|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: ASR ASR |
$5.04
|
| Rate for Payer: ASR Commercial |
$5.04
|
| Rate for Payer: BCBS Trust/PPO |
$4.24
|
| Rate for Payer: BCN Commercial |
$4.03
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Healthscope Whirlpool |
$5.04
|
| Rate for Payer: Mclaren Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.58
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: ASR ASR |
$5.04
|
| Rate for Payer: ASR Commercial |
$5.04
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Commercial |
$4.03
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Healthscope Whirlpool |
$5.04
|
| Rate for Payer: Mclaren Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.56
|
| Rate for Payer: Priority Health Narrow Network |
$3.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.58
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
IP
|
$500.32
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.21 |
| Max. Negotiated Rate |
$500.32 |
| Rate for Payer: Aetna Commercial |
$450.29
|
| Rate for Payer: ASR ASR |
$485.31
|
| Rate for Payer: ASR Commercial |
$485.31
|
| Rate for Payer: BCBS Trust/PPO |
$407.71
|
| Rate for Payer: BCN Commercial |
$387.90
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$500.32
|
| Rate for Payer: Healthscope Whirlpool |
$485.31
|
| Rate for Payer: Mclaren Commercial |
$450.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.28
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
OP
|
$500.32
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$500.32 |
| Rate for Payer: Aetna Commercial |
$450.29
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$485.31
|
| Rate for Payer: ASR Commercial |
$485.31
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$409.71
|
| Rate for Payer: BCN Commercial |
$387.90
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$500.32
|
| Rate for Payer: Healthscope Whirlpool |
$485.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$450.29
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.38
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$350.72
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$423.24
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.11 |
| Max. Negotiated Rate |
$423.24 |
| Rate for Payer: Aetna Commercial |
$380.92
|
| Rate for Payer: ASR ASR |
$410.54
|
| Rate for Payer: ASR Commercial |
$410.54
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$328.14
|
| Rate for Payer: Cash Price |
$338.59
|
| Rate for Payer: Cofinity Commercial |
$397.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.59
|
| Rate for Payer: Healthscope Commercial |
$423.24
|
| Rate for Payer: Healthscope Whirlpool |
$410.54
|
| Rate for Payer: Mclaren Commercial |
$380.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.75
|
| Rate for Payer: Nomi Health Commercial |
$347.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.45
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$423.24
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$459.84 |
| Rate for Payer: Aetna Commercial |
$380.92
|
| Rate for Payer: Aetna Medicare |
$296.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: ASR ASR |
$410.54
|
| Rate for Payer: ASR Commercial |
$410.54
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCBS Trust/PPO |
$346.59
|
| Rate for Payer: BCN Commercial |
$328.14
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$338.59
|
| Rate for Payer: Cash Price |
$338.59
|
| Rate for Payer: Cofinity Commercial |
$397.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$423.24
|
| Rate for Payer: Healthscope Whirlpool |
$410.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$296.67
|
| Rate for Payer: Mclaren Commercial |
$380.92
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.75
|
| Rate for Payer: Nomi Health Commercial |
$347.06
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$326.34
|
| Rate for Payer: PHP Medicaid |
$159.02
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.84
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health Narrow Network |
$296.69
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Exchange |
$459.84
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP DNSP |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$159.02
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$576.31
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.60 |
| Max. Negotiated Rate |
$576.31 |
| Rate for Payer: Aetna Commercial |
$518.68
|
| Rate for Payer: ASR ASR |
$559.02
|
| Rate for Payer: ASR Commercial |
$559.02
|
| Rate for Payer: BCBS Trust/PPO |
$469.64
|
| Rate for Payer: BCN Commercial |
$446.81
|
| Rate for Payer: Cash Price |
$461.05
|
| Rate for Payer: Cofinity Commercial |
$541.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.05
|
| Rate for Payer: Healthscope Commercial |
$576.31
|
| Rate for Payer: Healthscope Whirlpool |
$559.02
|
| Rate for Payer: Mclaren Commercial |
$518.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.86
|
| Rate for Payer: Nomi Health Commercial |
$472.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.15
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$576.31
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$576.31 |
| Rate for Payer: Aetna Commercial |
$518.68
|
| Rate for Payer: Aetna Medicare |
$226.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: ASR ASR |
$559.02
|
| Rate for Payer: ASR Commercial |
$559.02
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCBS Trust/PPO |
$471.94
|
| Rate for Payer: BCN Commercial |
$446.81
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Cash Price |
$461.05
|
| Rate for Payer: Cash Price |
$461.05
|
| Rate for Payer: Cofinity Commercial |
$541.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$576.31
|
| Rate for Payer: Healthscope Whirlpool |
$559.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$226.48
|
| Rate for Payer: Mclaren Commercial |
$518.68
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.86
|
| Rate for Payer: Nomi Health Commercial |
$472.57
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Commercial |
$249.13
|
| Rate for Payer: PHP Medicaid |
$121.39
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.96
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Priority Health Narrow Network |
$403.99
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$351.04
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP DNSP |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
OP
|
$199.25
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$199.25 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$193.27
|
| Rate for Payer: ASR Commercial |
$193.27
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$163.17
|
| Rate for Payer: BCN Commercial |
$154.48
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$159.40
|
| Rate for Payer: Cash Price |
$159.40
|
| Rate for Payer: Cofinity Commercial |
$187.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$199.25
|
| Rate for Payer: Healthscope Whirlpool |
$193.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$179.32
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.36
|
| Rate for Payer: Nomi Health Commercial |
$163.38
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.58
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$139.67
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
IP
|
$199.25
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.51 |
| Max. Negotiated Rate |
$199.25 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: ASR ASR |
$193.27
|
| Rate for Payer: ASR Commercial |
$193.27
|
| Rate for Payer: BCBS Trust/PPO |
$162.37
|
| Rate for Payer: BCN Commercial |
$154.48
|
| Rate for Payer: Cash Price |
$159.40
|
| Rate for Payer: Cofinity Commercial |
$187.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.40
|
| Rate for Payer: Healthscope Commercial |
$199.25
|
| Rate for Payer: Healthscope Whirlpool |
$193.27
|
| Rate for Payer: Mclaren Commercial |
$179.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.36
|
| Rate for Payer: Nomi Health Commercial |
$163.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.34
|
|
|
HC INSERT INFUSION PUMP
|
Facility
|
IP
|
$1,073.45
|
|
| Hospital Charge Code |
36100438
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$697.74 |
| Max. Negotiated Rate |
$1,073.45 |
| Rate for Payer: Aetna Commercial |
$966.11
|
| Rate for Payer: ASR ASR |
$1,041.25
|
| Rate for Payer: ASR Commercial |
$1,041.25
|
| Rate for Payer: BCBS Trust/PPO |
$874.75
|
| Rate for Payer: BCN Commercial |
$832.25
|
| Rate for Payer: Cash Price |
$858.76
|
| Rate for Payer: Cofinity Commercial |
$1,009.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.76
|
| Rate for Payer: Healthscope Commercial |
$1,073.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.25
|
| Rate for Payer: Mclaren Commercial |
$966.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.43
|
| Rate for Payer: Nomi Health Commercial |
$880.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.64
|
|
|
HC INSERT INFUSION PUMP
|
Facility
|
OP
|
$1,073.45
|
|
| Hospital Charge Code |
36100438
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.38 |
| Max. Negotiated Rate |
$1,073.45 |
| Rate for Payer: Aetna Commercial |
$966.11
|
| Rate for Payer: Aetna Medicare |
$536.73
|
| Rate for Payer: ASR ASR |
$1,041.25
|
| Rate for Payer: ASR Commercial |
$1,041.25
|
| Rate for Payer: BCBS Complete |
$429.38
|
| Rate for Payer: BCBS Trust/PPO |
$879.05
|
| Rate for Payer: BCN Commercial |
$832.25
|
| Rate for Payer: Cash Price |
$858.76
|
| Rate for Payer: Cofinity Commercial |
$1,009.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.76
|
| Rate for Payer: Healthscope Commercial |
$1,073.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.25
|
| Rate for Payer: Mclaren Commercial |
$966.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.43
|
| Rate for Payer: Nomi Health Commercial |
$880.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.56
|
| Rate for Payer: Priority Health Narrow Network |
$752.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.64
|
|
|
HC INSERTION CECO TUBE W FLUORO
|
Facility
|
OP
|
$1,470.15
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
36100227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$1,323.13
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$1,426.05
|
| Rate for Payer: ASR Commercial |
$1,426.05
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.91
|
| Rate for Payer: BCN Commercial |
$1,139.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,176.12
|
| Rate for Payer: Cash Price |
$1,176.12
|
| Rate for Payer: Cofinity Commercial |
$1,381.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,470.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,426.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,323.13
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.63
|
| Rate for Payer: Nomi Health Commercial |
$1,205.52
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,288.15
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
HC INSERTION CECO TUBE W FLUORO
|
Facility
|
IP
|
$1,470.15
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
36100227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$955.60 |
| Max. Negotiated Rate |
$1,470.15 |
| Rate for Payer: Aetna Commercial |
$1,323.13
|
| Rate for Payer: ASR ASR |
$1,426.05
|
| Rate for Payer: ASR Commercial |
$1,426.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.03
|
| Rate for Payer: BCN Commercial |
$1,139.81
|
| Rate for Payer: Cash Price |
$1,176.12
|
| Rate for Payer: Cofinity Commercial |
$1,381.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.12
|
| Rate for Payer: Healthscope Commercial |
$1,470.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,426.05
|
| Rate for Payer: Mclaren Commercial |
$1,323.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.63
|
| Rate for Payer: Nomi Health Commercial |
$1,205.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.73
|
|
|
HC INSERTION D OR J TUBE W FLUORO
|
Facility
|
OP
|
$1,521.35
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
36100226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$988.88 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$1,369.21
|
| Rate for Payer: Aetna Medicare |
$1,850.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: ASR ASR |
$1,475.71
|
| Rate for Payer: ASR Commercial |
$1,475.71
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.83
|
| Rate for Payer: BCN Commercial |
$1,179.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$1,217.08
|
| Rate for Payer: Cash Price |
$1,217.08
|
| Rate for Payer: Cofinity Commercial |
$1,430.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,521.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,475.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$1,369.21
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.15
|
| Rate for Payer: Nomi Health Commercial |
$1,247.51
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$2,035.11
|
| Rate for Payer: PHP Medicaid |
$991.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.01
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,066.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$2,867.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP DNSP |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
HC INSERTION D OR J TUBE W FLUORO
|
Facility
|
IP
|
$1,521.35
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
36100226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$988.88 |
| Max. Negotiated Rate |
$1,521.35 |
| Rate for Payer: Aetna Commercial |
$1,369.21
|
| Rate for Payer: ASR ASR |
$1,475.71
|
| Rate for Payer: ASR Commercial |
$1,475.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.75
|
| Rate for Payer: BCN Commercial |
$1,179.50
|
| Rate for Payer: Cash Price |
$1,217.08
|
| Rate for Payer: Cofinity Commercial |
$1,430.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.08
|
| Rate for Payer: Healthscope Commercial |
$1,521.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,475.71
|
| Rate for Payer: Mclaren Commercial |
$1,369.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.15
|
| Rate for Payer: Nomi Health Commercial |
$1,247.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.79
|
|
|
HC INSERTION DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$166.19
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
76100179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$194.85 |
| Rate for Payer: Aetna Commercial |
$149.57
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$161.20
|
| Rate for Payer: ASR Commercial |
$161.20
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$136.09
|
| Rate for Payer: BCN Commercial |
$128.85
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$132.95
|
| Rate for Payer: Cash Price |
$132.95
|
| Rate for Payer: Cofinity Commercial |
$156.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$166.19
|
| Rate for Payer: Healthscope Whirlpool |
$161.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$149.57
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.26
|
| Rate for Payer: Nomi Health Commercial |
$136.28
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.62
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$116.50
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC INSERTION DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$166.19
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
76100179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.02 |
| Max. Negotiated Rate |
$166.19 |
| Rate for Payer: Aetna Commercial |
$149.57
|
| Rate for Payer: ASR ASR |
$161.20
|
| Rate for Payer: ASR Commercial |
$161.20
|
| Rate for Payer: BCBS Trust/PPO |
$135.43
|
| Rate for Payer: BCN Commercial |
$128.85
|
| Rate for Payer: Cash Price |
$132.95
|
| Rate for Payer: Cofinity Commercial |
$156.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.95
|
| Rate for Payer: Healthscope Commercial |
$166.19
|
| Rate for Payer: Healthscope Whirlpool |
$161.20
|
| Rate for Payer: Mclaren Commercial |
$149.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.26
|
| Rate for Payer: Nomi Health Commercial |
$136.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.25
|
|
|
HC INSERTION GASTRO TUBE W FLUORO
|
Facility
|
OP
|
$1,445.62
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
36100225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.65 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$1,301.06
|
| Rate for Payer: Aetna Medicare |
$1,850.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: ASR ASR |
$1,402.25
|
| Rate for Payer: ASR Commercial |
$1,402.25
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.82
|
| Rate for Payer: BCN Commercial |
$1,120.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$1,156.50
|
| Rate for Payer: Cash Price |
$1,156.50
|
| Rate for Payer: Cofinity Commercial |
$1,358.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,445.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,402.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$1,301.06
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.78
|
| Rate for Payer: Nomi Health Commercial |
$1,185.41
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$2,035.11
|
| Rate for Payer: PHP Medicaid |
$991.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,266.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,272.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$2,867.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP DNSP |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
HC INSERTION GASTRO TUBE W FLUORO
|
Facility
|
IP
|
$1,445.62
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
36100225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.65 |
| Max. Negotiated Rate |
$1,445.62 |
| Rate for Payer: Aetna Commercial |
$1,301.06
|
| Rate for Payer: ASR ASR |
$1,402.25
|
| Rate for Payer: ASR Commercial |
$1,402.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,178.04
|
| Rate for Payer: BCN Commercial |
$1,120.79
|
| Rate for Payer: Cash Price |
$1,156.50
|
| Rate for Payer: Cofinity Commercial |
$1,358.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.50
|
| Rate for Payer: Healthscope Commercial |
$1,445.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,402.25
|
| Rate for Payer: Mclaren Commercial |
$1,301.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.78
|
| Rate for Payer: Nomi Health Commercial |
$1,185.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,272.15
|
|
|
HC INSERTION IUD
|
Facility
|
OP
|
$379.93
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
76100142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.97 |
| Max. Negotiated Rate |
$379.93 |
| Rate for Payer: Aetna Commercial |
$341.94
|
| Rate for Payer: Aetna Medicare |
$189.97
|
| Rate for Payer: ASR ASR |
$368.53
|
| Rate for Payer: ASR Commercial |
$368.53
|
| Rate for Payer: BCBS Complete |
$151.97
|
| Rate for Payer: BCBS Trust/PPO |
$311.12
|
| Rate for Payer: BCN Commercial |
$294.56
|
| Rate for Payer: Cash Price |
$303.94
|
| Rate for Payer: Cofinity Commercial |
$357.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.94
|
| Rate for Payer: Healthscope Commercial |
$379.93
|
| Rate for Payer: Healthscope Whirlpool |
$368.53
|
| Rate for Payer: Mclaren Commercial |
$341.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.94
|
| Rate for Payer: Nomi Health Commercial |
$311.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.89
|
| Rate for Payer: Priority Health Narrow Network |
$266.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.34
|
|
|
HC INSERTION IUD
|
Facility
|
IP
|
$379.93
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
76100142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.95 |
| Max. Negotiated Rate |
$379.93 |
| Rate for Payer: Aetna Commercial |
$341.94
|
| Rate for Payer: ASR ASR |
$368.53
|
| Rate for Payer: ASR Commercial |
$368.53
|
| Rate for Payer: BCBS Trust/PPO |
$309.60
|
| Rate for Payer: BCN Commercial |
$294.56
|
| Rate for Payer: Cash Price |
$303.94
|
| Rate for Payer: Cofinity Commercial |
$357.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.94
|
| Rate for Payer: Healthscope Commercial |
$379.93
|
| Rate for Payer: Healthscope Whirlpool |
$368.53
|
| Rate for Payer: Mclaren Commercial |
$341.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.94
|
| Rate for Payer: Nomi Health Commercial |
$311.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.34
|
|
