|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| 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: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
OP
|
$48.54
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$43.69
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$47.08
|
| Rate for Payer: ASR Commercial |
$47.08
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.75
|
| Rate for Payer: BCN Commercial |
$37.63
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$48.54
|
| Rate for Payer: Healthscope Whirlpool |
$47.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$43.69
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.26
|
| Rate for Payer: Nomi Health Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.53
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$34.03
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
IP
|
$48.54
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$48.54 |
| Rate for Payer: Aetna Commercial |
$43.69
|
| Rate for Payer: ASR ASR |
$47.08
|
| Rate for Payer: ASR Commercial |
$47.08
|
| Rate for Payer: BCBS Trust/PPO |
$39.56
|
| Rate for Payer: BCN Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$48.54
|
| Rate for Payer: Healthscope Whirlpool |
$47.08
|
| Rate for Payer: Mclaren Commercial |
$43.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.26
|
| Rate for Payer: Nomi Health Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.72
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
IP
|
$18.07
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: ASR ASR |
$17.53
|
| Rate for Payer: ASR Commercial |
$17.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Healthscope Whirlpool |
$17.53
|
| Rate for Payer: Mclaren Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: Nomi Health Commercial |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.90
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
OP
|
$18.07
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: ASR ASR |
$17.53
|
| Rate for Payer: ASR Commercial |
$17.53
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.80
|
| Rate for Payer: BCN Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Healthscope Whirlpool |
$17.53
|
| Rate for Payer: Mclaren Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: Nomi Health Commercial |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.90
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
OP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: ASR ASR |
$16.33
|
| Rate for Payer: ASR Commercial |
$16.33
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.33
|
| Rate for Payer: Mclaren Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.75
|
| Rate for Payer: Priority Health Narrow Network |
$11.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.81
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
IP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: ASR ASR |
$16.33
|
| Rate for Payer: ASR Commercial |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.71
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.33
|
| Rate for Payer: Mclaren Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.81
|
|
|
HC HH WET ONES
|
Facility
|
IP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: ASR Commercial |
$15.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.08
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Mclaren Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
HC HH WET ONES
|
Facility
|
OP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: ASR Commercial |
$15.57
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Mclaren Commercial |
$14.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.06
|
| Rate for Payer: Priority Health Narrow Network |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| 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 |
$43.40
|
| Rate for Payer: ASR Commercial |
$43.40
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$36.64
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.90
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$6.91
|
| 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 |
$7.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| 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 |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$20.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP DNSP |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$6.91
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: ASR Commercial |
$43.40
|
| Rate for Payer: BCBS Trust/PPO |
$36.46
|
| Rate for Payer: BCN Commercial |
$34.69
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$42.17
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$42.17 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: ASR ASR |
$40.90
|
| Rate for Payer: ASR Commercial |
$40.90
|
| Rate for Payer: BCBS Trust/PPO |
$34.36
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Healthscope Commercial |
$42.17
|
| Rate for Payer: Healthscope Whirlpool |
$40.90
|
| Rate for Payer: Mclaren Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.84
|
| Rate for Payer: Nomi Health Commercial |
$34.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.11
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$42.17
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$42.17 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$21.09
|
| Rate for Payer: ASR ASR |
$40.90
|
| Rate for Payer: ASR Commercial |
$40.90
|
| Rate for Payer: BCBS Complete |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Healthscope Commercial |
$42.17
|
| Rate for Payer: Healthscope Whirlpool |
$40.90
|
| Rate for Payer: Mclaren Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.84
|
| Rate for Payer: Nomi Health Commercial |
$34.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.11
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
IP
|
$1,043.46
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$678.25 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$939.11
|
| Rate for Payer: ASR ASR |
$1,012.16
|
| Rate for Payer: ASR Commercial |
$1,012.16
|
| Rate for Payer: BCBS Trust/PPO |
$850.32
|
| Rate for Payer: BCN Commercial |
$808.99
|
| Rate for Payer: Cash Price |
$834.77
|
| Rate for Payer: Cofinity Commercial |
$980.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.77
|
| Rate for Payer: Healthscope Commercial |
$1,043.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,012.16
|
| Rate for Payer: Mclaren Commercial |
$939.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.94
|
| Rate for Payer: Nomi Health Commercial |
$855.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$918.24
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
OP
|
$1,043.46
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$417.38 |
| Max. Negotiated Rate |
$1,043.46 |
| Rate for Payer: Aetna Commercial |
$939.11
|
| Rate for Payer: Aetna Medicare |
$521.73
|
| Rate for Payer: ASR ASR |
$1,012.16
|
| Rate for Payer: ASR Commercial |
$1,012.16
|
| Rate for Payer: BCBS Complete |
$417.38
|
| Rate for Payer: BCBS Trust/PPO |
$854.49
|
| Rate for Payer: BCN Commercial |
$808.99
|
| Rate for Payer: Cash Price |
$834.77
|
| Rate for Payer: Cofinity Commercial |
$980.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.77
|
| Rate for Payer: Healthscope Commercial |
$1,043.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,012.16
|
| Rate for Payer: Mclaren Commercial |
$939.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.94
|
| Rate for Payer: Nomi Health Commercial |
$855.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.28
|
| Rate for Payer: Priority Health Narrow Network |
$731.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$918.24
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
OP
|
$217.39
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$217.39 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: Aetna Medicare |
$108.69
|
| Rate for Payer: ASR ASR |
$210.87
|
| Rate for Payer: ASR Commercial |
$210.87
|
| Rate for Payer: BCBS Complete |
$86.96
|
| Rate for Payer: BCBS Trust/PPO |
$178.02
|
| Rate for Payer: BCN Commercial |
$168.54
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cofinity Commercial |
$204.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.91
|
| Rate for Payer: Healthscope Commercial |
$217.39
|
| Rate for Payer: Healthscope Whirlpool |
$210.87
|
| Rate for Payer: Mclaren Commercial |
$195.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.78
|
| Rate for Payer: Nomi Health Commercial |
$178.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.48
|
| Rate for Payer: Priority Health Narrow Network |
$152.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.30
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
IP
|
$217.39
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$217.39 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: ASR ASR |
$210.87
|
| Rate for Payer: ASR Commercial |
$210.87
|
| Rate for Payer: BCBS Trust/PPO |
$177.15
|
| Rate for Payer: BCN Commercial |
$168.54
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cofinity Commercial |
$204.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.91
|
| Rate for Payer: Healthscope Commercial |
$217.39
|
| Rate for Payer: Healthscope Whirlpool |
$210.87
|
| Rate for Payer: Mclaren Commercial |
$195.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.78
|
| Rate for Payer: Nomi Health Commercial |
$178.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.30
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
OP
|
$1,541.87
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$616.75 |
| Max. Negotiated Rate |
$1,541.87 |
| Rate for Payer: Aetna Commercial |
$1,387.68
|
| Rate for Payer: Aetna Medicare |
$770.93
|
| Rate for Payer: ASR ASR |
$1,495.61
|
| Rate for Payer: ASR Commercial |
$1,495.61
|
| Rate for Payer: BCBS Complete |
$616.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.64
|
| Rate for Payer: BCN Commercial |
$1,195.41
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cofinity Commercial |
$1,449.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,233.50
|
| Rate for Payer: Healthscope Commercial |
$1,541.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,495.61
|
| Rate for Payer: Mclaren Commercial |
$1,387.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,310.59
|
| Rate for Payer: Nomi Health Commercial |
$1,264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.85
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
IP
|
$1,541.87
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,002.22 |
| Max. Negotiated Rate |
$1,541.87 |
| Rate for Payer: Aetna Commercial |
$1,387.68
|
| Rate for Payer: ASR ASR |
$1,495.61
|
| Rate for Payer: ASR Commercial |
$1,495.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.47
|
| Rate for Payer: BCN Commercial |
$1,195.41
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cofinity Commercial |
$1,449.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,233.50
|
| Rate for Payer: Healthscope Commercial |
$1,541.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,495.61
|
| Rate for Payer: Mclaren Commercial |
$1,387.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,310.59
|
| Rate for Payer: Nomi Health Commercial |
$1,264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.85
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
IP
|
$391.43
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.43 |
| Max. Negotiated Rate |
$391.43 |
| Rate for Payer: Aetna Commercial |
$352.29
|
| Rate for Payer: ASR ASR |
$379.69
|
| Rate for Payer: ASR Commercial |
$379.69
|
| Rate for Payer: BCBS Trust/PPO |
$318.98
|
| Rate for Payer: BCN Commercial |
$303.48
|
| Rate for Payer: Cash Price |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$367.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.14
|
| Rate for Payer: Healthscope Commercial |
$391.43
|
| Rate for Payer: Healthscope Whirlpool |
$379.69
|
| Rate for Payer: Mclaren Commercial |
$352.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.72
|
| Rate for Payer: Nomi Health Commercial |
$320.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.46
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
OP
|
$391.43
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$391.43 |
| Rate for Payer: Aetna Commercial |
$352.29
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$379.69
|
| Rate for Payer: ASR Commercial |
$379.69
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$320.54
|
| Rate for Payer: BCN Commercial |
$303.48
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$313.14
|
| Rate for Payer: Cash Price |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$367.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$391.43
|
| Rate for Payer: Healthscope Whirlpool |
$379.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$352.29
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.72
|
| Rate for Payer: Nomi Health Commercial |
$320.97
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.97
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$274.39
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$394.51
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.12
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$337.71
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Trust/PPO |
$392.59
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
OP
|
$541.99
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$541.99 |
| Rate for Payer: Aetna Commercial |
$487.79
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$525.73
|
| Rate for Payer: ASR Commercial |
$525.73
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$443.84
|
| Rate for Payer: BCN Commercial |
$420.20
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$509.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$541.99
|
| Rate for Payer: Healthscope Whirlpool |
$525.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$487.79
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.89
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$379.93
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
IP
|
$541.99
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$541.99 |
| Rate for Payer: Aetna Commercial |
$487.79
|
| Rate for Payer: ASR ASR |
$525.73
|
| Rate for Payer: ASR Commercial |
$525.73
|
| Rate for Payer: BCBS Trust/PPO |
$441.67
|
| Rate for Payer: BCN Commercial |
$420.20
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$509.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Healthscope Commercial |
$541.99
|
| Rate for Payer: Healthscope Whirlpool |
$525.73
|
| Rate for Payer: Mclaren Commercial |
$487.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.95
|
|
