|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
OP
|
$642.60
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$578.34
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$623.32
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$498.21
|
| Rate for Payer: BCCCP Commercial |
$398.07
|
| Rate for Payer: BCN Commercial |
$498.21
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$604.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Healthscope Whirlpool |
$623.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$578.34
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.21
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$584.77
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$456.25
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.49
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
IP
|
$642.60
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$578.34
|
| Rate for Payer: ASR ASR |
$623.32
|
| Rate for Payer: BCBS Trust/PPO |
$498.21
|
| Rate for Payer: BCN Commercial |
$498.21
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$604.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.08
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Healthscope Whirlpool |
$623.32
|
| Rate for Payer: Mclaren Commercial |
$578.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.49
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
OP
|
$731.89
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.14 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna Commercial |
$658.70
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: ASR ASR |
$709.93
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$567.43
|
| Rate for Payer: BCN Commercial |
$567.43
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cofinity Commercial |
$687.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Healthscope Commercial |
$731.89
|
| Rate for Payer: Healthscope Whirlpool |
$709.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$607.20
|
| Rate for Payer: Mclaren Commercial |
$658.70
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.11
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Commercial |
$667.92
|
| Rate for Payer: PHP Medicaid |
$332.14
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.57
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$362.86
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.06
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
IP
|
$731.89
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.32 |
| Max. Negotiated Rate |
$731.89 |
| Rate for Payer: Aetna Commercial |
$658.70
|
| Rate for Payer: ASR ASR |
$709.93
|
| Rate for Payer: BCBS Trust/PPO |
$567.43
|
| Rate for Payer: BCN Commercial |
$567.43
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cofinity Commercial |
$687.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.51
|
| Rate for Payer: Healthscope Commercial |
$731.89
|
| Rate for Payer: Healthscope Whirlpool |
$709.93
|
| Rate for Payer: Mclaren Commercial |
$658.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.06
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
IP
|
$653.82
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.67 |
| Max. Negotiated Rate |
$653.82 |
| Rate for Payer: Aetna Commercial |
$588.44
|
| Rate for Payer: ASR ASR |
$634.21
|
| Rate for Payer: BCBS Trust/PPO |
$506.91
|
| Rate for Payer: BCN Commercial |
$506.91
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$614.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.06
|
| Rate for Payer: Healthscope Commercial |
$653.82
|
| Rate for Payer: Healthscope Whirlpool |
$634.21
|
| Rate for Payer: Mclaren Commercial |
$588.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$575.36
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
OP
|
$653.82
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$653.82 |
| Rate for Payer: Aetna Commercial |
$588.44
|
| 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 |
$634.21
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$506.91
|
| Rate for Payer: BCN Commercial |
$506.91
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$614.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$653.82
|
| Rate for Payer: Healthscope Whirlpool |
$634.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$588.44
|
| 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 |
$555.75
|
| 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 |
$457.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$594.98
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$464.21
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$575.36
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC INSULIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.29
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.43
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$6.25
|
| Rate for Payer: Mclaren Medicare |
$11.43
|
| Rate for Payer: Meridian Medicaid |
$6.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$12.57
|
| Rate for Payer: PHP Medicaid |
$6.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.05
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health Narrow Network |
$32.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
| Rate for Payer: UHC Medicare Advantage |
$11.77
|
| Rate for Payer: VA VA |
$11.43
|
|
|
HC INSULIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$218.58 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.41
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$11.71
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Medicaid |
$11.71
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.58
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$174.86
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.46
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$186.06 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: ASR ASR |
$180.48
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$186.06
|
| Rate for Payer: Healthscope Whirlpool |
$180.48
|
| Rate for Payer: Mclaren Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.73
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$186.06 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: ASR ASR |
$180.48
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$186.06
|
| Rate for Payer: Healthscope Whirlpool |
$180.48
|
| Rate for Payer: Mclaren Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.31
|
| Rate for Payer: Priority Health Narrow Network |
$132.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.73
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,162.39
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$813.67 |
| Max. Negotiated Rate |
$1,162.39 |
| Rate for Payer: Aetna Commercial |
$1,046.15
|
| Rate for Payer: ASR ASR |
$1,127.52
|
| Rate for Payer: BCBS Trust/PPO |
$901.20
|
| Rate for Payer: BCN Commercial |
$901.20
|
| Rate for Payer: Cash Price |
$929.91
|
| Rate for Payer: Cofinity Commercial |
$1,092.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.91
|
| Rate for Payer: Healthscope Commercial |
$1,162.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.52
|
| Rate for Payer: Mclaren Commercial |
$1,046.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.90
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,162.39
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.96 |
| Max. Negotiated Rate |
$1,162.39 |
| Rate for Payer: Aetna Commercial |
$1,046.15
|
| Rate for Payer: ASR ASR |
$1,127.52
|
| Rate for Payer: BCBS Complete |
$464.96
|
| Rate for Payer: BCBS Trust/PPO |
$901.20
|
| Rate for Payer: BCN Commercial |
$901.20
|
| Rate for Payer: Cash Price |
$929.91
|
| Rate for Payer: Cofinity Commercial |
$1,092.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.91
|
| Rate for Payer: Healthscope Commercial |
$1,162.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.52
|
| Rate for Payer: Mclaren Commercial |
$1,046.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.77
|
| Rate for Payer: Priority Health Narrow Network |
$825.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.90
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$292.46 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$125.13
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$100.01
|
| Rate for Payer: BCN Commercial |
$100.01
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$129.00
|
| Rate for Payer: Healthscope Whirlpool |
$125.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$116.10
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.46
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.52
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: ASR ASR |
$125.13
|
| Rate for Payer: BCBS Trust/PPO |
$100.01
|
| Rate for Payer: BCN Commercial |
$100.01
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$129.00
|
| Rate for Payer: Healthscope Whirlpool |
$125.13
|
| Rate for Payer: Mclaren Commercial |
$116.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.52
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,800.09
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,360.06 |
| Max. Negotiated Rate |
$4,800.09 |
| Rate for Payer: Aetna Commercial |
$4,320.08
|
| Rate for Payer: ASR ASR |
$4,656.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,721.51
|
| Rate for Payer: BCN Commercial |
$3,721.51
|
| Rate for Payer: Cash Price |
$3,840.07
|
| Rate for Payer: Cofinity Commercial |
$4,512.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.07
|
| Rate for Payer: Healthscope Commercial |
$4,800.09
|
| Rate for Payer: Healthscope Whirlpool |
$4,656.09
|
| Rate for Payer: Mclaren Commercial |
$4,320.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,224.08
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$2,824.42
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,977.09 |
| Max. Negotiated Rate |
$2,824.42 |
| Rate for Payer: Aetna Commercial |
$2,541.98
|
| Rate for Payer: ASR ASR |
$2,739.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.77
|
| Rate for Payer: BCN Commercial |
$2,189.77
|
| Rate for Payer: Cash Price |
$2,259.54
|
| Rate for Payer: Cofinity Commercial |
$2,654.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,259.54
|
| Rate for Payer: Healthscope Commercial |
$2,824.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,739.69
|
| Rate for Payer: Mclaren Commercial |
$2,541.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,400.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,977.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,485.49
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$526.32
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.42 |
| Max. Negotiated Rate |
$526.32 |
| Rate for Payer: Aetna Commercial |
$473.69
|
| Rate for Payer: ASR ASR |
$510.53
|
| Rate for Payer: BCBS Trust/PPO |
$408.06
|
| Rate for Payer: BCN Commercial |
$408.06
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$494.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.06
|
| Rate for Payer: Healthscope Commercial |
$526.32
|
| Rate for Payer: Healthscope Whirlpool |
$510.53
|
| Rate for Payer: Mclaren Commercial |
$473.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.16
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$526.32
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$526.32 |
| Rate for Payer: Aetna Commercial |
$473.69
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$510.53
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$408.06
|
| Rate for Payer: BCN Commercial |
$408.06
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$494.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$526.32
|
| Rate for Payer: Healthscope Whirlpool |
$510.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$473.69
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.37
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.16
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,851.36
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,295.95 |
| Max. Negotiated Rate |
$1,851.36 |
| Rate for Payer: Aetna Commercial |
$1,666.22
|
| Rate for Payer: ASR ASR |
$1,795.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.36
|
| Rate for Payer: BCN Commercial |
$1,435.36
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cofinity Commercial |
$1,740.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.09
|
| Rate for Payer: Healthscope Commercial |
$1,851.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,795.82
|
| Rate for Payer: Mclaren Commercial |
$1,666.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,573.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,629.20
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,851.36
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$740.54 |
| Max. Negotiated Rate |
$1,851.36 |
| Rate for Payer: Aetna Commercial |
$1,666.22
|
| Rate for Payer: ASR ASR |
$1,795.82
|
| Rate for Payer: BCBS Complete |
$740.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.36
|
| Rate for Payer: BCN Commercial |
$1,435.36
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cofinity Commercial |
$1,740.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.09
|
| Rate for Payer: Healthscope Commercial |
$1,851.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,795.82
|
| Rate for Payer: Mclaren Commercial |
$1,666.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,573.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,684.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,314.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,629.20
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
|
