|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,338.23 |
| Max. Negotiated Rate |
$2,058.81 |
| Rate for Payer: Aetna Commercial |
$1,852.93
|
| Rate for Payer: ASR ASR |
$1,997.05
|
| Rate for Payer: ASR Commercial |
$1,997.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,677.72
|
| Rate for Payer: BCN Commercial |
$1,596.20
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$2,058.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.05
|
| Rate for Payer: Mclaren Commercial |
$1,852.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: Nomi Health Commercial |
$1,688.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,811.75
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$823.52 |
| Max. Negotiated Rate |
$2,058.81 |
| Rate for Payer: Aetna Commercial |
$1,852.93
|
| Rate for Payer: Aetna Medicare |
$1,029.40
|
| Rate for Payer: ASR ASR |
$1,997.05
|
| Rate for Payer: ASR Commercial |
$1,997.05
|
| Rate for Payer: BCBS Complete |
$823.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.96
|
| Rate for Payer: BCN Commercial |
$1,596.20
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$2,058.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.05
|
| Rate for Payer: Mclaren Commercial |
$1,852.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: Nomi Health Commercial |
$1,688.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,803.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,443.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,811.75
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$900.11 |
| Max. Negotiated Rate |
$2,250.28 |
| Rate for Payer: Aetna Commercial |
$2,025.25
|
| Rate for Payer: Aetna Medicare |
$1,125.14
|
| Rate for Payer: ASR ASR |
$2,182.77
|
| Rate for Payer: ASR Commercial |
$2,182.77
|
| Rate for Payer: BCBS Complete |
$900.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,842.75
|
| Rate for Payer: BCN Commercial |
$1,744.64
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$2,115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,250.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.77
|
| Rate for Payer: Mclaren Commercial |
$2,025.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: Nomi Health Commercial |
$1,845.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,971.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,577.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,980.25
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,462.68 |
| Max. Negotiated Rate |
$2,250.28 |
| Rate for Payer: Aetna Commercial |
$2,025.25
|
| Rate for Payer: ASR ASR |
$2,182.77
|
| Rate for Payer: ASR Commercial |
$2,182.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,833.75
|
| Rate for Payer: BCN Commercial |
$1,744.64
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$2,115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,250.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.77
|
| Rate for Payer: Mclaren Commercial |
$2,025.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: Nomi Health Commercial |
$1,845.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,980.25
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,251.77 |
| Max. Negotiated Rate |
$1,925.80 |
| Rate for Payer: Aetna Commercial |
$1,733.22
|
| Rate for Payer: ASR ASR |
$1,868.03
|
| Rate for Payer: ASR Commercial |
$1,868.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.33
|
| Rate for Payer: BCN Commercial |
$1,493.07
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,810.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,925.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,868.03
|
| Rate for Payer: Mclaren Commercial |
$1,733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: Nomi Health Commercial |
$1,579.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.70
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$770.32 |
| Max. Negotiated Rate |
$1,925.80 |
| Rate for Payer: Aetna Commercial |
$1,733.22
|
| Rate for Payer: Aetna Medicare |
$962.90
|
| Rate for Payer: ASR ASR |
$1,868.03
|
| Rate for Payer: ASR Commercial |
$1,868.03
|
| Rate for Payer: BCBS Complete |
$770.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.04
|
| Rate for Payer: BCN Commercial |
$1,493.07
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,810.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,925.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,868.03
|
| Rate for Payer: Mclaren Commercial |
$1,733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: Nomi Health Commercial |
$1,579.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,687.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,694.70
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.79 |
| Max. Negotiated Rate |
$2,031.98 |
| Rate for Payer: Aetna Commercial |
$1,828.78
|
| Rate for Payer: Aetna Medicare |
$1,015.99
|
| Rate for Payer: ASR ASR |
$1,971.02
|
| Rate for Payer: ASR Commercial |
$1,971.02
|
| Rate for Payer: BCBS Complete |
$812.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.99
|
| Rate for Payer: BCN Commercial |
$1,575.39
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,910.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$2,031.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.02
|
| Rate for Payer: Mclaren Commercial |
$1,828.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,780.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.14
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.79 |
| Max. Negotiated Rate |
$2,031.98 |
| Rate for Payer: Aetna Commercial |
$1,828.78
|
| Rate for Payer: ASR ASR |
$1,971.02
|
| Rate for Payer: ASR Commercial |
$1,971.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.86
|
| Rate for Payer: BCN Commercial |
$1,575.39
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,910.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$2,031.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.02
|
| Rate for Payer: Mclaren Commercial |
$1,828.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.14
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.93 |
| Max. Negotiated Rate |
$2,370.66 |
| Rate for Payer: Aetna Commercial |
$2,133.59
|
| Rate for Payer: ASR ASR |
$2,299.54
|
| Rate for Payer: ASR Commercial |
$2,299.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.85
|
| Rate for Payer: BCN Commercial |
$1,837.97
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,228.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Healthscope Commercial |
$2,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.54
|
| Rate for Payer: Mclaren Commercial |
$2,133.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,086.18
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.26 |
| Max. Negotiated Rate |
$2,370.66 |
| Rate for Payer: Aetna Commercial |
$2,133.59
|
| Rate for Payer: Aetna Medicare |
$1,185.33
|
| Rate for Payer: ASR ASR |
$2,299.54
|
| Rate for Payer: ASR Commercial |
$2,299.54
|
| Rate for Payer: BCBS Complete |
$948.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,941.33
|
| Rate for Payer: BCN Commercial |
$1,837.97
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,228.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Healthscope Commercial |
$2,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.54
|
| Rate for Payer: Mclaren Commercial |
$2,133.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,077.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,661.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,086.18
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$91.13 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: ASR ASR |
$88.40
|
| Rate for Payer: ASR Commercial |
$88.40
|
| Rate for Payer: BCBS Trust/PPO |
$74.26
|
| Rate for Payer: BCN Commercial |
$70.65
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$91.13
|
| Rate for Payer: Healthscope Whirlpool |
$88.40
|
| Rate for Payer: Mclaren Commercial |
$82.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.19
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$91.13 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$88.40
|
| Rate for Payer: ASR Commercial |
$88.40
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$74.63
|
| Rate for Payer: BCN Commercial |
$70.65
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$91.13
|
| Rate for Payer: Healthscope Whirlpool |
$88.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$82.02
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.85
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$63.88
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$123.65
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$133.27
|
| Rate for Payer: ASR Commercial |
$133.27
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$112.51
|
| Rate for Payer: BCN Commercial |
$106.52
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$129.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Healthscope Whirlpool |
$133.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$123.65
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.38
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$96.31
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$123.65
|
| Rate for Payer: ASR ASR |
$133.27
|
| Rate for Payer: ASR Commercial |
$133.27
|
| Rate for Payer: BCBS Trust/PPO |
$111.96
|
| Rate for Payer: BCN Commercial |
$106.52
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$129.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Healthscope Whirlpool |
$133.27
|
| Rate for Payer: Mclaren Commercial |
$123.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.90
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$343.66 |
| Max. Negotiated Rate |
$993.78 |
| Rate for Payer: Aetna Commercial |
$518.79
|
| Rate for Payer: Aetna Medicare |
$641.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.44
|
| Rate for Payer: ASR ASR |
$559.14
|
| Rate for Payer: ASR Commercial |
$559.14
|
| Rate for Payer: BCBS Complete |
$360.84
|
| Rate for Payer: BCBS MAPPO |
$641.15
|
| Rate for Payer: BCBS Trust/PPO |
$472.04
|
| Rate for Payer: BCN Commercial |
$446.91
|
| Rate for Payer: BCN Medicare Advantage |
$641.15
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$541.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.15
|
| Rate for Payer: Healthscope Commercial |
$576.43
|
| Rate for Payer: Healthscope Whirlpool |
$559.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$641.15
|
| Rate for Payer: Mclaren Commercial |
$518.79
|
| Rate for Payer: Mclaren Medicaid |
$343.66
|
| Rate for Payer: Mclaren Medicare |
$641.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.21
|
| Rate for Payer: Meridian Medicaid |
$360.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| Rate for Payer: PACE Medicare |
$609.09
|
| Rate for Payer: PACE SWMI |
$641.15
|
| Rate for Payer: PHP Commercial |
$705.26
|
| Rate for Payer: PHP Medicaid |
$343.66
|
| Rate for Payer: PHP Medicare Advantage |
$641.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.07
|
| Rate for Payer: Priority Health Medicare |
$641.15
|
| Rate for Payer: Priority Health Narrow Network |
$404.08
|
| Rate for Payer: Railroad Medicare Medicare |
$641.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.15
|
| Rate for Payer: UHC Exchange |
$993.78
|
| Rate for Payer: UHC Medicare Advantage |
$641.15
|
| Rate for Payer: UHCCP DNSP |
$641.15
|
| Rate for Payer: UHCCP Medicaid |
$343.66
|
| Rate for Payer: VA VA |
$641.15
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$374.68 |
| Max. Negotiated Rate |
$576.43 |
| Rate for Payer: Aetna Commercial |
$518.79
|
| Rate for Payer: ASR ASR |
$559.14
|
| Rate for Payer: ASR Commercial |
$559.14
|
| Rate for Payer: BCBS Trust/PPO |
$469.73
|
| Rate for Payer: BCN Commercial |
$446.91
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$541.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Healthscope Commercial |
$576.43
|
| Rate for Payer: Healthscope Whirlpool |
$559.14
|
| Rate for Payer: Mclaren Commercial |
$518.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.26
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,838.32
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,844.91 |
| Max. Negotiated Rate |
$2,838.32 |
| Rate for Payer: Aetna Commercial |
$2,554.49
|
| Rate for Payer: ASR ASR |
$2,753.17
|
| Rate for Payer: ASR Commercial |
$2,753.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.95
|
| Rate for Payer: BCN Commercial |
$2,200.55
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cofinity Commercial |
$2,668.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.66
|
| Rate for Payer: Healthscope Commercial |
$2,838.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,753.17
|
| Rate for Payer: Mclaren Commercial |
$2,554.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.57
|
| Rate for Payer: Nomi Health Commercial |
$2,327.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,497.72
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,838.32
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$4,828.62 |
| Rate for Payer: Aetna Commercial |
$2,554.49
|
| Rate for Payer: Aetna Medicare |
$3,115.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: ASR ASR |
$2,753.17
|
| Rate for Payer: ASR Commercial |
$2,753.17
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.30
|
| Rate for Payer: BCN Commercial |
$2,200.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cofinity Commercial |
$2,668.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$2,838.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,753.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,115.24
|
| Rate for Payer: Mclaren Commercial |
$2,554.49
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.57
|
| Rate for Payer: Nomi Health Commercial |
$2,327.42
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,426.76
|
| Rate for Payer: PHP Medicaid |
$1,669.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,127.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,501.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,497.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,828.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP DNSP |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$390.69
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$390.69 |
| Rate for Payer: Aetna Commercial |
$351.62
|
| Rate for Payer: ASR ASR |
$378.97
|
| Rate for Payer: ASR Commercial |
$378.97
|
| Rate for Payer: BCBS Trust/PPO |
$318.37
|
| Rate for Payer: BCN Commercial |
$302.90
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.55
|
| Rate for Payer: Healthscope Commercial |
$390.69
|
| Rate for Payer: Healthscope Whirlpool |
$378.97
|
| Rate for Payer: Mclaren Commercial |
$351.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.09
|
| Rate for Payer: Nomi Health Commercial |
$320.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.81
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$390.69
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$773.37 |
| Rate for Payer: Aetna Commercial |
$351.62
|
| Rate for Payer: Aetna Medicare |
$498.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: ASR ASR |
$378.97
|
| Rate for Payer: ASR Commercial |
$378.97
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$319.94
|
| Rate for Payer: BCN Commercial |
$302.90
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$367.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$390.69
|
| Rate for Payer: Healthscope Whirlpool |
$378.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$498.95
|
| Rate for Payer: Mclaren Commercial |
$351.62
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.09
|
| Rate for Payer: Nomi Health Commercial |
$320.37
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$548.84
|
| Rate for Payer: PHP Medicaid |
$267.44
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.32
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$273.87
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$773.37
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP DNSP |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC EZPAP SUPPLY
|
Facility
|
OP
|
$127.99
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$127.99 |
| Rate for Payer: Aetna Commercial |
$115.19
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: ASR ASR |
$124.15
|
| Rate for Payer: ASR Commercial |
$124.15
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS Trust/PPO |
$104.81
|
| Rate for Payer: BCN Commercial |
$99.23
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cofinity Commercial |
$120.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.39
|
| Rate for Payer: Healthscope Commercial |
$127.99
|
| Rate for Payer: Healthscope Whirlpool |
$124.15
|
| Rate for Payer: Mclaren Commercial |
$115.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.79
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.14
|
| Rate for Payer: Priority Health Narrow Network |
$89.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.63
|
|
|
HC EZPAP SUPPLY
|
Facility
|
IP
|
$127.99
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$127.99 |
| Rate for Payer: Aetna Commercial |
$115.19
|
| Rate for Payer: ASR ASR |
$124.15
|
| Rate for Payer: ASR Commercial |
$124.15
|
| Rate for Payer: BCBS Trust/PPO |
$104.30
|
| Rate for Payer: BCN Commercial |
$99.23
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cofinity Commercial |
$120.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.39
|
| Rate for Payer: Healthscope Commercial |
$127.99
|
| Rate for Payer: Healthscope Whirlpool |
$124.15
|
| Rate for Payer: Mclaren Commercial |
$115.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.79
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.63
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
OP
|
$484.74
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$484.74 |
| Rate for Payer: Aetna Commercial |
$436.27
|
| Rate for Payer: Aetna Medicare |
$242.37
|
| Rate for Payer: ASR ASR |
$470.20
|
| Rate for Payer: ASR Commercial |
$470.20
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS Trust/PPO |
$396.95
|
| Rate for Payer: BCN Commercial |
$375.82
|
| Rate for Payer: Cash Price |
$387.79
|
| Rate for Payer: Cofinity Commercial |
$455.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.79
|
| Rate for Payer: Healthscope Commercial |
$484.74
|
| Rate for Payer: Healthscope Whirlpool |
$470.20
|
| Rate for Payer: Mclaren Commercial |
$436.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.03
|
| Rate for Payer: Nomi Health Commercial |
$397.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.73
|
| Rate for Payer: Priority Health Narrow Network |
$339.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.57
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
IP
|
$484.74
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$484.74 |
| Rate for Payer: Aetna Commercial |
$436.27
|
| Rate for Payer: ASR ASR |
$470.20
|
| Rate for Payer: ASR Commercial |
$470.20
|
| Rate for Payer: BCBS Trust/PPO |
$395.01
|
| Rate for Payer: BCN Commercial |
$375.82
|
| Rate for Payer: Cash Price |
$387.79
|
| Rate for Payer: Cofinity Commercial |
$455.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.79
|
| Rate for Payer: Healthscope Commercial |
$484.74
|
| Rate for Payer: Healthscope Whirlpool |
$470.20
|
| Rate for Payer: Mclaren Commercial |
$436.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.03
|
| Rate for Payer: Nomi Health Commercial |
$397.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.57
|
|
|
HC F232 OVALBUMIN
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: ASR Commercial |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$23.90
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
|
