|
HC INCISION EXT THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$292.09
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$323.86 |
| Rate for Payer: Aetna Commercial |
$262.88
|
| Rate for Payer: Aetna Medicare |
$219.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: ASR ASR |
$283.33
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.46
|
| Rate for Payer: BCN Commercial |
$226.46
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Cofinity Commercial |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$292.09
|
| Rate for Payer: Healthscope Whirlpool |
$283.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$262.88
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.28
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$241.65
|
| Rate for Payer: PHP Medicaid |
$120.16
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.86
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$259.09
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.04
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC INCISION OF LABIAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.52 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: ASR ASR |
$1,309.50
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.66
|
| Rate for Payer: BCN Commercial |
$1,046.66
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,269.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,309.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$489.06
|
| Rate for Payer: Mclaren Commercial |
$1,215.00
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Commercial |
$537.97
|
| Rate for Payer: PHP Medicaid |
$267.52
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.50
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$958.50
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.00
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: VA VA |
$489.06
|
|
|
HC INCISION OF LABIAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: ASR ASR |
$1,309.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.66
|
| Rate for Payer: BCN Commercial |
$1,046.66
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,269.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,309.50
|
| Rate for Payer: Mclaren Commercial |
$1,215.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.00
|
|
|
HC INCISION OF URETHRA
|
Facility
|
IP
|
$2,742.78
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,919.95 |
| Max. Negotiated Rate |
$2,742.78 |
| Rate for Payer: Aetna Commercial |
$2,468.50
|
| Rate for Payer: ASR ASR |
$2,660.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.48
|
| Rate for Payer: BCN Commercial |
$2,126.48
|
| Rate for Payer: Cash Price |
$2,194.22
|
| Rate for Payer: Cofinity Commercial |
$2,578.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,194.22
|
| Rate for Payer: Healthscope Commercial |
$2,742.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,660.50
|
| Rate for Payer: Mclaren Commercial |
$2,468.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,331.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,413.65
|
|
|
HC INCISION OF URETHRA
|
Facility
|
OP
|
$2,742.78
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.33 |
| Max. Negotiated Rate |
$2,742.78 |
| Rate for Payer: Aetna Commercial |
$2,468.50
|
| Rate for Payer: Aetna Medicare |
$1,810.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: ASR ASR |
$2,660.50
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.48
|
| Rate for Payer: BCN Commercial |
$2,126.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$2,194.22
|
| Rate for Payer: Cash Price |
$2,194.22
|
| Rate for Payer: Cofinity Commercial |
$2,578.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,194.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$2,742.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,660.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,810.48
|
| Rate for Payer: Mclaren Commercial |
$2,468.50
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,331.36
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$1,991.53
|
| Rate for Payer: PHP Medicaid |
$990.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,495.93
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,947.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,413.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
OP
|
$1,143.42
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$1,143.42 |
| Rate for Payer: Aetna Commercial |
$1,029.08
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$1,109.12
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$886.49
|
| Rate for Payer: BCN Commercial |
$886.49
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$914.74
|
| Rate for Payer: Cash Price |
$914.74
|
| Rate for Payer: Cofinity Commercial |
$1,074.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$1,143.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,109.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$1,029.08
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$971.91
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,040.51
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$811.83
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.21
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
IP
|
$1,143.42
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$800.39 |
| Max. Negotiated Rate |
$1,143.42 |
| Rate for Payer: Aetna Commercial |
$1,029.08
|
| Rate for Payer: ASR ASR |
$1,109.12
|
| Rate for Payer: BCBS Trust/PPO |
$886.49
|
| Rate for Payer: BCN Commercial |
$886.49
|
| Rate for Payer: Cash Price |
$914.74
|
| Rate for Payer: Cofinity Commercial |
$1,074.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.74
|
| Rate for Payer: Healthscope Commercial |
$1,143.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,109.12
|
| Rate for Payer: Mclaren Commercial |
$1,029.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$971.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.21
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
OP
|
$571.84
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$228.74 |
| Max. Negotiated Rate |
$571.84 |
| Rate for Payer: Aetna Commercial |
$514.66
|
| Rate for Payer: ASR ASR |
$554.68
|
| Rate for Payer: BCBS Complete |
$228.74
|
| Rate for Payer: BCBS Trust/PPO |
$443.35
|
| Rate for Payer: BCN Commercial |
$443.35
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$537.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Healthscope Commercial |
$571.84
|
| Rate for Payer: Healthscope Whirlpool |
$554.68
|
| Rate for Payer: Mclaren Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.37
|
| Rate for Payer: Priority Health Narrow Network |
$406.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.22
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$400.29 |
| Max. Negotiated Rate |
$571.84 |
| Rate for Payer: Aetna Commercial |
$514.66
|
| Rate for Payer: ASR ASR |
$554.68
|
| Rate for Payer: BCBS Trust/PPO |
$443.35
|
| Rate for Payer: BCN Commercial |
$443.35
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$537.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Healthscope Commercial |
$571.84
|
| Rate for Payer: Healthscope Whirlpool |
$554.68
|
| Rate for Payer: Mclaren Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.22
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
OP
|
$2,608.96
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,043.58 |
| Max. Negotiated Rate |
$2,608.96 |
| Rate for Payer: Aetna Commercial |
$2,348.06
|
| Rate for Payer: ASR ASR |
$2,530.69
|
| Rate for Payer: BCBS Complete |
$1,043.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,022.73
|
| Rate for Payer: BCN Commercial |
$2,022.73
|
| Rate for Payer: Cash Price |
$2,087.17
|
| Rate for Payer: Cash Price |
$2,087.17
|
| Rate for Payer: Cofinity Commercial |
$2,452.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,087.17
|
| Rate for Payer: Healthscope Commercial |
$2,608.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,530.69
|
| Rate for Payer: Mclaren Commercial |
$2,348.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,217.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,052.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,641.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,295.88
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
IP
|
$2,608.96
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,826.27 |
| Max. Negotiated Rate |
$2,608.96 |
| Rate for Payer: Aetna Commercial |
$2,348.06
|
| Rate for Payer: ASR ASR |
$2,530.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,022.73
|
| Rate for Payer: BCN Commercial |
$2,022.73
|
| Rate for Payer: Cash Price |
$2,087.17
|
| Rate for Payer: Cofinity Commercial |
$2,452.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,087.17
|
| Rate for Payer: Healthscope Commercial |
$2,608.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,530.69
|
| Rate for Payer: Mclaren Commercial |
$2,348.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,217.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,295.88
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
OP
|
$161.52
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$161.52 |
| Rate for Payer: Aetna Commercial |
$145.37
|
| Rate for Payer: ASR ASR |
$156.67
|
| Rate for Payer: BCBS Complete |
$64.61
|
| Rate for Payer: BCBS Trust/PPO |
$125.23
|
| Rate for Payer: BCN Commercial |
$125.23
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$151.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Healthscope Commercial |
$161.52
|
| Rate for Payer: Healthscope Whirlpool |
$156.67
|
| Rate for Payer: Mclaren Commercial |
$145.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.83
|
| Rate for Payer: Priority Health Narrow Network |
$88.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.14
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
IP
|
$161.52
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$113.06 |
| Max. Negotiated Rate |
$161.52 |
| Rate for Payer: Aetna Commercial |
$145.37
|
| Rate for Payer: ASR ASR |
$156.67
|
| Rate for Payer: BCBS Trust/PPO |
$125.23
|
| Rate for Payer: BCN Commercial |
$125.23
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$151.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Healthscope Commercial |
$161.52
|
| Rate for Payer: Healthscope Whirlpool |
$156.67
|
| Rate for Payer: Mclaren Commercial |
$145.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.14
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
OP
|
$3,679.65
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$578.66 |
| Max. Negotiated Rate |
$3,679.65 |
| Rate for Payer: Aetna Commercial |
$3,311.68
|
| Rate for Payer: Aetna Medicare |
$1,057.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,322.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,322.35
|
| Rate for Payer: ASR ASR |
$3,569.26
|
| Rate for Payer: BCBS Complete |
$607.65
|
| Rate for Payer: BCBS MAPPO |
$1,057.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.83
|
| Rate for Payer: BCN Commercial |
$2,852.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.88
|
| Rate for Payer: Cash Price |
$2,943.72
|
| Rate for Payer: Cash Price |
$2,943.72
|
| Rate for Payer: Cofinity Commercial |
$3,458.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.88
|
| Rate for Payer: Healthscope Commercial |
$3,679.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,569.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,057.88
|
| Rate for Payer: Mclaren Commercial |
$3,311.68
|
| Rate for Payer: Mclaren Medicaid |
$578.66
|
| Rate for Payer: Mclaren Medicare |
$1,057.88
|
| Rate for Payer: Meridian Medicaid |
$607.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,110.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,216.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,127.70
|
| Rate for Payer: PACE Medicare |
$1,004.99
|
| Rate for Payer: PACE SWMI |
$1,057.88
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: PHP Medicaid |
$578.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,348.48
|
| Rate for Payer: Priority Health Medicare |
$1,057.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,612.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,238.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,089.62
|
| Rate for Payer: VA VA |
$1,057.88
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
IP
|
$3,679.65
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,575.76 |
| Max. Negotiated Rate |
$3,679.65 |
| Rate for Payer: Aetna Commercial |
$3,311.68
|
| Rate for Payer: ASR ASR |
$3,569.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.83
|
| Rate for Payer: BCN Commercial |
$2,852.83
|
| Rate for Payer: Cash Price |
$2,943.72
|
| Rate for Payer: Cofinity Commercial |
$3,458.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.72
|
| Rate for Payer: Healthscope Commercial |
$3,679.65
|
| Rate for Payer: Healthscope Whirlpool |
$3,569.26
|
| Rate for Payer: Mclaren Commercial |
$3,311.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,127.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,238.09
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,334.80
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.92 |
| Max. Negotiated Rate |
$1,334.80 |
| Rate for Payer: Aetna Commercial |
$1,201.32
|
| Rate for Payer: ASR ASR |
$1,294.76
|
| Rate for Payer: BCBS Complete |
$533.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.87
|
| Rate for Payer: BCN Commercial |
$1,034.87
|
| Rate for Payer: Cash Price |
$1,067.84
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.84
|
| Rate for Payer: Healthscope Commercial |
$1,334.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,294.76
|
| Rate for Payer: Mclaren Commercial |
$1,201.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,214.67
|
| Rate for Payer: Priority Health Narrow Network |
$947.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,174.62
|
|
|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,334.80
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.36 |
| Max. Negotiated Rate |
$1,334.80 |
| Rate for Payer: Aetna Commercial |
$1,201.32
|
| Rate for Payer: ASR ASR |
$1,294.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.87
|
| Rate for Payer: BCN Commercial |
$1,034.87
|
| Rate for Payer: Cash Price |
$1,067.84
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.84
|
| Rate for Payer: Healthscope Commercial |
$1,334.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,294.76
|
| Rate for Payer: Mclaren Commercial |
$1,201.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,174.62
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$657.75
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$657.75 |
| Rate for Payer: Aetna Commercial |
$591.98
|
| Rate for Payer: ASR ASR |
$638.02
|
| Rate for Payer: BCBS Trust/PPO |
$509.95
|
| Rate for Payer: BCN Commercial |
$509.95
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$618.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.20
|
| Rate for Payer: Healthscope Commercial |
$657.75
|
| Rate for Payer: Healthscope Whirlpool |
$638.02
|
| Rate for Payer: Mclaren Commercial |
$591.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.82
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$657.75
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.10 |
| Max. Negotiated Rate |
$657.75 |
| Rate for Payer: Aetna Commercial |
$591.98
|
| Rate for Payer: ASR ASR |
$638.02
|
| Rate for Payer: BCBS Complete |
$263.10
|
| Rate for Payer: BCBS Trust/PPO |
$509.95
|
| Rate for Payer: BCN Commercial |
$509.95
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$618.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.20
|
| Rate for Payer: Healthscope Commercial |
$657.75
|
| Rate for Payer: Healthscope Whirlpool |
$638.02
|
| Rate for Payer: Mclaren Commercial |
$591.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.55
|
| Rate for Payer: Priority Health Narrow Network |
$467.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.82
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$118.62
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: BCBS Complete |
$55.03
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$118.62
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Mclaren Medicaid |
$52.40
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Medicaid |
$55.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$52.40
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.23
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$108.63
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
| Rate for Payer: UHC Medicare Advantage |
$98.67
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: ASR ASR |
$179.45
|
| Rate for Payer: BCBS Trust/PPO |
$143.43
|
| Rate for Payer: BCN Commercial |
$143.43
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$173.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.00
|
| Rate for Payer: Healthscope Commercial |
$185.00
|
| Rate for Payer: Healthscope Whirlpool |
$179.45
|
| Rate for Payer: Mclaren Commercial |
$166.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.80
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: ASR ASR |
$179.45
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.43
|
| Rate for Payer: BCN Commercial |
$143.43
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$173.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$185.00
|
| Rate for Payer: Healthscope Whirlpool |
$179.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.12
|
| Rate for Payer: Mclaren Commercial |
$166.50
|
| Rate for Payer: Mclaren Medicaid |
$7.72
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Medicaid |
$8.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.25
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicaid |
$7.72
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$131.35
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.80
|
| Rate for Payer: UHC Medicare Advantage |
$14.54
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Complete |
$22.15
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$21.10
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Medicaid |
$22.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$21.10
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.27
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$33.02
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
| Rate for Payer: UHC Medicare Advantage |
$39.73
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
|
