|
HC HH ALOE VESTA CLEANSER
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
OP
|
$17.17
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: ASR ASR |
$16.65
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$17.17
|
| Rate for Payer: Mclaren Commercial |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.59
|
| Rate for Payer: Nomi Health Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.04
|
| Rate for Payer: Priority Health Narrow Network |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.11
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
IP
|
$17.17
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: ASR ASR |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$14.10
|
| Rate for Payer: BCN Commercial |
$14.10
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$17.17
|
| Rate for Payer: Mclaren Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.59
|
| Rate for Payer: Nomi Health Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.11
|
|
|
HC HH WET ONES
|
Facility
|
IP
|
$16.37
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$16.37 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: ASR ASR |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.44
|
| Rate for Payer: BCN Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Whirlpool |
$16.37
|
| Rate for Payer: Mclaren Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.41
|
|
|
HC HH WET ONES
|
Facility
|
OP
|
$16.37
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$16.37 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: ASR ASR |
$15.88
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: BCBS Trust/PPO |
$13.50
|
| Rate for Payer: BCN Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Whirlpool |
$16.37
|
| Rate for Payer: Mclaren Commercial |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.41
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$45.63 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$37.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$41.07
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: ASR ASR |
$44.26
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$37.62
|
| Rate for Payer: BCN Commercial |
$37.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$42.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$44.26
|
| Rate for Payer: Healthscope Whirlpool |
$45.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$41.07
|
| Rate for Payer: Mclaren Medicaid |
$12.90
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: PHP Medicaid |
$6.91
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.85
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$59.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.90
|
| Rate for Payer: UHC Exchange |
$20.00
|
| Rate for Payer: UHC Medicaid |
$6.75
|
| Rate for Payer: UHCCP DNSP |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$43.01
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Aetna Commercial |
$38.71
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: ASR ASR |
$41.72
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.46
|
| Rate for Payer: BCN Commercial |
$35.46
|
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Cofinity Commercial |
$40.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Healthscope Whirlpool |
$43.01
|
| Rate for Payer: Mclaren Commercial |
$38.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.56
|
| Rate for Payer: Nomi Health Commercial |
$35.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.74
|
| Rate for Payer: Priority Health Narrow Network |
$28.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.85
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$43.01
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Aetna Commercial |
$38.71
|
| Rate for Payer: ASR ASR |
$41.72
|
| Rate for Payer: BCBS Trust/PPO |
$35.32
|
| Rate for Payer: BCN Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Cofinity Commercial |
$40.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Healthscope Whirlpool |
$43.01
|
| Rate for Payer: Mclaren Commercial |
$38.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.56
|
| Rate for Payer: Nomi Health Commercial |
$35.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.85
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
IP
|
$1,064.33
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$798.25 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$957.90
|
| Rate for Payer: ASR ASR |
$1,032.40
|
| Rate for Payer: BCBS Trust/PPO |
$874.03
|
| Rate for Payer: BCN Commercial |
$874.03
|
| Rate for Payer: Cash Price |
$851.46
|
| Rate for Payer: Cofinity Commercial |
$1,000.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.46
|
| Rate for Payer: Healthscope Commercial |
$1,032.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.33
|
| Rate for Payer: Mclaren Commercial |
$957.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$904.68
|
| Rate for Payer: Nomi Health Commercial |
$872.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$936.61
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
OP
|
$1,064.33
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$957.90
|
| Rate for Payer: Aetna Medicare |
$393.80
|
| Rate for Payer: ASR ASR |
$1,032.40
|
| Rate for Payer: BCBS Complete |
$425.73
|
| Rate for Payer: BCBS Trust/PPO |
$877.54
|
| Rate for Payer: BCN Commercial |
$877.54
|
| Rate for Payer: Cash Price |
$851.46
|
| Rate for Payer: Cofinity Commercial |
$1,000.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.46
|
| Rate for Payer: Healthscope Commercial |
$1,032.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.33
|
| Rate for Payer: Mclaren Commercial |
$957.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$851.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$904.68
|
| Rate for Payer: Nomi Health Commercial |
$872.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$932.57
|
| Rate for Payer: Priority Health Narrow Network |
$746.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$936.61
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
IP
|
$221.74
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.31 |
| Max. Negotiated Rate |
$221.74 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: ASR ASR |
$215.09
|
| Rate for Payer: BCBS Trust/PPO |
$182.09
|
| Rate for Payer: BCN Commercial |
$182.09
|
| Rate for Payer: Cash Price |
$177.39
|
| Rate for Payer: Cofinity Commercial |
$208.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.39
|
| Rate for Payer: Healthscope Commercial |
$215.09
|
| Rate for Payer: Healthscope Whirlpool |
$221.74
|
| Rate for Payer: Mclaren Commercial |
$199.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.48
|
| Rate for Payer: Nomi Health Commercial |
$181.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.13
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
OP
|
$221.74
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$221.74 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$82.04
|
| Rate for Payer: ASR ASR |
$215.09
|
| Rate for Payer: BCBS Complete |
$88.70
|
| Rate for Payer: BCBS Trust/PPO |
$182.82
|
| Rate for Payer: BCN Commercial |
$182.82
|
| Rate for Payer: Cash Price |
$177.39
|
| Rate for Payer: Cofinity Commercial |
$208.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.39
|
| Rate for Payer: Healthscope Commercial |
$215.09
|
| Rate for Payer: Healthscope Whirlpool |
$221.74
|
| Rate for Payer: Mclaren Commercial |
$199.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.48
|
| Rate for Payer: Nomi Health Commercial |
$181.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.29
|
| Rate for Payer: Priority Health Narrow Network |
$155.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.13
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
IP
|
$1,572.71
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,179.53 |
| Max. Negotiated Rate |
$1,572.71 |
| Rate for Payer: Aetna Commercial |
$1,415.44
|
| Rate for Payer: ASR ASR |
$1,525.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,291.51
|
| Rate for Payer: BCN Commercial |
$1,291.51
|
| Rate for Payer: Cash Price |
$1,258.17
|
| Rate for Payer: Cofinity Commercial |
$1,478.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.17
|
| Rate for Payer: Healthscope Commercial |
$1,525.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,572.71
|
| Rate for Payer: Mclaren Commercial |
$1,415.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.80
|
| Rate for Payer: Nomi Health Commercial |
$1,289.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,179.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.98
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
OP
|
$1,572.71
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$581.90 |
| Max. Negotiated Rate |
$1,572.71 |
| Rate for Payer: Aetna Commercial |
$1,415.44
|
| Rate for Payer: Aetna Medicare |
$581.90
|
| Rate for Payer: ASR ASR |
$1,525.53
|
| Rate for Payer: BCBS Complete |
$629.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.70
|
| Rate for Payer: BCN Commercial |
$1,296.70
|
| Rate for Payer: Cash Price |
$1,258.17
|
| Rate for Payer: Cofinity Commercial |
$1,478.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.17
|
| Rate for Payer: Healthscope Commercial |
$1,525.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,572.71
|
| Rate for Payer: Mclaren Commercial |
$1,415.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,258.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.80
|
| Rate for Payer: Nomi Health Commercial |
$1,289.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,179.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,378.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,102.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.98
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
OP
|
$399.26
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$399.26 |
| Rate for Payer: Aetna Commercial |
$359.33
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$387.28
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$329.19
|
| Rate for Payer: BCN Commercial |
$329.19
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$319.41
|
| Rate for Payer: Cash Price |
$319.41
|
| Rate for Payer: Cofinity Commercial |
$375.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$387.28
|
| Rate for Payer: Healthscope Whirlpool |
$399.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$359.33
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.37
|
| Rate for Payer: Nomi Health Commercial |
$327.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.44
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$349.83
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$279.88
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
IP
|
$399.26
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$299.44 |
| Max. Negotiated Rate |
$399.26 |
| Rate for Payer: Aetna Commercial |
$359.33
|
| Rate for Payer: ASR ASR |
$387.28
|
| Rate for Payer: BCBS Trust/PPO |
$327.87
|
| Rate for Payer: BCN Commercial |
$327.87
|
| Rate for Payer: Cash Price |
$319.41
|
| Rate for Payer: Cofinity Commercial |
$375.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.41
|
| Rate for Payer: Healthscope Commercial |
$387.28
|
| Rate for Payer: Healthscope Whirlpool |
$399.26
|
| Rate for Payer: Mclaren Commercial |
$359.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.37
|
| Rate for Payer: Nomi Health Commercial |
$327.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.35
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.55 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna Commercial |
$442.26
|
| Rate for Payer: ASR ASR |
$476.66
|
| Rate for Payer: BCBS Trust/PPO |
$403.54
|
| Rate for Payer: BCN Commercial |
$403.54
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$476.66
|
| Rate for Payer: Healthscope Whirlpool |
$491.40
|
| Rate for Payer: Mclaren Commercial |
$442.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.43
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna Commercial |
$442.26
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$476.66
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$476.66
|
| Rate for Payer: Healthscope Whirlpool |
$491.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$442.26
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.56
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$344.47
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$414.62 |
| Max. Negotiated Rate |
$552.83 |
| Rate for Payer: Aetna Commercial |
$497.55
|
| Rate for Payer: ASR ASR |
$536.25
|
| Rate for Payer: BCBS Trust/PPO |
$453.98
|
| Rate for Payer: BCN Commercial |
$453.98
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$519.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$536.25
|
| Rate for Payer: Healthscope Whirlpool |
$552.83
|
| Rate for Payer: Mclaren Commercial |
$497.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.49
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
OP
|
$552.83
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$552.83 |
| Rate for Payer: Aetna Commercial |
$497.55
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$536.25
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$455.81
|
| Rate for Payer: BCN Commercial |
$455.81
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$519.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$536.25
|
| Rate for Payer: Healthscope Whirlpool |
$552.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$497.55
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$484.39
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$387.53
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC HIP UNI W PELVIS IF PERFORMED 1 VIEW
|
Facility
|
OP
|
$153.55
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
32000309
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$153.55 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$148.94
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$126.60
|
| Rate for Payer: BCN Commercial |
$126.60
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$122.84
|
| Rate for Payer: Cash Price |
$122.84
|
| Rate for Payer: Cofinity Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$148.94
|
| Rate for Payer: Healthscope Whirlpool |
$153.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$138.19
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.52
|
| Rate for Payer: Nomi Health Commercial |
$125.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.16
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$134.54
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$107.64
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC HIP UNI W PELVIS IF PERFORMED 1 VIEW
|
Facility
|
IP
|
$153.55
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
32000309
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$153.55 |
| Rate for Payer: Aetna Commercial |
$138.19
|
| Rate for Payer: ASR ASR |
$148.94
|
| Rate for Payer: BCBS Trust/PPO |
$126.10
|
| Rate for Payer: BCN Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$122.84
|
| Rate for Payer: Cofinity Commercial |
$144.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.84
|
| Rate for Payer: Healthscope Commercial |
$148.94
|
| Rate for Payer: Healthscope Whirlpool |
$153.55
|
| Rate for Payer: Mclaren Commercial |
$138.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.52
|
| Rate for Payer: Nomi Health Commercial |
$125.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.12
|
|
|
HC HIP UNI W PELVIS IF PERFORMED 2 OR 3 VIEWS
|
Facility
|
IP
|
$307.12
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
32000310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$276.41
|
| Rate for Payer: ASR ASR |
$297.91
|
| Rate for Payer: BCBS Trust/PPO |
$252.21
|
| Rate for Payer: BCN Commercial |
$252.21
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cofinity Commercial |
$288.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.70
|
| Rate for Payer: Healthscope Commercial |
$297.91
|
| Rate for Payer: Healthscope Whirlpool |
$307.12
|
| Rate for Payer: Mclaren Commercial |
$276.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.05
|
| Rate for Payer: Nomi Health Commercial |
$251.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.27
|
|
|
HC HIP UNI W PELVIS IF PERFORMED 2 OR 3 VIEWS
|
Facility
|
OP
|
$307.12
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
32000310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$276.41
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$297.91
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$253.22
|
| Rate for Payer: BCN Commercial |
$253.22
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cofinity Commercial |
$288.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$297.91
|
| Rate for Payer: Healthscope Whirlpool |
$307.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$276.41
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.05
|
| Rate for Payer: Nomi Health Commercial |
$251.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.34
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$269.10
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$215.29
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
