|
HC LAAC IMPLANT
|
Facility
|
IP
|
$18,571.14
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,071.24 |
| Max. Negotiated Rate |
$18,571.14 |
| Rate for Payer: Aetna Commercial |
$16,714.03
|
| Rate for Payer: ASR ASR |
$18,014.01
|
| Rate for Payer: ASR Commercial |
$18,014.01
|
| Rate for Payer: BCBS Trust/PPO |
$15,133.62
|
| Rate for Payer: BCN Commercial |
$14,398.20
|
| Rate for Payer: Cash Price |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$17,456.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,856.91
|
| Rate for Payer: Healthscope Commercial |
$18,571.14
|
| Rate for Payer: Healthscope Whirlpool |
$18,014.01
|
| Rate for Payer: Mclaren Commercial |
$16,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,785.47
|
| Rate for Payer: Nomi Health Commercial |
$15,228.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,071.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,342.60
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,531.01
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$995.16 |
| Max. Negotiated Rate |
$1,531.01 |
| Rate for Payer: Aetna Commercial |
$1,377.91
|
| Rate for Payer: ASR ASR |
$1,485.08
|
| Rate for Payer: ASR Commercial |
$1,485.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.62
|
| Rate for Payer: BCN Commercial |
$1,186.99
|
| Rate for Payer: Cash Price |
$1,224.81
|
| Rate for Payer: Cofinity Commercial |
$1,439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.81
|
| Rate for Payer: Healthscope Commercial |
$1,531.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.08
|
| Rate for Payer: Mclaren Commercial |
$1,377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.36
|
| Rate for Payer: Nomi Health Commercial |
$1,255.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.29
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,531.01
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$612.40 |
| Max. Negotiated Rate |
$1,531.01 |
| Rate for Payer: Aetna Commercial |
$1,377.91
|
| Rate for Payer: Aetna Medicare |
$765.50
|
| Rate for Payer: ASR ASR |
$1,485.08
|
| Rate for Payer: ASR Commercial |
$1,485.08
|
| Rate for Payer: BCBS Complete |
$612.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.74
|
| Rate for Payer: BCN Commercial |
$1,186.99
|
| Rate for Payer: Cash Price |
$1,224.81
|
| Rate for Payer: Cofinity Commercial |
$1,439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.81
|
| Rate for Payer: Healthscope Commercial |
$1,531.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.08
|
| Rate for Payer: Mclaren Commercial |
$1,377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.36
|
| Rate for Payer: Nomi Health Commercial |
$1,255.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,341.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,073.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.29
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,041.41
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$816.56 |
| Max. Negotiated Rate |
$2,041.41 |
| Rate for Payer: Aetna Commercial |
$1,837.27
|
| Rate for Payer: Aetna Medicare |
$1,020.70
|
| Rate for Payer: ASR ASR |
$1,980.17
|
| Rate for Payer: ASR Commercial |
$1,980.17
|
| Rate for Payer: BCBS Complete |
$816.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.71
|
| Rate for Payer: BCN Commercial |
$1,582.71
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,918.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$2,041.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,980.17
|
| Rate for Payer: Mclaren Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,788.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.44
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,041.41
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,326.92 |
| Max. Negotiated Rate |
$2,041.41 |
| Rate for Payer: Aetna Commercial |
$1,837.27
|
| Rate for Payer: ASR ASR |
$1,980.17
|
| Rate for Payer: ASR Commercial |
$1,980.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.55
|
| Rate for Payer: BCN Commercial |
$1,582.71
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,918.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$2,041.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,980.17
|
| Rate for Payer: Mclaren Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.44
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,551.65
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,020.66 |
| Max. Negotiated Rate |
$2,551.65 |
| Rate for Payer: Aetna Commercial |
$2,296.48
|
| Rate for Payer: Aetna Medicare |
$1,275.82
|
| Rate for Payer: ASR ASR |
$2,475.10
|
| Rate for Payer: ASR Commercial |
$2,475.10
|
| Rate for Payer: BCBS Complete |
$1,020.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,089.55
|
| Rate for Payer: BCN Commercial |
$1,978.29
|
| Rate for Payer: Cash Price |
$2,041.32
|
| Rate for Payer: Cofinity Commercial |
$2,398.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.32
|
| Rate for Payer: Healthscope Commercial |
$2,551.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,475.10
|
| Rate for Payer: Mclaren Commercial |
$2,296.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.90
|
| Rate for Payer: Nomi Health Commercial |
$2,092.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,235.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,788.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.45
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,551.65
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,658.57 |
| Max. Negotiated Rate |
$2,551.65 |
| Rate for Payer: Aetna Commercial |
$2,296.48
|
| Rate for Payer: ASR ASR |
$2,475.10
|
| Rate for Payer: ASR Commercial |
$2,475.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,079.34
|
| Rate for Payer: BCN Commercial |
$1,978.29
|
| Rate for Payer: Cash Price |
$2,041.32
|
| Rate for Payer: Cofinity Commercial |
$2,398.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.32
|
| Rate for Payer: Healthscope Commercial |
$2,551.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,475.10
|
| Rate for Payer: Mclaren Commercial |
$2,296.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.90
|
| Rate for Payer: Nomi Health Commercial |
$2,092.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.45
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,062.03
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,990.32 |
| Max. Negotiated Rate |
$3,062.03 |
| Rate for Payer: Aetna Commercial |
$2,755.83
|
| Rate for Payer: ASR ASR |
$2,970.17
|
| Rate for Payer: ASR Commercial |
$2,970.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.25
|
| Rate for Payer: BCN Commercial |
$2,373.99
|
| Rate for Payer: Cash Price |
$2,449.62
|
| Rate for Payer: Cofinity Commercial |
$2,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,449.62
|
| Rate for Payer: Healthscope Commercial |
$3,062.03
|
| Rate for Payer: Healthscope Whirlpool |
$2,970.17
|
| Rate for Payer: Mclaren Commercial |
$2,755.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,602.73
|
| Rate for Payer: Nomi Health Commercial |
$2,510.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,990.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.59
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
OP
|
$3,062.03
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,224.81 |
| Max. Negotiated Rate |
$3,062.03 |
| Rate for Payer: Aetna Commercial |
$2,755.83
|
| Rate for Payer: Aetna Medicare |
$1,531.02
|
| Rate for Payer: ASR ASR |
$2,970.17
|
| Rate for Payer: ASR Commercial |
$2,970.17
|
| Rate for Payer: BCBS Complete |
$1,224.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,507.50
|
| Rate for Payer: BCN Commercial |
$2,373.99
|
| Rate for Payer: Cash Price |
$2,449.62
|
| Rate for Payer: Cofinity Commercial |
$2,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,449.62
|
| Rate for Payer: Healthscope Commercial |
$3,062.03
|
| Rate for Payer: Healthscope Whirlpool |
$2,970.17
|
| Rate for Payer: Mclaren Commercial |
$2,755.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,602.73
|
| Rate for Payer: Nomi Health Commercial |
$2,510.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,990.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,682.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,146.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.59
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
IP
|
$4,589.55
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,983.21 |
| Max. Negotiated Rate |
$4,589.55 |
| Rate for Payer: Aetna Commercial |
$4,130.60
|
| Rate for Payer: ASR ASR |
$4,451.86
|
| Rate for Payer: ASR Commercial |
$4,451.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,740.02
|
| Rate for Payer: BCN Commercial |
$3,558.28
|
| Rate for Payer: Cash Price |
$3,671.64
|
| Rate for Payer: Cofinity Commercial |
$4,314.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,671.64
|
| Rate for Payer: Healthscope Commercial |
$4,589.55
|
| Rate for Payer: Healthscope Whirlpool |
$4,451.86
|
| Rate for Payer: Mclaren Commercial |
$4,130.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.12
|
| Rate for Payer: Nomi Health Commercial |
$3,763.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,038.80
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
OP
|
$4,589.55
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,835.82 |
| Max. Negotiated Rate |
$4,589.55 |
| Rate for Payer: Aetna Commercial |
$4,130.60
|
| Rate for Payer: Aetna Medicare |
$2,294.78
|
| Rate for Payer: ASR ASR |
$4,451.86
|
| Rate for Payer: ASR Commercial |
$4,451.86
|
| Rate for Payer: BCBS Complete |
$1,835.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,758.38
|
| Rate for Payer: BCN Commercial |
$3,558.28
|
| Rate for Payer: Cash Price |
$3,671.64
|
| Rate for Payer: Cofinity Commercial |
$4,314.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,671.64
|
| Rate for Payer: Healthscope Commercial |
$4,589.55
|
| Rate for Payer: Healthscope Whirlpool |
$4,451.86
|
| Rate for Payer: Mclaren Commercial |
$4,130.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.12
|
| Rate for Payer: Nomi Health Commercial |
$3,763.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,021.36
|
| Rate for Payer: Priority Health Narrow Network |
$3,217.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,038.80
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
IP
|
$6,790.05
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,413.53 |
| Max. Negotiated Rate |
$6,790.05 |
| Rate for Payer: Aetna Commercial |
$6,111.04
|
| Rate for Payer: ASR ASR |
$6,586.35
|
| Rate for Payer: ASR Commercial |
$6,586.35
|
| Rate for Payer: BCBS Trust/PPO |
$5,533.21
|
| Rate for Payer: BCN Commercial |
$5,264.33
|
| Rate for Payer: Cash Price |
$5,432.04
|
| Rate for Payer: Cofinity Commercial |
$6,382.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,432.04
|
| Rate for Payer: Healthscope Commercial |
$6,790.05
|
| Rate for Payer: Healthscope Whirlpool |
$6,586.35
|
| Rate for Payer: Mclaren Commercial |
$6,111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,771.54
|
| Rate for Payer: Nomi Health Commercial |
$5,567.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,413.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,975.24
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
OP
|
$6,790.05
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,716.02 |
| Max. Negotiated Rate |
$6,790.05 |
| Rate for Payer: Aetna Commercial |
$6,111.04
|
| Rate for Payer: Aetna Medicare |
$3,395.02
|
| Rate for Payer: ASR ASR |
$6,586.35
|
| Rate for Payer: ASR Commercial |
$6,586.35
|
| Rate for Payer: BCBS Complete |
$2,716.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,560.37
|
| Rate for Payer: BCN Commercial |
$5,264.33
|
| Rate for Payer: Cash Price |
$5,432.04
|
| Rate for Payer: Cofinity Commercial |
$6,382.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,432.04
|
| Rate for Payer: Healthscope Commercial |
$6,790.05
|
| Rate for Payer: Healthscope Whirlpool |
$6,586.35
|
| Rate for Payer: Mclaren Commercial |
$6,111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,771.54
|
| Rate for Payer: Nomi Health Commercial |
$5,567.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,413.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,949.44
|
| Rate for Payer: Priority Health Narrow Network |
$4,759.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,975.24
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
IP
|
$4,015.74
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,610.23 |
| Max. Negotiated Rate |
$4,015.74 |
| Rate for Payer: Aetna Commercial |
$3,614.17
|
| Rate for Payer: ASR ASR |
$3,895.27
|
| Rate for Payer: ASR Commercial |
$3,895.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,272.43
|
| Rate for Payer: BCN Commercial |
$3,113.40
|
| Rate for Payer: Cash Price |
$3,212.59
|
| Rate for Payer: Cofinity Commercial |
$3,774.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,212.59
|
| Rate for Payer: Healthscope Commercial |
$4,015.74
|
| Rate for Payer: Healthscope Whirlpool |
$3,895.27
|
| Rate for Payer: Mclaren Commercial |
$3,614.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,413.38
|
| Rate for Payer: Nomi Health Commercial |
$3,292.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,610.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,533.85
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
OP
|
$4,015.74
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.91 |
| Max. Negotiated Rate |
$4,015.74 |
| Rate for Payer: Aetna Commercial |
$3,614.17
|
| Rate for Payer: Aetna Medicare |
$1,451.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: ASR ASR |
$3,895.27
|
| Rate for Payer: ASR Commercial |
$3,895.27
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,288.49
|
| Rate for Payer: BCN Commercial |
$3,113.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Cash Price |
$3,212.59
|
| Rate for Payer: Cash Price |
$3,212.59
|
| Rate for Payer: Cofinity Commercial |
$3,774.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,212.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Healthscope Commercial |
$4,015.74
|
| Rate for Payer: Healthscope Whirlpool |
$3,895.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,451.33
|
| Rate for Payer: Mclaren Commercial |
$3,614.17
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,413.38
|
| Rate for Payer: Nomi Health Commercial |
$3,292.91
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Commercial |
$1,596.46
|
| Rate for Payer: PHP Medicaid |
$777.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,610.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,518.59
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,815.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,533.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$2,249.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP DNSP |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
IP
|
$1,555.91
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,011.34 |
| Max. Negotiated Rate |
$1,555.91 |
| Rate for Payer: Aetna Commercial |
$1,400.32
|
| Rate for Payer: ASR ASR |
$1,509.23
|
| Rate for Payer: ASR Commercial |
$1,509.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.91
|
| Rate for Payer: BCN Commercial |
$1,206.30
|
| Rate for Payer: Cash Price |
$1,244.73
|
| Rate for Payer: Cofinity Commercial |
$1,462.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,244.73
|
| Rate for Payer: Healthscope Commercial |
$1,555.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,509.23
|
| Rate for Payer: Mclaren Commercial |
$1,400.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.52
|
| Rate for Payer: Nomi Health Commercial |
$1,275.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.20
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
OP
|
$1,555.91
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$622.36 |
| Max. Negotiated Rate |
$1,555.91 |
| Rate for Payer: Aetna Commercial |
$1,400.32
|
| Rate for Payer: Aetna Medicare |
$777.96
|
| Rate for Payer: ASR ASR |
$1,509.23
|
| Rate for Payer: ASR Commercial |
$1,509.23
|
| Rate for Payer: BCBS Complete |
$622.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.13
|
| Rate for Payer: BCN Commercial |
$1,206.30
|
| Rate for Payer: Cash Price |
$1,244.73
|
| Rate for Payer: Cofinity Commercial |
$1,462.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,244.73
|
| Rate for Payer: Healthscope Commercial |
$1,555.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,509.23
|
| Rate for Payer: Mclaren Commercial |
$1,400.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.52
|
| Rate for Payer: Nomi Health Commercial |
$1,275.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,090.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.20
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.04
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Medicaid |
$3.24
|
| Rate for Payer: Mclaren Medicare |
$6.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: Meridian Medicaid |
$3.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PACE Medicare |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: PHP Medicaid |
$3.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.31
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow Network |
$16.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.04
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$6.04
|
| Rate for Payer: UHCCP DNSP |
$6.04
|
| Rate for Payer: UHCCP Medicaid |
$3.24
|
| Rate for Payer: VA VA |
$6.04
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
OP
|
$59.30
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$69.18 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: ASR ASR |
$57.52
|
| Rate for Payer: ASR Commercial |
$57.52
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$48.56
|
| Rate for Payer: BCN Commercial |
$45.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Commercial |
$55.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$59.30
|
| Rate for Payer: Healthscope Whirlpool |
$57.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.57
|
| Rate for Payer: Mclaren Commercial |
$53.37
|
| Rate for Payer: Mclaren Medicaid |
$6.20
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$6.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.40
|
| Rate for Payer: Nomi Health Commercial |
$48.63
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicaid |
$6.20
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.18
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$11.57
|
| Rate for Payer: UHCCP DNSP |
$11.57
|
| Rate for Payer: UHCCP Medicaid |
$6.20
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
IP
|
$59.30
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: ASR ASR |
$57.52
|
| Rate for Payer: ASR Commercial |
$57.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.32
|
| Rate for Payer: BCN Commercial |
$45.98
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Commercial |
$55.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Healthscope Commercial |
$59.30
|
| Rate for Payer: Healthscope Whirlpool |
$57.52
|
| Rate for Payer: Mclaren Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.40
|
| Rate for Payer: Nomi Health Commercial |
$48.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.18
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: ASR Commercial |
$91.23
|
| Rate for Payer: BCBS Trust/PPO |
$76.64
|
| Rate for Payer: BCN Commercial |
$72.92
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.23
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: ASR Commercial |
$91.23
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$77.02
|
| Rate for Payer: BCN Commercial |
$72.92
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: ASR ASR |
$75.10
|
| Rate for Payer: ASR Commercial |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$63.09
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Whirlpool |
$75.10
|
| Rate for Payer: Mclaren Commercial |
$69.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.13
|
|
|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$69.68
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$75.10
|
| Rate for Payer: ASR Commercial |
$75.10
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$60.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Whirlpool |
$75.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$69.68
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.84
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$54.27
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
