|
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
|
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 DIRECT OPERATIVE W BIOPSY
|
Facility
|
OP
|
$4,795.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,795.00 |
| Rate for Payer: Aetna Commercial |
$4,315.50
|
| Rate for Payer: Aetna Medicare |
$1,681.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: ASR ASR |
$4,651.15
|
| Rate for Payer: ASR Commercial |
$4,651.15
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,926.63
|
| Rate for Payer: BCN Commercial |
$3,717.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| 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 |
$1,681.84
|
| Rate for Payer: Healthscope Commercial |
$4,795.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,651.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,681.84
|
| Rate for Payer: Mclaren Commercial |
$4,315.50
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| 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 |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Commercial |
$1,850.02
|
| Rate for Payer: PHP Medicaid |
$901.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| 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 |
$1,681.84
|
| Rate for Payer: Priority Health Narrow Network |
$3,361.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,219.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$2,606.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP DNSP |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
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
|
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 FIBEROPTIC
|
Facility
|
OP
|
$372.28
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$372.28 |
| Rate for Payer: Aetna Commercial |
$335.05
|
| Rate for Payer: Aetna Medicare |
$189.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: ASR ASR |
$361.11
|
| Rate for Payer: ASR Commercial |
$361.11
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCBS Trust/PPO |
$304.86
|
| Rate for Payer: BCN Commercial |
$288.63
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| 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 |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$372.28
|
| Rate for Payer: Healthscope Whirlpool |
$361.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.34
|
| Rate for Payer: Mclaren Commercial |
$335.05
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.44
|
| Rate for Payer: Nomi Health Commercial |
$305.27
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$208.27
|
| Rate for Payer: PHP Medicaid |
$101.49
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| 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 |
$189.34
|
| Rate for Payer: Priority Health Narrow Network |
$260.97
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Exchange |
$293.48
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP DNSP |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$101.49
|
| Rate for Payer: VA VA |
$189.34
|
|
|
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 |
$202.99 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Aetna Commercial |
$1,009.80
|
| Rate for Payer: Aetna Medicare |
$378.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$473.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$473.39
|
| Rate for Payer: ASR ASR |
$1,088.34
|
| Rate for Payer: ASR Commercial |
$1,088.34
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS MAPPO |
$378.71
|
| Rate for Payer: BCBS Trust/PPO |
$918.81
|
| Rate for Payer: BCN Commercial |
$869.89
|
| Rate for Payer: BCN Medicare Advantage |
$378.71
|
| 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 |
$378.71
|
| Rate for Payer: Healthscope Commercial |
$1,122.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$378.71
|
| Rate for Payer: Mclaren Commercial |
$1,009.80
|
| Rate for Payer: Mclaren Medicaid |
$202.99
|
| Rate for Payer: Mclaren Medicare |
$378.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.65
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.70
|
| Rate for Payer: Nomi Health Commercial |
$920.04
|
| Rate for Payer: PACE Medicare |
$359.77
|
| Rate for Payer: PACE SWMI |
$378.71
|
| Rate for Payer: PHP Commercial |
$416.58
|
| Rate for Payer: PHP Medicaid |
$202.99
|
| Rate for Payer: PHP Medicare Advantage |
$378.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| 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 |
$378.71
|
| Rate for Payer: Priority Health Narrow Network |
$786.52
|
| Rate for Payer: Railroad Medicare Medicare |
$378.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$987.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.71
|
| Rate for Payer: UHC Exchange |
$587.00
|
| Rate for Payer: UHC Medicare Advantage |
$378.71
|
| Rate for Payer: UHCCP DNSP |
$378.71
|
| Rate for Payer: UHCCP Medicaid |
$202.99
|
| Rate for Payer: VA VA |
$378.71
|
|
|
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
|
OP
|
$566.10
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna Commercial |
$509.49
|
| Rate for Payer: Aetna Medicare |
$189.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: ASR ASR |
$549.12
|
| Rate for Payer: ASR Commercial |
$549.12
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCBS Trust/PPO |
$463.58
|
| Rate for Payer: BCN Commercial |
$438.90
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| 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 |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$566.10
|
| Rate for Payer: Healthscope Whirlpool |
$549.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.34
|
| Rate for Payer: Mclaren Commercial |
$509.49
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.19
|
| Rate for Payer: Nomi Health Commercial |
$464.20
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$208.27
|
| Rate for Payer: PHP Medicaid |
$101.49
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.02
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health Narrow Network |
$396.84
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Exchange |
$293.48
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP DNSP |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$101.49
|
| Rate for Payer: VA VA |
$189.34
|
|
|
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 |
$481.19
|
| 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 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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.12 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Trust/PPO |
$406.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| 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: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
|
|
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 |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$408.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| 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 |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.91
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$349.55
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$11,013.34
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,158.67 |
| Max. Negotiated Rate |
$11,013.34 |
| Rate for Payer: Aetna Commercial |
$9,912.01
|
| Rate for Payer: ASR ASR |
$10,682.94
|
| Rate for Payer: ASR Commercial |
$10,682.94
|
| Rate for Payer: BCBS Trust/PPO |
$8,974.77
|
| Rate for Payer: BCN Commercial |
$8,538.64
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cofinity Commercial |
$10,352.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,810.67
|
| Rate for Payer: Healthscope Commercial |
$11,013.34
|
| Rate for Payer: Healthscope Whirlpool |
$10,682.94
|
| Rate for Payer: Mclaren Commercial |
$9,912.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,361.34
|
| Rate for Payer: Nomi Health Commercial |
$9,030.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,158.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,691.74
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$11,013.34
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$11,013.34 |
| Rate for Payer: Aetna Commercial |
$9,912.01
|
| Rate for Payer: Aetna Medicare |
$3,136.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: ASR ASR |
$10,682.94
|
| Rate for Payer: ASR Commercial |
$10,682.94
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCBS Trust/PPO |
$9,018.82
|
| Rate for Payer: BCN Commercial |
$8,538.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cofinity Commercial |
$10,352.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,810.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$11,013.34
|
| Rate for Payer: Healthscope Whirlpool |
$10,682.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,136.90
|
| Rate for Payer: Mclaren Commercial |
$9,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,361.34
|
| Rate for Payer: Nomi Health Commercial |
$9,030.94
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$3,450.59
|
| Rate for Payer: PHP Medicaid |
$1,681.38
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,158.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,649.89
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health Narrow Network |
$7,720.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,691.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Exchange |
$4,862.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP DNSP |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,681.38
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$59.77
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$53.79
|
| Rate for Payer: ASR ASR |
$57.98
|
| Rate for Payer: ASR Commercial |
$57.98
|
| Rate for Payer: BCBS Trust/PPO |
$48.71
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.82
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Healthscope Whirlpool |
$57.98
|
| Rate for Payer: Mclaren Commercial |
$53.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.80
|
| Rate for Payer: Nomi Health Commercial |
$49.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.60
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$59.77
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$53.79
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: ASR ASR |
$57.98
|
| Rate for Payer: ASR Commercial |
$57.98
|
| Rate for Payer: BCBS Complete |
$5.91
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.95
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Healthscope Whirlpool |
$57.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.50
|
| Rate for Payer: Mclaren Commercial |
$53.79
|
| Rate for Payer: Mclaren Medicaid |
$5.63
|
| Rate for Payer: Mclaren Medicare |
$10.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: Meridian Medicaid |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.80
|
| Rate for Payer: Nomi Health Commercial |
$49.01
|
| Rate for Payer: PACE Medicare |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$11.55
|
| Rate for Payer: PHP Medicaid |
$5.63
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.37
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health Narrow Network |
$41.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$16.27
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: UHCCP DNSP |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$5.63
|
| Rate for Payer: VA VA |
$10.50
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,469.87
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$955.42 |
| Max. Negotiated Rate |
$1,469.87 |
| Rate for Payer: Aetna Commercial |
$1,322.88
|
| Rate for Payer: ASR ASR |
$1,425.77
|
| Rate for Payer: ASR Commercial |
$1,425.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.80
|
| Rate for Payer: BCN Commercial |
$1,139.59
|
| Rate for Payer: Cash Price |
$1,175.90
|
| Rate for Payer: Cofinity Commercial |
$1,381.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.90
|
| Rate for Payer: Healthscope Commercial |
$1,469.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.77
|
| Rate for Payer: Mclaren Commercial |
$1,322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.39
|
| Rate for Payer: Nomi Health Commercial |
$1,205.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.49
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,469.87
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$587.95 |
| Max. Negotiated Rate |
$1,469.87 |
| Rate for Payer: Aetna Commercial |
$1,322.88
|
| Rate for Payer: Aetna Medicare |
$734.93
|
| Rate for Payer: ASR ASR |
$1,425.77
|
| Rate for Payer: ASR Commercial |
$1,425.77
|
| Rate for Payer: BCBS Complete |
$587.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.68
|
| Rate for Payer: BCN Commercial |
$1,139.59
|
| Rate for Payer: Cash Price |
$1,175.90
|
| Rate for Payer: Cofinity Commercial |
$1,381.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.90
|
| Rate for Payer: Healthscope Commercial |
$1,469.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.77
|
| Rate for Payer: Mclaren Commercial |
$1,322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.39
|
| Rate for Payer: Nomi Health Commercial |
$1,205.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,287.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.49
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,674.46
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,388.40 |
| Max. Negotiated Rate |
$3,674.46 |
| Rate for Payer: Aetna Commercial |
$3,307.01
|
| Rate for Payer: ASR ASR |
$3,564.23
|
| Rate for Payer: ASR Commercial |
$3,564.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,994.32
|
| Rate for Payer: BCN Commercial |
$2,848.81
|
| Rate for Payer: Cash Price |
$2,939.57
|
| Rate for Payer: Cofinity Commercial |
$3,453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.57
|
| Rate for Payer: Healthscope Commercial |
$3,674.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,564.23
|
| Rate for Payer: Mclaren Commercial |
$3,307.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,123.29
|
| Rate for Payer: Nomi Health Commercial |
$3,013.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,233.52
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,674.46
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,469.78 |
| Max. Negotiated Rate |
$3,674.46 |
| Rate for Payer: Aetna Commercial |
$3,307.01
|
| Rate for Payer: Aetna Medicare |
$1,837.23
|
| Rate for Payer: ASR ASR |
$3,564.23
|
| Rate for Payer: ASR Commercial |
$3,564.23
|
| Rate for Payer: BCBS Complete |
$1,469.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,009.02
|
| Rate for Payer: BCN Commercial |
$2,848.81
|
| Rate for Payer: Cash Price |
$2,939.57
|
| Rate for Payer: Cofinity Commercial |
$3,453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.57
|
| Rate for Payer: Healthscope Commercial |
$3,674.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,564.23
|
| Rate for Payer: Mclaren Commercial |
$3,307.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,123.29
|
| Rate for Payer: Nomi Health Commercial |
$3,013.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,219.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,575.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,233.52
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,939.47
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,175.79 |
| Max. Negotiated Rate |
$2,939.47 |
| Rate for Payer: Aetna Commercial |
$2,645.52
|
| Rate for Payer: Aetna Medicare |
$1,469.73
|
| Rate for Payer: ASR ASR |
$2,851.29
|
| Rate for Payer: ASR Commercial |
$2,851.29
|
| Rate for Payer: BCBS Complete |
$1,175.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,407.13
|
| Rate for Payer: BCN Commercial |
$2,278.97
|
| Rate for Payer: Cash Price |
$2,351.58
|
| Rate for Payer: Cofinity Commercial |
$2,763.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,351.58
|
| Rate for Payer: Healthscope Commercial |
$2,939.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,851.29
|
| Rate for Payer: Mclaren Commercial |
$2,645.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,498.55
|
| Rate for Payer: Nomi Health Commercial |
$2,410.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,575.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,060.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,586.73
|
|
