer: Nomi Health Commercial |
$1,626.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Commercial |
$7,095.59
|
| Rate for Payer: PHP Medicaid |
$3,457.49
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,737.50
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,390.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,745.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Exchange |
$9,998.34
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP DNSP |
$6,450.54
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: VA VA |
$6,450.54
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$8,102.32 |
| Rate for Payer: Aetna Commercial |
$7,292.09
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$7,859.25
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,680.36
|
| Rate for Payer: BCN Commercial |
$6,680.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Commercial |
$7,616.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,859.25
|
| Rate for Payer: Healthscope Whirlpool |
$8,102.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$7,292.09
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Nomi Health Commercial |
$6,643.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,099.25
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$5,679.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,130.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,076.74 |
| Max. Negotiated Rate |
$8,102.32 |
| Rate for Payer: Aetna Commercial |
$7,292.09
|
| Rate for Payer: ASR ASR |
$7,859.25
|
| Rate for Payer: BCBS Trust/PPO |
$6,653.63
|
| Rate for Payer: BCN Commercial |
$6,653.63
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Commercial |
$7,616.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Healthscope Commercial |
$7,859.25
|
| Rate for Payer: Healthscope Whirlpool |
$8,102.32
|
| Rate for Payer: Mclaren Commercial |
$7,292.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Nomi Health Commercial |
$6,643.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,130.04
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
IP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,493.18 |
| Max. Negotiated Rate |
$9,990.90 |
| Rate for Payer: Aetna Commercial |
$8,991.81
|
| Rate for Payer: ASR ASR |
$9,691.17
|
| Rate for Payer: BCBS Trust/PPO |
$8,204.53
|
| Rate for Payer: BCN Commercial |
$8,204.53
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Commercial |
$9,391.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Healthscope Commercial |
$9,691.17
|
| Rate for Payer: Healthscope Whirlpool |
$9,990.90
|
| Rate for Payer: Mclaren Commercial |
$8,991.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Nomi Health Commercial |
$8,192.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,791.99
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
OP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$9,990.90 |
| Rate for Payer: Aetna Commercial |
$8,991.81
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$9,691.17
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$8,237.50
|
| Rate for Payer: BCN Commercial |
$8,237.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Commercial |
$9,391.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$9,691.17
|
| Rate for Payer: Healthscope Whirlpool |
$9,990.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$8,991.81
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Nomi Health Commercial |
$8,192.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,754.03
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$7,003.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,791.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.17 |
| Max. Negotiated Rate |
$220.23 |
| Rate for Payer: Aetna Commercial |
$198.21
|
| Rate for Payer: ASR ASR |
$213.62
|
| Rate for Payer: BCBS Trust/PPO |
$180.85
|
| Rate for Payer: BCN Commercial |
$180.85
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$207.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Healthscope Commercial |
$213.62
|
| Rate for Payer: Healthscope Whirlpool |
$220.23
|
| Rate for Payer: Mclaren Commercial |
$198.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Nomi Health Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.80
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$220.23 |
| Rate for Payer: Aetna Commercial |
$198.21
|
| Rate for Payer: Aetna Medicare |
$128.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: ASR ASR |
$213.62
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$181.58
|
| Rate for Payer: BCN Commercial |
$181.58
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$207.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$213.62
|
| Rate for Payer: Healthscope Whirlpool |
$220.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$198.21
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$70.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Nomi Health Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$141.03
|
| Rate for Payer: PHP Medicaid |
$68.72
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$192.97
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$154.38
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$198.73
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP DNSP |
$128.21
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: Aetna Commercial |
$336.53
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$362.70
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$308.30
|
| Rate for Payer: BCN Commercial |
$308.30
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Commercial |
$351.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$362.70
|
| Rate for Payer: Healthscope Whirlpool |
$373.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$336.53
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$306.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$327.63
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$262.12
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.44 |
| Max. Negotiated Rate |
$373.92 |
| Rate for Payer: Aetna Commercial |
$336.53
|
| Rate for Payer: ASR ASR |
$362.70
|
| Rate for Payer: BCBS Trust/PPO |
$307.06
|
| Rate for Payer: BCN Commercial |
$307.06
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Commercial |
$351.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$362.70
|
| Rate for Payer: Healthscope Whirlpool |
$373.92
|
| Rate for Payer: Mclaren Commercial |
$336.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$306.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.05
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Aetna Commercial |
$31.73
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: ASR ASR |
$34.20
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.07
|
| Rate for Payer: BCN Commercial |
$29.07
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Commercial |
$33.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.26
|
| Rate for Payer: Mclaren Commercial |
$31.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Nomi Health Commercial |
$28.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.89
|
| Rate for Payer: Priority Health Narrow Network |
$24.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.03
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Aetna Commercial |
$31.73
|
| Rate for Payer: ASR ASR |
$34.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.96
|
| Rate for Payer: BCN Commercial |
$28.96
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Commercial |
$33.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Healthscope Whirlpool |
$35.26
|
| Rate for Payer: Mclaren Commercial |
$31.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Nomi Health Commercial |
$28.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.03
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: ASR ASR |
$25.04
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$25.04
|
| Rate for Payer: Healthscope Whirlpool |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.61
|
| Rate for Payer: Priority Health Narrow Network |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.71
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: ASR ASR |
$25.04
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$25.04
|
| Rate for Payer: Healthscope Whirlpool |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$23.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.71
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: ASR ASR |
$25.04
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$25.04
|
| Rate for Payer: Healthscope Whirlpool |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.61
|
| Rate for Payer: Priority Health Narrow Network |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.71
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: ASR ASR |
$25.04
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$25.04
|
| Rate for Payer: Healthscope Whirlpool |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$23.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.71
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$5,444.08 |
| Rate for Payer: Aetna Commercial |
$4,192.84
|
| Rate for Payer: Aetna Medicare |
$3,512.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: ASR ASR |
$4,518.95
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,841.11
|
| Rate for Payer: BCN Commercial |
$3,841.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Commercial |
$4,379.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Healthscope Commercial |
$4,518.95
|
| Rate for Payer: Healthscope Whirlpool |
$4,658.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,512.31
|
| Rate for Payer: Mclaren Commercial |
$4,192.84
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$1,928.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Nomi Health Commercial |
$3,820.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Commercial |
$3,863.54
|
| Rate for Payer: PHP Medicaid |
$1,882.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,694.44
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,955.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,099.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Exchange |
$5,444.08
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP DNSP |
$3,512.31
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,494.03 |
| Max. Negotiated Rate |
$4,658.71 |
| Rate for Payer: Aetna Commercial |
$4,192.84
|
| Rate for Payer: ASR ASR |
$4,518.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,825.73
|
| Rate for Payer: BCN Commercial |
$3,825.73
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Commercial |
$4,379.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Healthscope Commercial |
$4,518.95
|
| Rate for Payer: Healthscope Whirlpool |
$4,658.71
|
| Rate for Payer: Mclaren Commercial |
$4,192.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Nomi Health Commercial |
$3,820.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,099.66
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$46.30 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: ASR ASR |
$44.91
|
| Rate for Payer: BCBS Trust/PPO |
$38.02
|
| Rate for Payer: BCN Commercial |
$38.02
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Commercial |
$43.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Healthscope Commercial |
$44.91
|
| Rate for Payer: Healthscope Whirlpool |
$46.30
|
| Rate for Payer: Mclaren Commercial |
$41.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.74
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$46.30 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$44.91
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$38.17
|
| Rate for Payer: BCN Commercial |
$38.17
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Commercial |
$43.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$44.91
|
| Rate for Payer: Healthscope Whirlpool |
$46.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$41.67
|
| Rate for Payer: Mclaren Medicaid |
$14.99
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$32.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.23
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP DNSP |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$148.10 |
| Rate for Payer: Aetna Commercial |
$113.46
|
| Rate for Payer: Aetna Medicare |
$46.65
|
| Rate for Payer: ASR ASR |
$122.29
|
| Rate for Payer: BCBS Complete |
$50.43
|
| Rate for Payer: BCBS Trust/PPO |
$103.94
|
| Rate for Payer: BCN Commercial |
$103.94
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Commercial |
$118.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$122.29
|
| Rate for Payer: Healthscope Whirlpool |
$126.07
|
| Rate for Payer: Mclaren Commercial |
$113.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Nomi Health Commercial |
$103.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$148.10
|
| Rate for Payer: Priority Health Narrow Network |
$118.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.94
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.55 |
| Max. Negotiated Rate |
$126.07 |
| Rate for Payer: Aetna Commercial |
$113.46
|
| Rate for Payer: ASR ASR |
$122.29
|
| Rate for Payer: BCBS Trust/PPO |
$103.53
|
| Rate for Payer: BCN Commercial |
$103.53
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Commercial |
$118.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$122.29
|
| Rate for Payer: Healthscope Whirlpool |
$126.07
|
| Rate for Payer: Mclaren Commercial |
$113.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Nomi Health Commercial |
$103.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.94
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$54.86 |
| Rate for Payer: Aetna Commercial |
$49.37
|
| Rate for Payer: ASR ASR |
$53.21
|
| Rate for Payer: BCBS Trust/PPO |
$45.05
|
| Rate for Payer: BCN Commercial |
$45.05
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$53.21
|
| Rate for Payer: Healthscope Whirlpool |
$54.86
|
| Rate for Payer: Mclaren Commercial |
$49.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Nomi Health Commercial |
$44.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.28
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$54.86 |
| Rate for Payer: Aetna Commercial |
$49.37
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: ASR ASR |
$53.21
|
| Rate for Payer: BCBS Complete |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$45.23
|
| Rate for Payer: BCN Commercial |
$45.23
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$53.21
|
| Rate for Payer: Healthscope Whirlpool |
$54.86
|
| Rate for Payer: Mclaren Commercial |
$49.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Nomi Health Commercial |
$44.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.31
|
| Rate for Payer: Priority Health Narrow Network |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.28
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$118.45 |
| Max. Negotiated Rate |
$157.93 |
| Rate for Payer: Aetna Commercial |
$142.14
|
| Rate for Payer: ASR ASR |
$153.19
|
| Rate for Payer: BCBS Trust/PPO |
$129.69
|
| Rate for Payer: BCN Commercial |
$129.69
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$148.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$153.19
|
| Rate for Payer: Healthscope Whirlpool |
$157.93
|
| Rate for Payer: Mclaren Commercial |
$142.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.98
|
|
