|
HC KOH PREPARATION
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: ASR ASR |
$22.76
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Healthscope Whirlpool |
$22.76
|
| Rate for Payer: Mclaren Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.64
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
OP
|
$2,878.85
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$2,878.85 |
| Rate for Payer: Aetna Commercial |
$2,590.96
|
| Rate for Payer: ASR ASR |
$2,792.48
|
| Rate for Payer: BCBS Complete |
$1,151.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,231.97
|
| Rate for Payer: BCN Commercial |
$2,231.97
|
| Rate for Payer: Cash Price |
$2,303.08
|
| Rate for Payer: Cofinity Commercial |
$2,706.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.08
|
| Rate for Payer: Healthscope Commercial |
$2,878.85
|
| Rate for Payer: Healthscope Whirlpool |
$2,792.48
|
| Rate for Payer: Mclaren Commercial |
$2,590.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,447.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,619.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,043.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,533.39
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
IP
|
$2,878.85
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,015.20 |
| Max. Negotiated Rate |
$2,878.85 |
| Rate for Payer: Aetna Commercial |
$2,590.96
|
| Rate for Payer: ASR ASR |
$2,792.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,231.97
|
| Rate for Payer: BCN Commercial |
$2,231.97
|
| Rate for Payer: Cash Price |
$2,303.08
|
| Rate for Payer: Cofinity Commercial |
$2,706.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,303.08
|
| Rate for Payer: Healthscope Commercial |
$2,878.85
|
| Rate for Payer: Healthscope Whirlpool |
$2,792.48
|
| Rate for Payer: Mclaren Commercial |
$2,590.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,447.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,533.39
|
|
|
HC LAAC IMPLANT
|
Facility
|
OP
|
$18,207.00
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,282.80 |
| Max. Negotiated Rate |
$18,207.00 |
| Rate for Payer: Aetna Commercial |
$16,386.30
|
| Rate for Payer: ASR ASR |
$17,660.79
|
| Rate for Payer: BCBS Complete |
$7,282.80
|
| Rate for Payer: BCBS Trust/PPO |
$14,115.89
|
| Rate for Payer: BCN Commercial |
$14,115.89
|
| Rate for Payer: Cash Price |
$14,565.60
|
| Rate for Payer: Cofinity Commercial |
$17,114.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,565.60
|
| Rate for Payer: Healthscope Commercial |
$18,207.00
|
| Rate for Payer: Healthscope Whirlpool |
$17,660.79
|
| Rate for Payer: Mclaren Commercial |
$16,386.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,475.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,744.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,568.37
|
| Rate for Payer: Priority Health Narrow Network |
$12,926.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,022.16
|
|
|
HC LAAC IMPLANT
|
Facility
|
IP
|
$18,207.00
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,744.90 |
| Max. Negotiated Rate |
$18,207.00 |
| Rate for Payer: Aetna Commercial |
$16,386.30
|
| Rate for Payer: ASR ASR |
$17,660.79
|
| Rate for Payer: BCBS Trust/PPO |
$14,115.89
|
| Rate for Payer: BCN Commercial |
$14,115.89
|
| Rate for Payer: Cash Price |
$14,565.60
|
| Rate for Payer: Cofinity Commercial |
$17,114.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,565.60
|
| Rate for Payer: Healthscope Commercial |
$18,207.00
|
| Rate for Payer: Healthscope Whirlpool |
$17,660.79
|
| Rate for Payer: Mclaren Commercial |
$16,386.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,475.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,744.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,022.16
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,500.99
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.69 |
| Max. Negotiated Rate |
$1,500.99 |
| Rate for Payer: Aetna Commercial |
$1,350.89
|
| Rate for Payer: ASR ASR |
$1,455.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.72
|
| Rate for Payer: BCN Commercial |
$1,163.72
|
| Rate for Payer: Cash Price |
$1,200.79
|
| Rate for Payer: Cofinity Commercial |
$1,410.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.79
|
| Rate for Payer: Healthscope Commercial |
$1,500.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,455.96
|
| Rate for Payer: Mclaren Commercial |
$1,350.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.87
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,500.99
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$600.40 |
| Max. Negotiated Rate |
$1,500.99 |
| Rate for Payer: Aetna Commercial |
$1,350.89
|
| Rate for Payer: ASR ASR |
$1,455.96
|
| Rate for Payer: BCBS Complete |
$600.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.72
|
| Rate for Payer: BCN Commercial |
$1,163.72
|
| Rate for Payer: Cash Price |
$1,200.79
|
| Rate for Payer: Cofinity Commercial |
$1,410.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.79
|
| Rate for Payer: Healthscope Commercial |
$1,500.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,455.96
|
| Rate for Payer: Mclaren Commercial |
$1,350.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,365.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,065.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.87
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,001.38
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$800.55 |
| Max. Negotiated Rate |
$2,001.38 |
| Rate for Payer: Aetna Commercial |
$1,801.24
|
| Rate for Payer: ASR ASR |
$1,941.34
|
| Rate for Payer: BCBS Complete |
$800.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.67
|
| Rate for Payer: BCN Commercial |
$1,551.67
|
| Rate for Payer: Cash Price |
$1,601.10
|
| Rate for Payer: Cofinity Commercial |
$1,881.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.10
|
| Rate for Payer: Healthscope Commercial |
$2,001.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,941.34
|
| Rate for Payer: Mclaren Commercial |
$1,801.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,701.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,821.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,420.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,761.21
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,001.38
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,400.97 |
| Max. Negotiated Rate |
$2,001.38 |
| Rate for Payer: Aetna Commercial |
$1,801.24
|
| Rate for Payer: ASR ASR |
$1,941.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.67
|
| Rate for Payer: BCN Commercial |
$1,551.67
|
| Rate for Payer: Cash Price |
$1,601.10
|
| Rate for Payer: Cofinity Commercial |
$1,881.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.10
|
| Rate for Payer: Healthscope Commercial |
$2,001.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,941.34
|
| Rate for Payer: Mclaren Commercial |
$1,801.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,701.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,761.21
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,501.62
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,000.65 |
| Max. Negotiated Rate |
$2,501.62 |
| Rate for Payer: Aetna Commercial |
$2,251.46
|
| Rate for Payer: ASR ASR |
$2,426.57
|
| Rate for Payer: BCBS Complete |
$1,000.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,939.51
|
| Rate for Payer: BCN Commercial |
$1,939.51
|
| Rate for Payer: Cash Price |
$2,001.30
|
| Rate for Payer: Cofinity Commercial |
$2,351.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,001.30
|
| Rate for Payer: Healthscope Commercial |
$2,501.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,426.57
|
| Rate for Payer: Mclaren Commercial |
$2,251.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,126.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,276.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,201.43
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,501.62
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,751.13 |
| Max. Negotiated Rate |
$2,501.62 |
| Rate for Payer: Aetna Commercial |
$2,251.46
|
| Rate for Payer: ASR ASR |
$2,426.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,939.51
|
| Rate for Payer: BCN Commercial |
$1,939.51
|
| Rate for Payer: Cash Price |
$2,001.30
|
| Rate for Payer: Cofinity Commercial |
$2,351.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,001.30
|
| Rate for Payer: Healthscope Commercial |
$2,501.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,426.57
|
| Rate for Payer: Mclaren Commercial |
$2,251.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,126.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,201.43
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,001.99
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,101.39 |
| Max. Negotiated Rate |
$3,001.99 |
| Rate for Payer: Aetna Commercial |
$2,701.79
|
| Rate for Payer: ASR ASR |
$2,911.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,327.44
|
| Rate for Payer: BCN Commercial |
$2,327.44
|
| Rate for Payer: Cash Price |
$2,401.59
|
| Rate for Payer: Cofinity Commercial |
$2,821.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,401.59
|
| Rate for Payer: Healthscope Commercial |
$3,001.99
|
| Rate for Payer: Healthscope Whirlpool |
$2,911.93
|
| Rate for Payer: Mclaren Commercial |
$2,701.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,551.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,101.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,641.75
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
OP
|
$3,001.99
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,200.80 |
| Max. Negotiated Rate |
$3,001.99 |
| Rate for Payer: Aetna Commercial |
$2,701.79
|
| Rate for Payer: ASR ASR |
$2,911.93
|
| Rate for Payer: BCBS Complete |
$1,200.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,327.44
|
| Rate for Payer: BCN Commercial |
$2,327.44
|
| Rate for Payer: Cash Price |
$2,401.59
|
| Rate for Payer: Cofinity Commercial |
$2,821.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,401.59
|
| Rate for Payer: Healthscope Commercial |
$3,001.99
|
| Rate for Payer: Healthscope Whirlpool |
$2,911.93
|
| Rate for Payer: Mclaren Commercial |
$2,701.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,551.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,101.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,731.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,131.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,641.75
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
OP
|
$4,499.56
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,799.82 |
| Max. Negotiated Rate |
$4,499.56 |
| Rate for Payer: Aetna Commercial |
$4,049.60
|
| Rate for Payer: ASR ASR |
$4,364.57
|
| Rate for Payer: BCBS Complete |
$1,799.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,488.51
|
| Rate for Payer: BCN Commercial |
$3,488.51
|
| Rate for Payer: Cash Price |
$3,599.65
|
| Rate for Payer: Cofinity Commercial |
$4,229.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,599.65
|
| Rate for Payer: Healthscope Commercial |
$4,499.56
|
| Rate for Payer: Healthscope Whirlpool |
$4,364.57
|
| Rate for Payer: Mclaren Commercial |
$4,049.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,824.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,149.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,094.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,194.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,959.61
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
IP
|
$4,499.56
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,149.69 |
| Max. Negotiated Rate |
$4,499.56 |
| Rate for Payer: Aetna Commercial |
$4,049.60
|
| Rate for Payer: ASR ASR |
$4,364.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,488.51
|
| Rate for Payer: BCN Commercial |
$3,488.51
|
| Rate for Payer: Cash Price |
$3,599.65
|
| Rate for Payer: Cofinity Commercial |
$4,229.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,599.65
|
| Rate for Payer: Healthscope Commercial |
$4,499.56
|
| Rate for Payer: Healthscope Whirlpool |
$4,364.57
|
| Rate for Payer: Mclaren Commercial |
$4,049.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,824.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,149.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,959.61
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
IP
|
$6,656.91
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,659.84 |
| Max. Negotiated Rate |
$6,656.91 |
| Rate for Payer: Aetna Commercial |
$5,991.22
|
| Rate for Payer: ASR ASR |
$6,457.20
|
| Rate for Payer: BCBS Trust/PPO |
$5,161.10
|
| Rate for Payer: BCN Commercial |
$5,161.10
|
| Rate for Payer: Cash Price |
$5,325.53
|
| Rate for Payer: Cofinity Commercial |
$6,257.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,325.53
|
| Rate for Payer: Healthscope Commercial |
$6,656.91
|
| Rate for Payer: Healthscope Whirlpool |
$6,457.20
|
| Rate for Payer: Mclaren Commercial |
$5,991.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,658.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,659.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,858.08
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
OP
|
$6,656.91
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,662.76 |
| Max. Negotiated Rate |
$6,656.91 |
| Rate for Payer: Aetna Commercial |
$5,991.22
|
| Rate for Payer: ASR ASR |
$6,457.20
|
| Rate for Payer: BCBS Complete |
$2,662.76
|
| Rate for Payer: BCBS Trust/PPO |
$5,161.10
|
| Rate for Payer: BCN Commercial |
$5,161.10
|
| Rate for Payer: Cash Price |
$5,325.53
|
| Rate for Payer: Cofinity Commercial |
$6,257.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,325.53
|
| Rate for Payer: Healthscope Commercial |
$6,656.91
|
| Rate for Payer: Healthscope Whirlpool |
$6,457.20
|
| Rate for Payer: Mclaren Commercial |
$5,991.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,658.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,659.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,057.79
|
| Rate for Payer: Priority Health Narrow Network |
$4,726.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,858.08
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.50 |
| Max. Negotiated Rate |
$3,937.00 |
| Rate for Payer: Aetna Commercial |
$3,543.30
|
| Rate for Payer: Aetna Medicare |
$1,355.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: ASR ASR |
$3,818.89
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,052.36
|
| Rate for Payer: BCN Commercial |
$3,052.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Cash Price |
$3,149.60
|
| Rate for Payer: Cash Price |
$3,149.60
|
| Rate for Payer: Cofinity Commercial |
$3,700.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,149.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Healthscope Commercial |
$3,937.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,818.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,355.58
|
| Rate for Payer: Mclaren Commercial |
$3,543.30
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,346.45
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Commercial |
$1,491.14
|
| Rate for Payer: PHP Medicaid |
$741.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,755.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,582.67
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,795.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,464.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,755.90 |
| Max. Negotiated Rate |
$3,937.00 |
| Rate for Payer: Aetna Commercial |
$3,543.30
|
| Rate for Payer: ASR ASR |
$3,818.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,052.36
|
| Rate for Payer: BCN Commercial |
$3,052.36
|
| Rate for Payer: Cash Price |
$3,149.60
|
| Rate for Payer: Cofinity Commercial |
$3,700.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,149.60
|
| Rate for Payer: Healthscope Commercial |
$3,937.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,818.89
|
| Rate for Payer: Mclaren Commercial |
$3,543.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,346.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,755.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,464.56
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
OP
|
$1,525.40
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$610.16 |
| Max. Negotiated Rate |
$1,525.40 |
| Rate for Payer: Aetna Commercial |
$1,372.86
|
| Rate for Payer: ASR ASR |
$1,479.64
|
| Rate for Payer: BCBS Complete |
$610.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.64
|
| Rate for Payer: BCN Commercial |
$1,182.64
|
| Rate for Payer: Cash Price |
$1,220.32
|
| Rate for Payer: Cofinity Commercial |
$1,433.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.32
|
| Rate for Payer: Healthscope Commercial |
$1,525.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,479.64
|
| Rate for Payer: Mclaren Commercial |
$1,372.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,296.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,067.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,388.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,083.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,342.35
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
IP
|
$1,525.40
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,067.78 |
| Max. Negotiated Rate |
$1,525.40 |
| Rate for Payer: Aetna Commercial |
$1,372.86
|
| Rate for Payer: ASR ASR |
$1,479.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.64
|
| Rate for Payer: BCN Commercial |
$1,182.64
|
| Rate for Payer: Cash Price |
$1,220.32
|
| Rate for Payer: Cofinity Commercial |
$1,433.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.32
|
| Rate for Payer: Healthscope Commercial |
$1,525.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,479.64
|
| Rate for Payer: Mclaren Commercial |
$1,372.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,296.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,067.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,342.35
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: ASR ASR |
$21.11
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Healthscope Commercial |
$21.76
|
| Rate for Payer: Healthscope Whirlpool |
$21.11
|
| Rate for Payer: Mclaren Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.15
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$6.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: ASR ASR |
$21.11
|
| Rate for Payer: BCBS Complete |
$3.47
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Healthscope Commercial |
$21.76
|
| Rate for Payer: Healthscope Whirlpool |
$21.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.04
|
| Rate for Payer: Mclaren Commercial |
$19.58
|
| Rate for Payer: Mclaren Medicaid |
$3.30
|
| Rate for Payer: Mclaren Medicare |
$6.04
|
| Rate for Payer: Meridian Medicaid |
$3.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.50
|
| Rate for Payer: PACE Medicare |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: PHP Medicaid |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.98
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.15
|
| Rate for Payer: UHC Medicare Advantage |
$6.22
|
| Rate for Payer: VA VA |
$6.04
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: ASR ASR |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$45.08
|
| Rate for Payer: BCN Commercial |
$45.08
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$54.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$58.14
|
| Rate for Payer: Healthscope Whirlpool |
$56.40
|
| Rate for Payer: Mclaren Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.16
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$64.65 |
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: ASR ASR |
$56.40
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$45.08
|
| Rate for Payer: BCN Commercial |
$45.08
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$54.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$58.14
|
| Rate for Payer: Healthscope Whirlpool |
$56.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.57
|
| Rate for Payer: Mclaren Commercial |
$52.33
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.42
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicaid |
$6.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.65
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow Network |
$51.72
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: VA VA |
$11.57
|
|
