|
HC LAMBS QUARTERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200091
|
|
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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| 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 LAMBS QUARTERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200091
|
|
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 LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
30100278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
30100278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.15
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS MAPPO |
$19.32
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: BCN Medicare Advantage |
$19.32
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.32
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$10.36
|
| Rate for Payer: Mclaren Medicare |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.29
|
| Rate for Payer: Meridian Medicaid |
$10.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PACE Medicare |
$18.35
|
| Rate for Payer: PACE SWMI |
$19.32
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicaid |
$10.36
|
| Rate for Payer: PHP Medicare Advantage |
$19.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.56
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow Network |
$50.05
|
| Rate for Payer: Railroad Medicare Medicare |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.32
|
| Rate for Payer: UHC Exchange |
$29.95
|
| Rate for Payer: UHC Medicare Advantage |
$19.32
|
| Rate for Payer: UHCCP DNSP |
$19.32
|
| Rate for Payer: UHCCP Medicaid |
$10.36
|
| Rate for Payer: VA VA |
$19.32
|
|
|
HC LAMICTAL LEVEL
|
Facility
|
IP
|
$54.10
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
30100054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: ASR ASR |
$52.48
|
| Rate for Payer: ASR Commercial |
$52.48
|
| Rate for Payer: BCBS Trust/PPO |
$44.09
|
| Rate for Payer: BCN Commercial |
$41.94
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$50.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Healthscope Whirlpool |
$52.48
|
| Rate for Payer: Mclaren Commercial |
$48.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.61
|
|
|
HC LAMICTAL LEVEL
|
Facility
|
OP
|
$54.10
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
30100054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$52.48
|
| Rate for Payer: ASR Commercial |
$52.48
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$44.30
|
| Rate for Payer: BCN Commercial |
$41.94
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$50.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Healthscope Whirlpool |
$52.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$48.69
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.58
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.72
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$16.58
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Facility
|
OP
|
$10,480.00
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,936.25 |
| Max. Negotiated Rate |
$10,480.00 |
| Rate for Payer: Aetna Commercial |
$9,432.00
|
| Rate for Payer: Aetna Medicare |
$3,612.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.50
|
| Rate for Payer: ASR ASR |
$10,165.60
|
| Rate for Payer: ASR Commercial |
$10,165.60
|
| Rate for Payer: BCBS Complete |
$2,033.06
|
| Rate for Payer: BCBS MAPPO |
$3,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$8,582.07
|
| Rate for Payer: BCN Commercial |
$8,125.14
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.40
|
| Rate for Payer: Cash Price |
$8,384.00
|
| Rate for Payer: Cash Price |
$8,384.00
|
| Rate for Payer: Cofinity Commercial |
$9,851.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,384.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.40
|
| Rate for Payer: Healthscope Commercial |
$10,480.00
|
| Rate for Payer: Healthscope Whirlpool |
$10,165.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,612.40
|
| Rate for Payer: Mclaren Commercial |
$9,432.00
|
| Rate for Payer: Mclaren Medicaid |
$1,936.25
|
| Rate for Payer: Mclaren Medicare |
$3,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,793.02
|
| Rate for Payer: Meridian Medicaid |
$2,033.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,908.00
|
| Rate for Payer: Nomi Health Commercial |
$8,593.60
|
| Rate for Payer: PACE Medicare |
$3,431.78
|
| Rate for Payer: PACE SWMI |
$3,612.40
|
| Rate for Payer: PHP Commercial |
$3,973.64
|
| Rate for Payer: PHP Medicaid |
$1,936.25
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,936.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,812.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,182.58
|
| Rate for Payer: Priority Health Medicare |
$3,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$7,346.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,222.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$5,599.22
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP DNSP |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
HC LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Facility
|
IP
|
$10,480.00
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,812.00 |
| Max. Negotiated Rate |
$10,480.00 |
| Rate for Payer: Aetna Commercial |
$9,432.00
|
| Rate for Payer: ASR ASR |
$10,165.60
|
| Rate for Payer: ASR Commercial |
$10,165.60
|
| Rate for Payer: BCBS Trust/PPO |
$8,540.15
|
| Rate for Payer: BCN Commercial |
$8,125.14
|
| Rate for Payer: Cash Price |
$8,384.00
|
| Rate for Payer: Cofinity Commercial |
$9,851.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,384.00
|
| Rate for Payer: Healthscope Commercial |
$10,480.00
|
| Rate for Payer: Healthscope Whirlpool |
$10,165.60
|
| Rate for Payer: Mclaren Commercial |
$9,432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,908.00
|
| Rate for Payer: Nomi Health Commercial |
$8,593.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,812.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,222.40
|
|
|
HC LA RO SSB SJOGRENS AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.66
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
|
|
HC LA RO SSB SJOGRENS AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$153.73 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.11
|
| Rate for Payer: ASR Commercial |
$34.11
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.80
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$33.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.73
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$122.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC LARYNGOSCOPY
|
Facility
|
IP
|
$2,564.80
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,667.12 |
| Max. Negotiated Rate |
$2,564.80 |
| Rate for Payer: Aetna Commercial |
$2,308.32
|
| Rate for Payer: ASR ASR |
$2,487.86
|
| Rate for Payer: ASR Commercial |
$2,487.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,090.06
|
| Rate for Payer: BCN Commercial |
$1,988.49
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$2,410.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,564.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,487.86
|
| Rate for Payer: Mclaren Commercial |
$2,308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: Nomi Health Commercial |
$2,103.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,257.02
|
|
|
HC LARYNGOSCOPY
|
Facility
|
OP
|
$2,564.80
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,025.92 |
| Max. Negotiated Rate |
$2,564.80 |
| Rate for Payer: Aetna Commercial |
$2,308.32
|
| Rate for Payer: Aetna Medicare |
$1,282.40
|
| Rate for Payer: ASR ASR |
$2,487.86
|
| Rate for Payer: ASR Commercial |
$2,487.86
|
| Rate for Payer: BCBS Complete |
$1,025.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,100.31
|
| Rate for Payer: BCN Commercial |
$1,988.49
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$2,410.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,564.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,487.86
|
| Rate for Payer: Mclaren Commercial |
$2,308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: Nomi Health Commercial |
$2,103.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,247.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,797.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,257.02
|
|
|
HC LARYNGOSCOPY DIRECT OPERATIVE W BIOPSY
|
Facility
|
OP
|
$4,795.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$905.63 |
| Max. Negotiated Rate |
$4,795.00 |
| Rate for Payer: Aetna Commercial |
$4,315.50
|
| Rate for Payer: Aetna Medicare |
$1,689.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: ASR ASR |
$4,651.15
|
| Rate for Payer: ASR Commercial |
$4,651.15
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,926.63
|
| Rate for Payer: BCN Commercial |
$3,717.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cofinity Commercial |
$4,507.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,836.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Healthscope Commercial |
$4,795.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,651.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,689.60
|
| Rate for Payer: Mclaren Commercial |
$4,315.50
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,075.75
|
| Rate for Payer: Nomi Health Commercial |
$3,931.90
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Commercial |
$1,858.56
|
| Rate for Payer: PHP Medicaid |
$905.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,116.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,201.38
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,361.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,219.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$2,618.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP DNSP |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
HC LARYNGOSCOPY DIRECT OPERATIVE W BIOPSY
|
Facility
|
IP
|
$4,795.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,116.75 |
| Max. Negotiated Rate |
$4,795.00 |
| Rate for Payer: Aetna Commercial |
$4,315.50
|
| Rate for Payer: ASR ASR |
$4,651.15
|
| Rate for Payer: ASR Commercial |
$4,651.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,907.45
|
| Rate for Payer: BCN Commercial |
$3,717.56
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cofinity Commercial |
$4,507.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,836.00
|
| Rate for Payer: Healthscope Commercial |
$4,795.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,651.15
|
| Rate for Payer: Mclaren Commercial |
$4,315.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,075.75
|
| Rate for Payer: Nomi Health Commercial |
$3,931.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,116.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,219.60
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
OP
|
$372.28
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$372.28 |
| Rate for Payer: Aetna Commercial |
$335.05
|
| Rate for Payer: Aetna Medicare |
$190.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$361.11
|
| Rate for Payer: ASR Commercial |
$361.11
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$304.86
|
| Rate for Payer: BCN Commercial |
$288.63
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$297.82
|
| Rate for Payer: Cash Price |
$297.82
|
| Rate for Payer: Cofinity Commercial |
$349.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Healthscope Commercial |
$372.28
|
| Rate for Payer: Healthscope Whirlpool |
$361.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.21
|
| Rate for Payer: Mclaren Commercial |
$335.05
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.44
|
| Rate for Payer: Nomi Health Commercial |
$305.27
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$209.23
|
| Rate for Payer: PHP Medicaid |
$101.95
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.19
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$260.97
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$294.83
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP DNSP |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: VA VA |
$190.21
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
IP
|
$372.28
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.98 |
| Max. Negotiated Rate |
$372.28 |
| Rate for Payer: Aetna Commercial |
$335.05
|
| Rate for Payer: ASR ASR |
$361.11
|
| Rate for Payer: ASR Commercial |
$361.11
|
| Rate for Payer: BCBS Trust/PPO |
$303.37
|
| Rate for Payer: BCN Commercial |
$288.63
|
| Rate for Payer: Cash Price |
$297.82
|
| Rate for Payer: Cofinity Commercial |
$349.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.82
|
| Rate for Payer: Healthscope Commercial |
$372.28
|
| Rate for Payer: Healthscope Whirlpool |
$361.11
|
| Rate for Payer: Mclaren Commercial |
$335.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.44
|
| Rate for Payer: Nomi Health Commercial |
$305.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.61
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Aetna Commercial |
$1,009.80
|
| Rate for Payer: Aetna Medicare |
$380.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$475.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$475.58
|
| Rate for Payer: ASR ASR |
$1,088.34
|
| Rate for Payer: ASR Commercial |
$1,088.34
|
| Rate for Payer: BCBS Complete |
$214.12
|
| Rate for Payer: BCBS MAPPO |
$380.46
|
| Rate for Payer: BCBS Trust/PPO |
$918.81
|
| Rate for Payer: BCN Commercial |
$869.89
|
| Rate for Payer: BCN Medicare Advantage |
$380.46
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$1,054.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.46
|
| Rate for Payer: Healthscope Commercial |
$1,122.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$380.46
|
| Rate for Payer: Mclaren Commercial |
$1,009.80
|
| Rate for Payer: Mclaren Medicaid |
$203.93
|
| Rate for Payer: Mclaren Medicare |
$380.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.48
|
| Rate for Payer: Meridian Medicaid |
$214.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$437.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.70
|
| Rate for Payer: Nomi Health Commercial |
$920.04
|
| Rate for Payer: PACE Medicare |
$361.44
|
| Rate for Payer: PACE SWMI |
$380.46
|
| Rate for Payer: PHP Commercial |
$418.51
|
| Rate for Payer: PHP Medicaid |
$203.93
|
| Rate for Payer: PHP Medicare Advantage |
$380.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.10
|
| Rate for Payer: Priority Health Medicare |
$380.46
|
| Rate for Payer: Priority Health Narrow Network |
$786.52
|
| Rate for Payer: Railroad Medicare Medicare |
$380.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$987.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.46
|
| Rate for Payer: UHC Exchange |
$589.71
|
| Rate for Payer: UHC Medicare Advantage |
$380.46
|
| Rate for Payer: UHCCP DNSP |
$380.46
|
| Rate for Payer: UHCCP Medicaid |
$203.93
|
| Rate for Payer: VA VA |
$380.46
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.30 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Aetna Commercial |
$1,009.80
|
| Rate for Payer: ASR ASR |
$1,088.34
|
| Rate for Payer: ASR Commercial |
$1,088.34
|
| Rate for Payer: BCBS Trust/PPO |
$914.32
|
| Rate for Payer: BCN Commercial |
$869.89
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$1,054.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.60
|
| Rate for Payer: Healthscope Commercial |
$1,122.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.34
|
| Rate for Payer: Mclaren Commercial |
$1,009.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.70
|
| Rate for Payer: Nomi Health Commercial |
$920.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$987.36
|
|
|
HC LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Facility
|
IP
|
$566.10
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.96 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna Commercial |
$509.49
|
| Rate for Payer: ASR ASR |
$549.12
|
| Rate for Payer: ASR Commercial |
$549.12
|
| Rate for Payer: BCBS Trust/PPO |
$461.31
|
| Rate for Payer: BCN Commercial |
$438.90
|
| Rate for Payer: Cash Price |
$452.88
|
| Rate for Payer: Cofinity Commercial |
$532.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.88
|
| Rate for Payer: Healthscope Commercial |
$566.10
|
| Rate for Payer: Healthscope Whirlpool |
$549.12
|
| Rate for Payer: Mclaren Commercial |
$509.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.18
|
| Rate for Payer: Nomi Health Commercial |
$464.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.17
|
|
|
HC LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Facility
|
OP
|
$566.10
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna Commercial |
$509.49
|
| Rate for Payer: Aetna Medicare |
$190.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$549.12
|
| Rate for Payer: ASR Commercial |
$549.12
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$463.58
|
| Rate for Payer: BCN Commercial |
$438.90
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$452.88
|
| Rate for Payer: Cash Price |
$452.88
|
| Rate for Payer: Cofinity Commercial |
$532.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Healthscope Commercial |
$566.10
|
| Rate for Payer: Healthscope Whirlpool |
$549.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.21
|
| Rate for Payer: Mclaren Commercial |
$509.49
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.18
|
| Rate for Payer: Nomi Health Commercial |
$464.20
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$209.23
|
| Rate for Payer: PHP Medicaid |
$101.95
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.54
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$112.43
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$294.83
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP DNSP |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: VA VA |
$190.21
|
|
|
HC LASER CATHETER
|
Facility
|
IP
|
$4,939.32
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,210.56 |
| Max. Negotiated Rate |
$4,939.32 |
| Rate for Payer: Aetna Commercial |
$4,445.39
|
| Rate for Payer: ASR ASR |
$4,791.14
|
| Rate for Payer: ASR Commercial |
$4,791.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,025.05
|
| Rate for Payer: BCN Commercial |
$3,829.45
|
| Rate for Payer: Cash Price |
$3,951.46
|
| Rate for Payer: Cofinity Commercial |
$4,642.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,951.46
|
| Rate for Payer: Healthscope Commercial |
$4,939.32
|
| Rate for Payer: Healthscope Whirlpool |
$4,791.14
|
| Rate for Payer: Mclaren Commercial |
$4,445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,198.42
|
| Rate for Payer: Nomi Health Commercial |
$4,050.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,210.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,346.60
|
|
|
HC LASER CATHETER
|
Facility
|
OP
|
$4,939.32
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,975.73 |
| Max. Negotiated Rate |
$4,939.32 |
| Rate for Payer: Aetna Commercial |
$4,445.39
|
| Rate for Payer: Aetna Medicare |
$2,469.66
|
| Rate for Payer: ASR ASR |
$4,791.14
|
| Rate for Payer: ASR Commercial |
$4,791.14
|
| Rate for Payer: BCBS Complete |
$1,975.73
|
| Rate for Payer: BCBS Trust/PPO |
$4,044.81
|
| Rate for Payer: BCN Commercial |
$3,829.45
|
| Rate for Payer: Cash Price |
$3,951.46
|
| Rate for Payer: Cofinity Commercial |
$4,642.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,951.46
|
| Rate for Payer: Healthscope Commercial |
$4,939.32
|
| Rate for Payer: Healthscope Whirlpool |
$4,791.14
|
| Rate for Payer: Mclaren Commercial |
$4,445.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,198.42
|
| Rate for Payer: Nomi Health Commercial |
$4,050.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,210.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,327.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,462.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,346.60
|
|
|
HC LATEX IGE
|
Facility
|
OP
|
$35.79
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Aetna Commercial |
$32.21
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$34.72
|
| Rate for Payer: ASR Commercial |
$34.72
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$29.31
|
| Rate for Payer: BCN Commercial |
$27.75
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$33.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$35.79
|
| Rate for Payer: Healthscope Whirlpool |
$34.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$32.21
|
| 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 |
$30.42
|
| Rate for Payer: Nomi Health Commercial |
$29.35
|
| 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 |
$23.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.36
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$25.09
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.50
|
| 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 LATEX IGE
|
Facility
|
IP
|
$35.79
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Aetna Commercial |
$32.21
|
| Rate for Payer: ASR ASR |
$34.72
|
| Rate for Payer: ASR Commercial |
$34.72
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$27.75
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$33.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.63
|
| Rate for Payer: Healthscope Commercial |
$35.79
|
| Rate for Payer: Healthscope Whirlpool |
$34.72
|
| Rate for Payer: Mclaren Commercial |
$32.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.42
|
| Rate for Payer: Nomi Health Commercial |
$29.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.50
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
OP
|
$498.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$408.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
