|
HC KIT ATS
|
Facility
|
IP
|
$156.06
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC KIT DILATOR VASC
|
Facility
|
IP
|
$546.21
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$409.66 |
| Max. Negotiated Rate |
$546.21 |
| Rate for Payer: Aetna Commercial |
$491.59
|
| Rate for Payer: ASR ASR |
$529.82
|
| Rate for Payer: BCBS Trust/PPO |
$448.55
|
| Rate for Payer: BCN Commercial |
$448.55
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$513.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Healthscope Commercial |
$529.82
|
| Rate for Payer: Healthscope Whirlpool |
$546.21
|
| Rate for Payer: Mclaren Commercial |
$491.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$447.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.66
|
|
|
HC KIT DILATOR VASC
|
Facility
|
OP
|
$546.21
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$546.21 |
| Rate for Payer: Aetna Commercial |
$491.59
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: ASR ASR |
$529.82
|
| Rate for Payer: BCBS Complete |
$218.48
|
| Rate for Payer: BCBS Trust/PPO |
$450.35
|
| Rate for Payer: BCN Commercial |
$450.35
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$513.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Healthscope Commercial |
$529.82
|
| Rate for Payer: Healthscope Whirlpool |
$546.21
|
| Rate for Payer: Mclaren Commercial |
$491.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$447.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$478.59
|
| Rate for Payer: Priority Health Narrow Network |
$382.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.66
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$125.68
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$94.26 |
| Max. Negotiated Rate |
$125.68 |
| Rate for Payer: Aetna Commercial |
$113.11
|
| Rate for Payer: ASR ASR |
$121.91
|
| Rate for Payer: BCBS Trust/PPO |
$103.21
|
| Rate for Payer: BCN Commercial |
$103.21
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Cofinity Commercial |
$118.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.54
|
| Rate for Payer: Healthscope Commercial |
$121.91
|
| Rate for Payer: Healthscope Whirlpool |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$113.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.83
|
| Rate for Payer: Nomi Health Commercial |
$103.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.60
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$125.68
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$143.46 |
| Rate for Payer: Aetna Commercial |
$113.11
|
| Rate for Payer: Aetna Medicare |
$7.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.66
|
| Rate for Payer: ASR ASR |
$121.91
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: BCBS MAPPO |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$103.62
|
| Rate for Payer: BCN Commercial |
$103.62
|
| Rate for Payer: BCN Medicare Advantage |
$7.73
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Cofinity Commercial |
$118.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.73
|
| Rate for Payer: Healthscope Commercial |
$121.91
|
| Rate for Payer: Healthscope Whirlpool |
$125.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.73
|
| Rate for Payer: Mclaren Commercial |
$113.11
|
| Rate for Payer: Mclaren Medicaid |
$7.73
|
| Rate for Payer: Mclaren Medicare |
$7.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.12
|
| Rate for Payer: Meridian Medicaid |
$4.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.83
|
| Rate for Payer: Nomi Health Commercial |
$103.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.26
|
| Rate for Payer: PACE Medicare |
$7.34
|
| Rate for Payer: PACE SWMI |
$7.73
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicaid |
$4.14
|
| Rate for Payer: PHP Medicare Advantage |
$7.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.46
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow Network |
$114.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.73
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicaid |
$4.04
|
| Rate for Payer: UHCCP DNSP |
$7.73
|
| Rate for Payer: UHCCP Medicaid |
$4.04
|
| Rate for Payer: VA VA |
$7.73
|
|
|
HC KOH PREPARATION
|
Facility
|
OP
|
$24.41
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$48.43 |
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$23.68
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$22.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$21.97
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.43
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$38.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC KOH PREPARATION
|
Facility
|
IP
|
$24.41
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: ASR ASR |
$23.68
|
| Rate for Payer: BCBS Trust/PPO |
$20.05
|
| Rate for Payer: BCN Commercial |
$20.05
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$22.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Mclaren Commercial |
$21.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.48
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
IP
|
$2,995.16
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,246.37 |
| Max. Negotiated Rate |
$2,995.16 |
| Rate for Payer: Aetna Commercial |
$2,695.64
|
| Rate for Payer: ASR ASR |
$2,905.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.63
|
| Rate for Payer: BCN Commercial |
$2,459.63
|
| Rate for Payer: Cash Price |
$2,396.13
|
| Rate for Payer: Cofinity Commercial |
$2,815.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.13
|
| Rate for Payer: Healthscope Commercial |
$2,905.31
|
| Rate for Payer: Healthscope Whirlpool |
$2,995.16
|
| Rate for Payer: Mclaren Commercial |
$2,695.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,545.89
|
| Rate for Payer: Nomi Health Commercial |
$2,456.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,246.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,635.74
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
OP
|
$2,995.16
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$991.14 |
| Max. Negotiated Rate |
$2,995.16 |
| Rate for Payer: Aetna Commercial |
$2,695.64
|
| Rate for Payer: Aetna Medicare |
$1,108.21
|
| Rate for Payer: ASR ASR |
$2,905.31
|
| Rate for Payer: BCBS Complete |
$1,198.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,469.51
|
| Rate for Payer: BCN Commercial |
$2,469.51
|
| Rate for Payer: Cash Price |
$2,396.13
|
| Rate for Payer: Cash Price |
$2,396.13
|
| Rate for Payer: Cofinity Commercial |
$2,815.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.13
|
| Rate for Payer: Healthscope Commercial |
$2,905.31
|
| Rate for Payer: Healthscope Whirlpool |
$2,995.16
|
| Rate for Payer: Mclaren Commercial |
$2,695.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,396.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,545.89
|
| Rate for Payer: Nomi Health Commercial |
$2,456.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,246.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,238.93
|
| Rate for Payer: Priority Health Narrow Network |
$991.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,635.74
|
|
|
HC LAAC IMPLANT
|
Facility
|
OP
|
$18,942.56
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,008.75 |
| Max. Negotiated Rate |
$18,942.56 |
| Rate for Payer: Aetna Commercial |
$17,048.30
|
| Rate for Payer: Aetna Medicare |
$7,008.75
|
| Rate for Payer: ASR ASR |
$18,374.28
|
| Rate for Payer: BCBS Complete |
$7,577.02
|
| Rate for Payer: BCBS Trust/PPO |
$15,618.14
|
| Rate for Payer: BCN Commercial |
$15,618.14
|
| Rate for Payer: Cash Price |
$15,154.05
|
| Rate for Payer: Cofinity Commercial |
$17,806.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,154.05
|
| Rate for Payer: Healthscope Commercial |
$18,374.28
|
| Rate for Payer: Healthscope Whirlpool |
$18,942.56
|
| Rate for Payer: Mclaren Commercial |
$17,048.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,154.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,101.18
|
| Rate for Payer: Nomi Health Commercial |
$15,532.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,206.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,597.47
|
| Rate for Payer: Priority Health Narrow Network |
$13,278.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,669.45
|
|
|
HC LAAC IMPLANT
|
Facility
|
IP
|
$18,942.56
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,206.92 |
| Max. Negotiated Rate |
$18,942.56 |
| Rate for Payer: Aetna Commercial |
$17,048.30
|
| Rate for Payer: ASR ASR |
$18,374.28
|
| Rate for Payer: BCBS Trust/PPO |
$15,555.63
|
| Rate for Payer: BCN Commercial |
$15,555.63
|
| Rate for Payer: Cash Price |
$15,154.05
|
| Rate for Payer: Cofinity Commercial |
$17,806.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,154.05
|
| Rate for Payer: Healthscope Commercial |
$18,374.28
|
| Rate for Payer: Healthscope Whirlpool |
$18,942.56
|
| Rate for Payer: Mclaren Commercial |
$17,048.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,101.18
|
| Rate for Payer: Nomi Health Commercial |
$15,532.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,206.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,669.45
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,561.63
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,171.22 |
| Max. Negotiated Rate |
$1,561.63 |
| Rate for Payer: Aetna Commercial |
$1,405.47
|
| Rate for Payer: ASR ASR |
$1,514.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,282.41
|
| Rate for Payer: BCN Commercial |
$1,282.41
|
| Rate for Payer: Cash Price |
$1,249.30
|
| Rate for Payer: Cofinity Commercial |
$1,467.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.30
|
| Rate for Payer: Healthscope Commercial |
$1,514.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,561.63
|
| Rate for Payer: Mclaren Commercial |
$1,405.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.39
|
| Rate for Payer: Nomi Health Commercial |
$1,280.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,374.23
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,561.63
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$577.80 |
| Max. Negotiated Rate |
$1,561.63 |
| Rate for Payer: Aetna Commercial |
$1,405.47
|
| Rate for Payer: Aetna Medicare |
$577.80
|
| Rate for Payer: ASR ASR |
$1,514.78
|
| Rate for Payer: BCBS Complete |
$624.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.56
|
| Rate for Payer: BCN Commercial |
$1,287.56
|
| Rate for Payer: Cash Price |
$1,249.30
|
| Rate for Payer: Cofinity Commercial |
$1,467.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.30
|
| Rate for Payer: Healthscope Commercial |
$1,514.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,561.63
|
| Rate for Payer: Mclaren Commercial |
$1,405.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,249.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.39
|
| Rate for Payer: Nomi Health Commercial |
$1,280.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,368.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,094.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,374.23
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,082.24
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$770.43 |
| Max. Negotiated Rate |
$2,082.24 |
| Rate for Payer: Aetna Commercial |
$1,874.02
|
| Rate for Payer: Aetna Medicare |
$770.43
|
| Rate for Payer: ASR ASR |
$2,019.77
|
| Rate for Payer: BCBS Complete |
$832.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.81
|
| Rate for Payer: BCN Commercial |
$1,716.81
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Commercial |
$1,957.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Healthscope Commercial |
$2,019.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.24
|
| Rate for Payer: Mclaren Commercial |
$1,874.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,665.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Nomi Health Commercial |
$1,707.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,824.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,832.37
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,082.24
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,561.68 |
| Max. Negotiated Rate |
$2,082.24 |
| Rate for Payer: Aetna Commercial |
$1,874.02
|
| Rate for Payer: ASR ASR |
$2,019.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.94
|
| Rate for Payer: BCN Commercial |
$1,709.94
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Commercial |
$1,957.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Healthscope Commercial |
$2,019.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.24
|
| Rate for Payer: Mclaren Commercial |
$1,874.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Nomi Health Commercial |
$1,707.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,832.37
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,602.68
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,952.01 |
| Max. Negotiated Rate |
$2,602.68 |
| Rate for Payer: Aetna Commercial |
$2,342.41
|
| Rate for Payer: ASR ASR |
$2,524.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,137.32
|
| Rate for Payer: BCN Commercial |
$2,137.32
|
| Rate for Payer: Cash Price |
$2,082.14
|
| Rate for Payer: Cofinity Commercial |
$2,446.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,082.14
|
| Rate for Payer: Healthscope Commercial |
$2,524.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,602.68
|
| Rate for Payer: Mclaren Commercial |
$2,342.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.28
|
| Rate for Payer: Nomi Health Commercial |
$2,134.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,290.36
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,602.68
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$962.99 |
| Max. Negotiated Rate |
$2,602.68 |
| Rate for Payer: Aetna Commercial |
$2,342.41
|
| Rate for Payer: Aetna Medicare |
$962.99
|
| Rate for Payer: ASR ASR |
$2,524.60
|
| Rate for Payer: BCBS Complete |
$1,041.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,145.91
|
| Rate for Payer: BCN Commercial |
$2,145.91
|
| Rate for Payer: Cash Price |
$2,082.14
|
| Rate for Payer: Cofinity Commercial |
$2,446.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,082.14
|
| Rate for Payer: Healthscope Commercial |
$2,524.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,602.68
|
| Rate for Payer: Mclaren Commercial |
$2,342.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.28
|
| Rate for Payer: Nomi Health Commercial |
$2,134.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,280.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,824.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,290.36
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,123.27
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,342.45 |
| Max. Negotiated Rate |
$3,123.27 |
| Rate for Payer: Aetna Commercial |
$2,810.94
|
| Rate for Payer: ASR ASR |
$3,029.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,564.83
|
| Rate for Payer: BCN Commercial |
$2,564.83
|
| Rate for Payer: Cash Price |
$2,498.62
|
| Rate for Payer: Cofinity Commercial |
$2,935.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,498.62
|
| Rate for Payer: Healthscope Commercial |
$3,029.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,123.27
|
| Rate for Payer: Mclaren Commercial |
$2,810.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,654.78
|
| Rate for Payer: Nomi Health Commercial |
$2,561.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,342.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,748.48
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
OP
|
$3,123.27
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,155.61 |
| Max. Negotiated Rate |
$3,123.27 |
| Rate for Payer: Aetna Commercial |
$2,810.94
|
| Rate for Payer: Aetna Medicare |
$1,155.61
|
| Rate for Payer: ASR ASR |
$3,029.57
|
| Rate for Payer: BCBS Complete |
$1,249.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,575.14
|
| Rate for Payer: BCN Commercial |
$2,575.14
|
| Rate for Payer: Cash Price |
$2,498.62
|
| Rate for Payer: Cofinity Commercial |
$2,935.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,498.62
|
| Rate for Payer: Healthscope Commercial |
$3,029.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,123.27
|
| Rate for Payer: Mclaren Commercial |
$2,810.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,498.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,654.78
|
| Rate for Payer: Nomi Health Commercial |
$2,561.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,342.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,736.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,189.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,748.48
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
IP
|
$4,681.34
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,511.01 |
| Max. Negotiated Rate |
$4,681.34 |
| Rate for Payer: Aetna Commercial |
$4,213.21
|
| Rate for Payer: ASR ASR |
$4,540.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,844.32
|
| Rate for Payer: BCN Commercial |
$3,844.32
|
| Rate for Payer: Cash Price |
$3,745.07
|
| Rate for Payer: Cofinity Commercial |
$4,400.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.07
|
| Rate for Payer: Healthscope Commercial |
$4,540.90
|
| Rate for Payer: Healthscope Whirlpool |
$4,681.34
|
| Rate for Payer: Mclaren Commercial |
$4,213.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.14
|
| Rate for Payer: Nomi Health Commercial |
$3,838.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,119.58
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
OP
|
$4,681.34
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,732.10 |
| Max. Negotiated Rate |
$4,681.34 |
| Rate for Payer: Aetna Commercial |
$4,213.21
|
| Rate for Payer: Aetna Medicare |
$1,732.10
|
| Rate for Payer: ASR ASR |
$4,540.90
|
| Rate for Payer: BCBS Complete |
$1,872.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,859.76
|
| Rate for Payer: BCN Commercial |
$3,859.76
|
| Rate for Payer: Cash Price |
$3,745.07
|
| Rate for Payer: Cofinity Commercial |
$4,400.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.07
|
| Rate for Payer: Healthscope Commercial |
$4,540.90
|
| Rate for Payer: Healthscope Whirlpool |
$4,681.34
|
| Rate for Payer: Mclaren Commercial |
$4,213.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,745.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.14
|
| Rate for Payer: Nomi Health Commercial |
$3,838.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,101.79
|
| Rate for Payer: Priority Health Narrow Network |
$3,281.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,119.58
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
OP
|
$6,925.85
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,562.56 |
| Max. Negotiated Rate |
$6,925.85 |
| Rate for Payer: Aetna Commercial |
$6,233.27
|
| Rate for Payer: Aetna Medicare |
$2,562.56
|
| Rate for Payer: ASR ASR |
$6,718.07
|
| Rate for Payer: BCBS Complete |
$2,770.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,710.36
|
| Rate for Payer: BCN Commercial |
$5,710.36
|
| Rate for Payer: Cash Price |
$5,540.68
|
| Rate for Payer: Cofinity Commercial |
$6,510.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,540.68
|
| Rate for Payer: Healthscope Commercial |
$6,718.07
|
| Rate for Payer: Healthscope Whirlpool |
$6,925.85
|
| Rate for Payer: Mclaren Commercial |
$6,233.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,540.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,886.97
|
| Rate for Payer: Nomi Health Commercial |
$5,679.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,194.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,068.43
|
| Rate for Payer: Priority Health Narrow Network |
$4,855.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,094.75
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
IP
|
$6,925.85
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$5,194.39 |
| Max. Negotiated Rate |
$6,925.85 |
| Rate for Payer: Aetna Commercial |
$6,233.27
|
| Rate for Payer: ASR ASR |
$6,718.07
|
| Rate for Payer: BCBS Trust/PPO |
$5,687.51
|
| Rate for Payer: BCN Commercial |
$5,687.51
|
| Rate for Payer: Cash Price |
$5,540.68
|
| Rate for Payer: Cofinity Commercial |
$6,510.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,540.68
|
| Rate for Payer: Healthscope Commercial |
$6,718.07
|
| Rate for Payer: Healthscope Whirlpool |
$6,925.85
|
| Rate for Payer: Mclaren Commercial |
$6,233.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,886.97
|
| Rate for Payer: Nomi Health Commercial |
$5,679.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,094.75
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
IP
|
$4,096.05
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,072.04 |
| Max. Negotiated Rate |
$4,096.05 |
| Rate for Payer: Aetna Commercial |
$3,686.45
|
| Rate for Payer: Aetna Commercial |
$5,529.67
|
| Rate for Payer: ASR ASR |
$3,973.17
|
| Rate for Payer: ASR ASR |
$5,959.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,363.68
|
| Rate for Payer: BCBS Trust/PPO |
$5,045.52
|
| Rate for Payer: BCN Commercial |
$3,363.68
|
| Rate for Payer: BCN Commercial |
$5,045.52
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cofinity Commercial |
$5,775.44
|
| Rate for Payer: Cofinity Commercial |
$3,850.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,915.26
|
| Rate for Payer: Healthscope Commercial |
$3,973.17
|
| Rate for Payer: Healthscope Commercial |
$5,959.76
|
| Rate for Payer: Healthscope Whirlpool |
$6,144.08
|
| Rate for Payer: Healthscope Whirlpool |
$4,096.05
|
| Rate for Payer: Mclaren Commercial |
$5,529.67
|
| Rate for Payer: Mclaren Commercial |
$3,686.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,222.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,481.64
|
| Rate for Payer: Nomi Health Commercial |
$5,038.15
|
| Rate for Payer: Nomi Health Commercial |
$3,358.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,072.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,608.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,406.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,604.52
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
OP
|
$4,096.05
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$4,096.05 |
| Rate for Payer: Aetna Commercial |
$3,686.45
|
| Rate for Payer: Aetna Commercial |
$5,529.67
|
| Rate for Payer: Aetna Medicare |
$1,546.00
|
| Rate for Payer: Aetna Medicare |
$1,546.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: ASR ASR |
$5,959.76
|
| Rate for Payer: ASR ASR |
$3,973.17
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,065.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,377.19
|
| Rate for Payer: BCN Commercial |
$3,377.19
|
| Rate for Payer: BCN Commercial |
$5,065.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cofinity Commercial |
$3,850.29
|
| Rate for Payer: Cofinity Commercial |
$5,775.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,915.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$3,973.17
|
| Rate for Payer: Healthscope Commercial |
$5,959.76
|
| Rate for Payer: Healthscope Whirlpool |
$6,144.08
|
| Rate for Payer: Healthscope Whirlpool |
$4,096.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,546.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,546.00
|
| Rate for Payer: Mclaren Commercial |
$5,529.67
|
| Rate for Payer: Mclaren Commercial |
$3,686.45
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$849.06
|
| Rate for Payer: Meridian Medicaid |
$849.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,222.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,481.64
|
| Rate for Payer: Nomi Health Commercial |
$3,358.76
|
| Rate for Payer: Nomi Health Commercial |
$5,038.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,608.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,072.04
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$1,700.60
|
| Rate for Payer: PHP Commercial |
$1,700.60
|
| Rate for Payer: PHP Medicaid |
$828.66
|
| Rate for Payer: PHP Medicaid |
$828.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,588.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,383.44
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,871.33
|
| Rate for Payer: Priority Health Narrow Network |
$4,307.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,604.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,406.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$2,396.30
|
| Rate for Payer: UHC Exchange |
$2,396.30
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP DNSP |
$1,546.00
|
| Rate for Payer: UHCCP DNSP |
$1,546.00
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
| Rate for Payer: VA VA |
$1,546.00
|
|
