|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$141.54
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$141.54 |
| Rate for Payer: Aetna Commercial |
$127.39
|
| Rate for Payer: ASR ASR |
$137.29
|
| Rate for Payer: BCBS Trust/PPO |
$109.74
|
| Rate for Payer: BCN Commercial |
$109.74
|
| Rate for Payer: Cash Price |
$113.23
|
| Rate for Payer: Cofinity Commercial |
$133.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.23
|
| Rate for Payer: Healthscope Commercial |
$141.54
|
| Rate for Payer: Healthscope Whirlpool |
$137.29
|
| Rate for Payer: Mclaren Commercial |
$127.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.56
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$707.43
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$495.20 |
| Max. Negotiated Rate |
$707.43 |
| Rate for Payer: Aetna Commercial |
$636.69
|
| Rate for Payer: ASR ASR |
$686.21
|
| Rate for Payer: BCBS Trust/PPO |
$548.47
|
| Rate for Payer: BCN Commercial |
$548.47
|
| Rate for Payer: Cash Price |
$565.94
|
| Rate for Payer: Cofinity Commercial |
$664.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.94
|
| Rate for Payer: Healthscope Commercial |
$707.43
|
| Rate for Payer: Healthscope Whirlpool |
$686.21
|
| Rate for Payer: Mclaren Commercial |
$636.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$601.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.54
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$707.43
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$282.97 |
| Max. Negotiated Rate |
$707.43 |
| Rate for Payer: Aetna Commercial |
$636.69
|
| Rate for Payer: ASR ASR |
$686.21
|
| Rate for Payer: BCBS Complete |
$282.97
|
| Rate for Payer: BCBS Trust/PPO |
$548.47
|
| Rate for Payer: BCN Commercial |
$548.47
|
| Rate for Payer: Cash Price |
$565.94
|
| Rate for Payer: Cofinity Commercial |
$664.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.94
|
| Rate for Payer: Healthscope Commercial |
$707.43
|
| Rate for Payer: Healthscope Whirlpool |
$686.21
|
| Rate for Payer: Mclaren Commercial |
$636.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$601.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.76
|
| Rate for Payer: Priority Health Narrow Network |
$502.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.54
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: ASR ASR |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.85
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Healthscope Whirlpool |
$3.57
|
| Rate for Payer: Mclaren Commercial |
$3.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.24
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: ASR ASR |
$3.57
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$2.85
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Healthscope Whirlpool |
$3.57
|
| Rate for Payer: Mclaren Commercial |
$3.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.08
|
| Rate for Payer: Priority Health Narrow Network |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.24
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$211.80
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.72 |
| Max. Negotiated Rate |
$211.80 |
| Rate for Payer: Aetna Commercial |
$190.62
|
| Rate for Payer: ASR ASR |
$205.45
|
| Rate for Payer: BCBS Complete |
$84.72
|
| Rate for Payer: BCBS Trust/PPO |
$164.21
|
| Rate for Payer: BCN Commercial |
$164.21
|
| Rate for Payer: Cash Price |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$199.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.44
|
| Rate for Payer: Healthscope Commercial |
$211.80
|
| Rate for Payer: Healthscope Whirlpool |
$205.45
|
| Rate for Payer: Mclaren Commercial |
$190.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.74
|
| Rate for Payer: Priority Health Narrow Network |
$150.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.38
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$211.80
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$211.80 |
| Rate for Payer: Aetna Commercial |
$190.62
|
| Rate for Payer: ASR ASR |
$205.45
|
| Rate for Payer: BCBS Trust/PPO |
$164.21
|
| Rate for Payer: BCN Commercial |
$164.21
|
| Rate for Payer: Cash Price |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$199.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.44
|
| Rate for Payer: Healthscope Commercial |
$211.80
|
| Rate for Payer: Healthscope Whirlpool |
$205.45
|
| Rate for Payer: Mclaren Commercial |
$190.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.38
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.90
|
| Rate for Payer: Priority Health Narrow Network |
$63.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| 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 LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$23.46
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$148.79 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.08
|
| Rate for Payer: ASR ASR |
$22.76
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$18.77
|
| 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: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$23.46
|
| Rate for Payer: Healthscope Whirlpool |
$22.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$21.11
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.94
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$12.39
|
| Rate for Payer: PHP Medicaid |
$6.16
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.79
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$119.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.64
|
| Rate for Payer: UHC Medicare Advantage |
$11.60
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC LTC ROOM AND BOARD
|
Facility
|
IP
|
$377.40
|
|
| Hospital Charge Code |
11000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$264.18 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: ASR ASR |
$366.08
|
| Rate for Payer: BCBS Trust/PPO |
$292.60
|
| Rate for Payer: BCN Commercial |
$292.60
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cofinity Commercial |
$354.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.92
|
| Rate for Payer: Healthscope Commercial |
$377.40
|
| Rate for Payer: Healthscope Whirlpool |
$366.08
|
| Rate for Payer: Mclaren Commercial |
$339.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.11
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,115.61
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,584.36 |
| Max. Negotiated Rate |
$12,115.61 |
| Rate for Payer: Aetna Commercial |
$10,904.05
|
| Rate for Payer: Aetna Medicare |
$2,896.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,620.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,620.58
|
| Rate for Payer: ASR ASR |
$11,752.14
|
| Rate for Payer: BCBS Complete |
$1,663.73
|
| Rate for Payer: BCBS MAPPO |
$2,896.46
|
| Rate for Payer: BCBS Trust/PPO |
$9,393.23
|
| Rate for Payer: BCN Commercial |
$9,393.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,896.46
|
| Rate for Payer: Cash Price |
$9,692.49
|
| Rate for Payer: Cash Price |
$9,692.49
|
| Rate for Payer: Cofinity Commercial |
$11,388.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,692.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,896.46
|
| Rate for Payer: Healthscope Commercial |
$12,115.61
|
| Rate for Payer: Healthscope Whirlpool |
$11,752.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,896.46
|
| Rate for Payer: Mclaren Commercial |
$10,904.05
|
| Rate for Payer: Mclaren Medicaid |
$1,584.36
|
| Rate for Payer: Mclaren Medicare |
$2,896.46
|
| Rate for Payer: Meridian Medicaid |
$1,663.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,041.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,330.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,298.27
|
| Rate for Payer: PACE Medicare |
$2,751.64
|
| Rate for Payer: PACE SWMI |
$2,896.46
|
| Rate for Payer: PHP Commercial |
$3,186.11
|
| Rate for Payer: PHP Medicaid |
$1,584.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,896.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,480.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,025.21
|
| Rate for Payer: Priority Health Medicare |
$2,896.46
|
| Rate for Payer: Priority Health Narrow Network |
$8,602.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,896.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,661.74
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.35
|
| Rate for Payer: VA VA |
$2,896.46
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,115.61
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,480.93 |
| Max. Negotiated Rate |
$12,115.61 |
| Rate for Payer: Aetna Commercial |
$10,904.05
|
| Rate for Payer: ASR ASR |
$11,752.14
|
| Rate for Payer: BCBS Trust/PPO |
$9,393.23
|
| Rate for Payer: BCN Commercial |
$9,393.23
|
| Rate for Payer: Cash Price |
$9,692.49
|
| Rate for Payer: Cofinity Commercial |
$11,388.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,692.49
|
| Rate for Payer: Healthscope Commercial |
$12,115.61
|
| Rate for Payer: Healthscope Whirlpool |
$11,752.14
|
| Rate for Payer: Mclaren Commercial |
$10,904.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,298.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,480.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,661.74
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$77.94
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$77.94 |
| Rate for Payer: Aetna Commercial |
$70.15
|
| Rate for Payer: ASR ASR |
$75.60
|
| Rate for Payer: BCBS Trust/PPO |
$60.43
|
| Rate for Payer: BCN Commercial |
$60.43
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Cofinity Commercial |
$73.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.35
|
| Rate for Payer: Healthscope Commercial |
$77.94
|
| Rate for Payer: Healthscope Whirlpool |
$75.60
|
| Rate for Payer: Mclaren Commercial |
$70.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.59
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$77.94
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$77.94 |
| Rate for Payer: Aetna Commercial |
$70.15
|
| Rate for Payer: ASR ASR |
$75.60
|
| Rate for Payer: BCBS Complete |
$31.18
|
| Rate for Payer: BCBS Trust/PPO |
$60.43
|
| Rate for Payer: BCN Commercial |
$60.43
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Cofinity Commercial |
$73.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.35
|
| Rate for Payer: Healthscope Commercial |
$77.94
|
| Rate for Payer: Healthscope Whirlpool |
$75.60
|
| Rate for Payer: Mclaren Commercial |
$70.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.93
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.59
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$523.98 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: BCBS Trust/PPO |
$580.34
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS Trust/PPO |
$580.34
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.17
|
| Rate for Payer: Priority Health Narrow Network |
$531.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$898.41
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$628.89 |
| Max. Negotiated Rate |
$898.41 |
| Rate for Payer: Aetna Commercial |
$808.57
|
| Rate for Payer: Aetna Commercial |
$768.27
|
| Rate for Payer: ASR ASR |
$871.46
|
| Rate for Payer: ASR ASR |
$828.02
|
| Rate for Payer: BCBS Trust/PPO |
$696.54
|
| Rate for Payer: BCBS Trust/PPO |
$661.82
|
| Rate for Payer: BCN Commercial |
$661.82
|
| Rate for Payer: BCN Commercial |
$696.54
|
| Rate for Payer: Cash Price |
$682.90
|
| Rate for Payer: Cash Price |
$718.73
|
| Rate for Payer: Cofinity Commercial |
$802.41
|
| Rate for Payer: Cofinity Commercial |
$844.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.73
|
| Rate for Payer: Healthscope Commercial |
$853.63
|
| Rate for Payer: Healthscope Commercial |
$898.41
|
| Rate for Payer: Healthscope Whirlpool |
$871.46
|
| Rate for Payer: Healthscope Whirlpool |
$828.02
|
| Rate for Payer: Mclaren Commercial |
$768.27
|
| Rate for Payer: Mclaren Commercial |
$808.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$763.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$790.60
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$853.63
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$853.63 |
| Rate for Payer: Aetna Commercial |
$768.27
|
| Rate for Payer: Aetna Commercial |
$808.57
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$828.02
|
| Rate for Payer: ASR ASR |
$871.46
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$696.54
|
| Rate for Payer: BCBS Trust/PPO |
$661.82
|
| Rate for Payer: BCN Commercial |
$696.54
|
| Rate for Payer: BCN Commercial |
$661.82
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$718.73
|
| Rate for Payer: Cash Price |
$718.73
|
| Rate for Payer: Cash Price |
$682.90
|
| Rate for Payer: Cash Price |
$682.90
|
| Rate for Payer: Cofinity Commercial |
$844.51
|
| Rate for Payer: Cofinity Commercial |
$802.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$898.41
|
| Rate for Payer: Healthscope Commercial |
$853.63
|
| Rate for Payer: Healthscope Whirlpool |
$828.02
|
| Rate for Payer: Healthscope Whirlpool |
$871.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$808.57
|
| Rate for Payer: Mclaren Commercial |
$768.27
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$763.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.59
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.01
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$439.21
|
| Rate for Payer: Priority Health Narrow Network |
$439.21
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$790.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.19
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: VA VA |
$614.70
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$755.88
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$768.38 |
| Rate for Payer: Aetna Commercial |
$680.29
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$733.20
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$586.03
|
| Rate for Payer: BCN Commercial |
$586.03
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$604.70
|
| Rate for Payer: Cash Price |
$604.70
|
| Rate for Payer: Cofinity Commercial |
$710.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Healthscope Whirlpool |
$733.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$680.29
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$642.50
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$687.85
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$536.67
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.17
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$755.88
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.12 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna Commercial |
$680.29
|
| Rate for Payer: ASR ASR |
$733.20
|
| Rate for Payer: BCBS Trust/PPO |
$586.03
|
| Rate for Payer: BCN Commercial |
$586.03
|
| Rate for Payer: Cash Price |
$604.70
|
| Rate for Payer: Cofinity Commercial |
$710.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.70
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Healthscope Whirlpool |
$733.20
|
| Rate for Payer: Mclaren Commercial |
$680.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$642.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.17
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
IP
|
$2,066.60
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,446.62 |
| Max. Negotiated Rate |
$2,066.60 |
| Rate for Payer: Aetna Commercial |
$1,859.94
|
| Rate for Payer: ASR ASR |
$2,004.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,602.23
|
| Rate for Payer: BCN Commercial |
$1,602.23
|
| Rate for Payer: Cash Price |
$1,653.28
|
| Rate for Payer: Cofinity Commercial |
$1,942.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,653.28
|
| Rate for Payer: Healthscope Commercial |
$2,066.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,004.60
|
| Rate for Payer: Mclaren Commercial |
$1,859.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,756.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,446.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,818.61
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,066.60
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.30 |
| Max. Negotiated Rate |
$2,066.60 |
| Rate for Payer: Aetna Commercial |
$1,859.94
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$2,004.60
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,602.23
|
| Rate for Payer: BCN Commercial |
$1,602.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$1,653.28
|
| Rate for Payer: Cash Price |
$1,653.28
|
| Rate for Payer: Cofinity Commercial |
$1,942.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,653.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$2,066.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,004.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$1,859.94
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,756.61
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,446.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.61
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,467.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,818.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$112.00 |
| 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 |
$124.05
|
| Rate for Payer: BCN Commercial |
$124.05
|
| 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 |
$160.00
|
| Rate for Payer: Healthscope Whirlpool |
$155.20
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
