|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$247.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$247.66 |
| Rate for Payer: Aetna Commercial |
$222.89
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$240.23
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$192.01
|
| Rate for Payer: BCN Commercial |
$192.01
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cofinity Commercial |
$232.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$247.66
|
| Rate for Payer: Healthscope Whirlpool |
$240.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$222.89
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.51
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.37
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$175.84
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.94
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
OP
|
$72.45
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna Commercial |
$65.20
|
| Rate for Payer: ASR ASR |
$70.28
|
| Rate for Payer: BCBS Complete |
$28.98
|
| Rate for Payer: BCBS Trust/PPO |
$56.17
|
| Rate for Payer: BCN Commercial |
$56.17
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Healthscope Whirlpool |
$70.28
|
| Rate for Payer: Mclaren Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.93
|
| Rate for Payer: Priority Health Narrow Network |
$51.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.76
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
IP
|
$72.45
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna Commercial |
$65.20
|
| Rate for Payer: ASR ASR |
$70.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.17
|
| Rate for Payer: BCN Commercial |
$56.17
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$68.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Healthscope Whirlpool |
$70.28
|
| Rate for Payer: Mclaren Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.76
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$29.12
|
| Rate for Payer: PHP Medicaid |
$14.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.16
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$36.13
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$45.16 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$29.12
|
| Rate for Payer: PHP Medicaid |
$14.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.16
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$36.13
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$66.03 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$29.12
|
| Rate for Payer: PHP Medicaid |
$14.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.03
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$52.82
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.34
|
| Rate for Payer: Priority Health Narrow Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
IP
|
$228.62
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.03 |
| Max. Negotiated Rate |
$228.62 |
| Rate for Payer: Aetna Commercial |
$205.76
|
| Rate for Payer: ASR ASR |
$221.76
|
| Rate for Payer: BCBS Trust/PPO |
$177.25
|
| Rate for Payer: BCN Commercial |
$177.25
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Cofinity Commercial |
$214.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.90
|
| Rate for Payer: Healthscope Commercial |
$228.62
|
| Rate for Payer: Healthscope Whirlpool |
$221.76
|
| Rate for Payer: Mclaren Commercial |
$205.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.19
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
OP
|
$228.62
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$228.62 |
| Rate for Payer: Aetna Commercial |
$205.76
|
| Rate for Payer: ASR ASR |
$221.76
|
| Rate for Payer: BCBS Complete |
$91.45
|
| Rate for Payer: BCBS Trust/PPO |
$177.25
|
| Rate for Payer: BCN Commercial |
$177.25
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Cofinity Commercial |
$214.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.90
|
| Rate for Payer: Healthscope Commercial |
$228.62
|
| Rate for Payer: Healthscope Whirlpool |
$221.76
|
| Rate for Payer: Mclaren Commercial |
$205.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.04
|
| Rate for Payer: Priority Health Narrow Network |
$162.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.19
|
|
|
HC NEG PRES CANIST 500CC
|
Facility
|
OP
|
$148.49
|
|
| Hospital Charge Code |
27200136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$148.49 |
| Rate for Payer: Aetna Commercial |
$133.64
|
| Rate for Payer: ASR ASR |
$144.04
|
| Rate for Payer: BCBS Complete |
$59.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.12
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: Cash Price |
$118.79
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.79
|
| Rate for Payer: Healthscope Commercial |
$148.49
|
| Rate for Payer: Healthscope Whirlpool |
$144.04
|
| Rate for Payer: Mclaren Commercial |
$133.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.13
|
| Rate for Payer: Priority Health Narrow Network |
$105.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.67
|
|
|
HC NEG PRES CANIST 500CC
|
Facility
|
IP
|
$148.49
|
|
| Hospital Charge Code |
27200136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$148.49 |
| Rate for Payer: Aetna Commercial |
$133.64
|
| Rate for Payer: ASR ASR |
$144.04
|
| Rate for Payer: BCBS Trust/PPO |
$115.12
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: Cash Price |
$118.79
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.79
|
| Rate for Payer: Healthscope Commercial |
$148.49
|
| Rate for Payer: Healthscope Whirlpool |
$144.04
|
| Rate for Payer: Mclaren Commercial |
$133.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.67
|
|
|
HC NEG PRES CLEANSE DRSG MED
|
Facility
|
IP
|
$500.88
|
|
| Hospital Charge Code |
27200229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.62 |
| Max. Negotiated Rate |
$500.88 |
| Rate for Payer: Aetna Commercial |
$450.79
|
| Rate for Payer: ASR ASR |
$485.85
|
| Rate for Payer: BCBS Trust/PPO |
$388.33
|
| Rate for Payer: BCN Commercial |
$388.33
|
| Rate for Payer: Cash Price |
$400.70
|
| Rate for Payer: Cofinity Commercial |
$470.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.70
|
| Rate for Payer: Healthscope Commercial |
$500.88
|
| Rate for Payer: Healthscope Whirlpool |
$485.85
|
| Rate for Payer: Mclaren Commercial |
$450.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.77
|
|
|
HC NEG PRES CLEANSE DRSG MED
|
Facility
|
OP
|
$500.88
|
|
| Hospital Charge Code |
27200229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.35 |
| Max. Negotiated Rate |
$500.88 |
| Rate for Payer: Aetna Commercial |
$450.79
|
| Rate for Payer: ASR ASR |
$485.85
|
| Rate for Payer: BCBS Complete |
$200.35
|
| Rate for Payer: BCBS Trust/PPO |
$388.33
|
| Rate for Payer: BCN Commercial |
$388.33
|
| Rate for Payer: Cash Price |
$400.70
|
| Rate for Payer: Cofinity Commercial |
$470.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.70
|
| Rate for Payer: Healthscope Commercial |
$500.88
|
| Rate for Payer: Healthscope Whirlpool |
$485.85
|
| Rate for Payer: Mclaren Commercial |
$450.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.80
|
| Rate for Payer: Priority Health Narrow Network |
$355.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.77
|
|
|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
OP
|
$530.23
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.11 |
| Max. Negotiated Rate |
$530.23 |
| Rate for Payer: Aetna Commercial |
$477.21
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$514.32
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$411.09
|
| Rate for Payer: BCN Commercial |
$411.09
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$424.18
|
| Rate for Payer: Cash Price |
$424.18
|
| Rate for Payer: Cofinity Commercial |
$498.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$530.23
|
| Rate for Payer: Healthscope Whirlpool |
$514.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$477.21
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$450.70
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.39
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$169.11
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.60
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
IP
|
$530.23
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.16 |
| Max. Negotiated Rate |
$530.23 |
| Rate for Payer: Aetna Commercial |
$477.21
|
| Rate for Payer: ASR ASR |
$514.32
|
| Rate for Payer: BCBS Trust/PPO |
$411.09
|
| Rate for Payer: BCN Commercial |
$411.09
|
| Rate for Payer: Cash Price |
$424.18
|
| Rate for Payer: Cofinity Commercial |
$498.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.18
|
| Rate for Payer: Healthscope Commercial |
$530.23
|
| Rate for Payer: Healthscope Whirlpool |
$514.32
|
| Rate for Payer: Mclaren Commercial |
$477.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$450.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.60
|
|
|
HC NEG PRESSURE WND TX DME UP TO 50 SQ CM
|
Facility
|
OP
|
$419.92
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$419.92 |
| Rate for Payer: Aetna Commercial |
$377.93
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$407.32
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$325.56
|
| Rate for Payer: BCN Commercial |
$325.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$335.94
|
| Rate for Payer: Cash Price |
$335.94
|
| Rate for Payer: Cofinity Commercial |
$394.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$419.92
|
| Rate for Payer: Healthscope Whirlpool |
$407.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$377.93
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.93
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.53
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC NEG PRESSURE WND TX DME UP TO 50 SQ CM
|
Facility
|
IP
|
$419.92
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.94 |
| Max. Negotiated Rate |
$419.92 |
| Rate for Payer: Aetna Commercial |
$377.93
|
| Rate for Payer: ASR ASR |
$407.32
|
| Rate for Payer: BCBS Trust/PPO |
$325.56
|
| Rate for Payer: BCN Commercial |
$325.56
|
| Rate for Payer: Cash Price |
$335.94
|
| Rate for Payer: Cofinity Commercial |
$394.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.94
|
| Rate for Payer: Healthscope Commercial |
$419.92
|
| Rate for Payer: Healthscope Whirlpool |
$407.32
|
| Rate for Payer: Mclaren Commercial |
$377.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.53
|
|
|
HC NEG PRES TRAC PAD
|
Facility
|
IP
|
$72.36
|
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.65 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna Commercial |
$65.12
|
| Rate for Payer: ASR ASR |
$70.19
|
| Rate for Payer: BCBS Trust/PPO |
$56.10
|
| Rate for Payer: BCN Commercial |
$56.10
|
| Rate for Payer: Cash Price |
$57.89
|
| Rate for Payer: Cofinity Commercial |
$68.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.89
|
| Rate for Payer: Healthscope Commercial |
$72.36
|
| Rate for Payer: Healthscope Whirlpool |
$70.19
|
| Rate for Payer: Mclaren Commercial |
$65.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.68
|
|
|
HC NEG PRES TRAC PAD
|
Facility
|
OP
|
$72.36
|
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna Commercial |
$65.12
|
| Rate for Payer: ASR ASR |
$70.19
|
| Rate for Payer: BCBS Complete |
$28.94
|
| Rate for Payer: BCBS Trust/PPO |
$56.10
|
| Rate for Payer: BCN Commercial |
$56.10
|
| Rate for Payer: Cash Price |
$57.89
|
| Rate for Payer: Cofinity Commercial |
$68.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.89
|
| Rate for Payer: Healthscope Commercial |
$72.36
|
| Rate for Payer: Healthscope Whirlpool |
$70.19
|
| Rate for Payer: Mclaren Commercial |
$65.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.85
|
| Rate for Payer: Priority Health Narrow Network |
$51.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.68
|
|
|
HC NEG PRES VF CASSETTE
|
Facility
|
OP
|
$208.70
|
|
| Hospital Charge Code |
27200230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.48 |
| Max. Negotiated Rate |
$208.70 |
| Rate for Payer: Aetna Commercial |
$187.83
|
| Rate for Payer: ASR ASR |
$202.44
|
| Rate for Payer: BCBS Complete |
$83.48
|
| Rate for Payer: BCBS Trust/PPO |
$161.81
|
| Rate for Payer: BCN Commercial |
$161.81
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cofinity Commercial |
$196.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.96
|
| Rate for Payer: Healthscope Commercial |
$208.70
|
| Rate for Payer: Healthscope Whirlpool |
$202.44
|
| Rate for Payer: Mclaren Commercial |
$187.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.92
|
| Rate for Payer: Priority Health Narrow Network |
$148.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.66
|
|
|
HC NEG PRES VF CASSETTE
|
Facility
|
IP
|
$208.70
|
|
| Hospital Charge Code |
27200230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.09 |
| Max. Negotiated Rate |
$208.70 |
| Rate for Payer: Aetna Commercial |
$187.83
|
| Rate for Payer: ASR ASR |
$202.44
|
| Rate for Payer: BCBS Trust/PPO |
$161.81
|
| Rate for Payer: BCN Commercial |
$161.81
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cofinity Commercial |
$196.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.96
|
| Rate for Payer: Healthscope Commercial |
$208.70
|
| Rate for Payer: Healthscope Whirlpool |
$202.44
|
| Rate for Payer: Mclaren Commercial |
$187.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.66
|
|
