|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,423.98
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$2,567.99 |
| Max. Negotiated Rate |
$3,423.98 |
| Rate for Payer: Aetna Commercial |
$3,081.58
|
| Rate for Payer: ASR ASR |
$3,321.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,811.77
|
| Rate for Payer: BCN Commercial |
$2,811.77
|
| Rate for Payer: Cash Price |
$2,739.18
|
| Rate for Payer: Cofinity Commercial |
$3,218.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,739.18
|
| Rate for Payer: Healthscope Commercial |
$3,321.26
|
| Rate for Payer: Healthscope Whirlpool |
$3,423.98
|
| Rate for Payer: Mclaren Commercial |
$3,081.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,910.38
|
| Rate for Payer: Nomi Health Commercial |
$2,807.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,567.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,013.10
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.64 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: Aetna Medicare |
$260.64
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: BCBS Trust/PPO |
$580.79
|
| Rate for Payer: BCN Commercial |
$580.79
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$683.29
|
| Rate for Payer: Healthscope Whirlpool |
$704.42
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$617.21
|
| Rate for Payer: Priority Health Narrow Network |
$493.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$528.32 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: BCBS Trust/PPO |
$578.47
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$683.29
|
| Rate for Payer: Healthscope Whirlpool |
$704.42
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.64 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: Aetna Medicare |
$260.64
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: BCBS Trust/PPO |
$580.79
|
| Rate for Payer: BCN Commercial |
$580.79
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$683.29
|
| Rate for Payer: Healthscope Whirlpool |
$704.42
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$617.21
|
| Rate for Payer: Priority Health Narrow Network |
$493.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$528.32 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: BCBS Trust/PPO |
$578.47
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$683.29
|
| Rate for Payer: Healthscope Whirlpool |
$704.42
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$18.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.49
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS MAPPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.79
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$18.79
|
| Rate for Payer: Mclaren Medicare |
$18.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.73
|
| Rate for Payer: Meridian Medicaid |
$10.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$17.85
|
| Rate for Payer: PACE SWMI |
$18.79
|
| Rate for Payer: PHP Commercial |
$20.67
|
| Rate for Payer: PHP Medicaid |
$10.07
|
| Rate for Payer: PHP Medicare Advantage |
$18.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79.89
|
| Rate for Payer: Priority Health Medicare |
$18.79
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: Railroad Medicare Medicare |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.79
|
| Rate for Payer: UHC Exchange |
$29.12
|
| Rate for Payer: UHC Medicaid |
$9.83
|
| Rate for Payer: UHCCP DNSP |
$18.79
|
| Rate for Payer: UHCCP Medicaid |
$9.83
|
| Rate for Payer: VA VA |
$18.79
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,404.77
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$519.76 |
| Max. Negotiated Rate |
$1,404.77 |
| Rate for Payer: Aetna Commercial |
$1,264.29
|
| Rate for Payer: Aetna Medicare |
$519.76
|
| Rate for Payer: ASR ASR |
$1,362.63
|
| Rate for Payer: BCBS Complete |
$561.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.23
|
| Rate for Payer: BCN Commercial |
$1,158.23
|
| Rate for Payer: Cash Price |
$1,123.82
|
| Rate for Payer: Cofinity Commercial |
$1,320.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.82
|
| Rate for Payer: Healthscope Commercial |
$1,362.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.77
|
| Rate for Payer: Mclaren Commercial |
$1,264.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,123.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,194.05
|
| Rate for Payer: Nomi Health Commercial |
$1,151.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,230.86
|
| Rate for Payer: Priority Health Narrow Network |
$984.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,236.20
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,404.77
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,053.58 |
| Max. Negotiated Rate |
$1,404.77 |
| Rate for Payer: Aetna Commercial |
$1,264.29
|
| Rate for Payer: ASR ASR |
$1,362.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.60
|
| Rate for Payer: BCN Commercial |
$1,153.60
|
| Rate for Payer: Cash Price |
$1,123.82
|
| Rate for Payer: Cofinity Commercial |
$1,320.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.82
|
| Rate for Payer: Healthscope Commercial |
$1,362.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.77
|
| Rate for Payer: Mclaren Commercial |
$1,264.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,194.05
|
| Rate for Payer: Nomi Health Commercial |
$1,151.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,236.20
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
OP
|
$2,439.74
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,439.74 |
| Rate for Payer: Aetna Commercial |
$2,195.77
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$2,366.55
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,011.57
|
| Rate for Payer: BCN Commercial |
$2,011.57
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,951.79
|
| Rate for Payer: Cash Price |
$1,951.79
|
| Rate for Payer: Cofinity Commercial |
$2,293.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,366.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,439.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$2,195.77
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.78
|
| Rate for Payer: Nomi Health Commercial |
$2,000.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,829.81
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,137.70
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,710.26
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,146.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
IP
|
$2,439.74
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,829.81 |
| Max. Negotiated Rate |
$2,439.74 |
| Rate for Payer: Aetna Commercial |
$2,195.77
|
| Rate for Payer: ASR ASR |
$2,366.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,003.51
|
| Rate for Payer: BCN Commercial |
$2,003.51
|
| Rate for Payer: Cash Price |
$1,951.79
|
| Rate for Payer: Cofinity Commercial |
$2,293.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.79
|
| Rate for Payer: Healthscope Commercial |
$2,366.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,439.74
|
| Rate for Payer: Mclaren Commercial |
$2,195.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.78
|
| Rate for Payer: Nomi Health Commercial |
$2,000.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,829.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,146.97
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
IP
|
$1,480.45
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,110.34 |
| Max. Negotiated Rate |
$1,480.45 |
| Rate for Payer: Aetna Commercial |
$1,332.40
|
| Rate for Payer: ASR ASR |
$1,436.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,215.75
|
| Rate for Payer: BCN Commercial |
$1,215.75
|
| Rate for Payer: Cash Price |
$1,184.36
|
| Rate for Payer: Cofinity Commercial |
$1,391.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,184.36
|
| Rate for Payer: Healthscope Commercial |
$1,436.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,480.45
|
| Rate for Payer: Mclaren Commercial |
$1,332.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,258.38
|
| Rate for Payer: Nomi Health Commercial |
$1,213.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,110.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,302.80
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
OP
|
$1,480.45
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$547.77 |
| Max. Negotiated Rate |
$1,480.45 |
| Rate for Payer: Aetna Commercial |
$1,332.40
|
| Rate for Payer: Aetna Medicare |
$547.77
|
| Rate for Payer: ASR ASR |
$1,436.04
|
| Rate for Payer: BCBS Complete |
$592.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.63
|
| Rate for Payer: BCN Commercial |
$1,220.63
|
| Rate for Payer: Cash Price |
$1,184.36
|
| Rate for Payer: Cofinity Commercial |
$1,391.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,184.36
|
| Rate for Payer: Healthscope Commercial |
$1,436.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,480.45
|
| Rate for Payer: Mclaren Commercial |
$1,332.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,184.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,258.38
|
| Rate for Payer: Nomi Health Commercial |
$1,213.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,110.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,297.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,037.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,302.80
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,257.53
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$943.15 |
| Max. Negotiated Rate |
$1,257.53 |
| Rate for Payer: Aetna Commercial |
$1,131.78
|
| Rate for Payer: ASR ASR |
$1,219.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,032.68
|
| Rate for Payer: BCN Commercial |
$1,032.68
|
| Rate for Payer: Cash Price |
$1,006.02
|
| Rate for Payer: Cofinity Commercial |
$1,182.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,006.02
|
| Rate for Payer: Healthscope Commercial |
$1,219.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.53
|
| Rate for Payer: Mclaren Commercial |
$1,131.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.90
|
| Rate for Payer: Nomi Health Commercial |
$1,031.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$943.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.63
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,257.53
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$465.29 |
| Max. Negotiated Rate |
$1,257.53 |
| Rate for Payer: Aetna Commercial |
$1,131.78
|
| Rate for Payer: Aetna Medicare |
$465.29
|
| Rate for Payer: ASR ASR |
$1,219.80
|
| Rate for Payer: BCBS Complete |
$503.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,036.83
|
| Rate for Payer: BCN Commercial |
$1,036.83
|
| Rate for Payer: Cash Price |
$1,006.02
|
| Rate for Payer: Cofinity Commercial |
$1,182.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,006.02
|
| Rate for Payer: Healthscope Commercial |
$1,219.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.53
|
| Rate for Payer: Mclaren Commercial |
$1,131.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,006.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.90
|
| Rate for Payer: Nomi Health Commercial |
$1,031.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$943.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,101.85
|
| Rate for Payer: Priority Health Narrow Network |
$881.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.63
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$97.42
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: ASR ASR |
$104.99
|
| Rate for Payer: BCBS Complete |
$43.30
|
| Rate for Payer: BCBS Trust/PPO |
$89.24
|
| Rate for Payer: BCN Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$101.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$104.99
|
| Rate for Payer: Healthscope Whirlpool |
$108.24
|
| Rate for Payer: Mclaren Commercial |
$97.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$88.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.43
|
| Rate for Payer: Priority Health Narrow Network |
$38.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.25
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$97.42
|
| Rate for Payer: ASR ASR |
$104.99
|
| Rate for Payer: BCBS Trust/PPO |
$88.89
|
| Rate for Payer: BCN Commercial |
$88.89
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$101.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$104.99
|
| Rate for Payer: Healthscope Whirlpool |
$108.24
|
| Rate for Payer: Mclaren Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$88.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.25
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: Aetna Medicare |
$27.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: BCBS Complete |
$15.34
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$46.32
|
| Rate for Payer: BCN Commercial |
$46.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$54.49
|
| Rate for Payer: Healthscope Whirlpool |
$56.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Mclaren Medicaid |
$27.94
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$15.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicaid |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.94
|
| Rate for Payer: UHC Exchange |
$43.31
|
| Rate for Payer: UHC Medicaid |
$14.61
|
| Rate for Payer: UHCCP DNSP |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$14.61
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: BCBS Trust/PPO |
$46.14
|
| Rate for Payer: BCN Commercial |
$46.14
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$54.49
|
| Rate for Payer: Healthscope Whirlpool |
$56.18
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$27.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$15.34
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.94
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$27.94
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$15.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicaid |
$14.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.94
|
| Rate for Payer: UHC Exchange |
$43.31
|
| Rate for Payer: UHC Medicaid |
$14.61
|
| Rate for Payer: UHCCP DNSP |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$14.61
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.36
|
| Rate for Payer: BCN Commercial |
$65.36
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$237.27 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: ASR ASR |
$50.44
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$42.87
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$48.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$52.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.18
|
| Rate for Payer: Mclaren Commercial |
$46.80
|
| Rate for Payer: Mclaren Medicaid |
$24.18
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicaid |
$12.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$237.27
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow Network |
$189.81
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.18
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicaid |
$12.65
|
| Rate for Payer: UHCCP DNSP |
$24.18
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: VA VA |
$24.18
|
|
