|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Aetna Medicare |
$73.44
|
| Rate for Payer: ASR ASR |
$142.47
|
| Rate for Payer: ASR Commercial |
$142.47
|
| Rate for Payer: BCBS Complete |
$58.75
|
| Rate for Payer: BCBS Trust/PPO |
$120.28
|
| Rate for Payer: BCN Commercial |
$113.88
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$138.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Healthscope Whirlpool |
$142.47
|
| Rate for Payer: Mclaren Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: Nomi Health Commercial |
$120.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.70
|
| Rate for Payer: Priority Health Narrow Network |
$102.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.25
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$144.37
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$144.37 |
| Rate for Payer: Aetna Commercial |
$129.93
|
| Rate for Payer: ASR ASR |
$140.04
|
| Rate for Payer: ASR Commercial |
$140.04
|
| Rate for Payer: BCBS Trust/PPO |
$117.65
|
| Rate for Payer: BCN Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$135.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$144.37
|
| Rate for Payer: Healthscope Whirlpool |
$140.04
|
| Rate for Payer: Mclaren Commercial |
$129.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.71
|
| Rate for Payer: Nomi Health Commercial |
$118.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.05
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
OP
|
$144.37
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$144.37 |
| Rate for Payer: Aetna Commercial |
$129.93
|
| Rate for Payer: Aetna Medicare |
$72.18
|
| Rate for Payer: ASR ASR |
$140.04
|
| Rate for Payer: ASR Commercial |
$140.04
|
| Rate for Payer: BCBS Complete |
$57.75
|
| Rate for Payer: BCBS Trust/PPO |
$118.22
|
| Rate for Payer: BCN Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$135.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$144.37
|
| Rate for Payer: Healthscope Whirlpool |
$140.04
|
| Rate for Payer: Mclaren Commercial |
$129.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.71
|
| Rate for Payer: Nomi Health Commercial |
$118.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.50
|
| Rate for Payer: Priority Health Narrow Network |
$101.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.05
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$721.58
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$469.03 |
| Max. Negotiated Rate |
$721.58 |
| Rate for Payer: Aetna Commercial |
$649.42
|
| Rate for Payer: ASR ASR |
$699.93
|
| Rate for Payer: ASR Commercial |
$699.93
|
| Rate for Payer: BCBS Trust/PPO |
$588.02
|
| Rate for Payer: BCN Commercial |
$559.44
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cofinity Commercial |
$678.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.26
|
| Rate for Payer: Healthscope Commercial |
$721.58
|
| Rate for Payer: Healthscope Whirlpool |
$699.93
|
| Rate for Payer: Mclaren Commercial |
$649.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.34
|
| Rate for Payer: Nomi Health Commercial |
$591.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.99
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$721.58
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$288.63 |
| Max. Negotiated Rate |
$721.58 |
| Rate for Payer: Aetna Commercial |
$649.42
|
| Rate for Payer: Aetna Medicare |
$360.79
|
| Rate for Payer: ASR ASR |
$699.93
|
| Rate for Payer: ASR Commercial |
$699.93
|
| Rate for Payer: BCBS Complete |
$288.63
|
| Rate for Payer: BCBS Trust/PPO |
$590.90
|
| Rate for Payer: BCN Commercial |
$559.44
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cofinity Commercial |
$678.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.26
|
| Rate for Payer: Healthscope Commercial |
$721.58
|
| Rate for Payer: Healthscope Whirlpool |
$699.93
|
| Rate for Payer: Mclaren Commercial |
$649.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.34
|
| Rate for Payer: Nomi Health Commercial |
$591.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.25
|
| Rate for Payer: Priority Health Narrow Network |
$505.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.99
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: ASR ASR |
$3.64
|
| Rate for Payer: ASR Commercial |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Healthscope Whirlpool |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.30
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: ASR ASR |
$3.64
|
| Rate for Payer: ASR Commercial |
$3.64
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Healthscope Whirlpool |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.30
|
| Rate for Payer: Priority Health Narrow Network |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.30
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$216.04 |
| Rate for Payer: Aetna Commercial |
$194.44
|
| Rate for Payer: ASR ASR |
$209.56
|
| Rate for Payer: ASR Commercial |
$209.56
|
| Rate for Payer: BCBS Trust/PPO |
$176.05
|
| Rate for Payer: BCN Commercial |
$167.50
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$203.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$216.04
|
| Rate for Payer: Healthscope Whirlpool |
$209.56
|
| Rate for Payer: Mclaren Commercial |
$194.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.12
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.42 |
| Max. Negotiated Rate |
$216.04 |
| Rate for Payer: Aetna Commercial |
$194.44
|
| Rate for Payer: Aetna Medicare |
$108.02
|
| Rate for Payer: ASR ASR |
$209.56
|
| Rate for Payer: ASR Commercial |
$209.56
|
| Rate for Payer: BCBS Complete |
$86.42
|
| Rate for Payer: BCBS Trust/PPO |
$176.92
|
| Rate for Payer: BCN Commercial |
$167.50
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$203.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$216.04
|
| Rate for Payer: Healthscope Whirlpool |
$209.56
|
| Rate for Payer: Mclaren Commercial |
$194.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.29
|
| Rate for Payer: Priority Health Narrow Network |
$151.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.12
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$159.21 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.08
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$12.39
|
| Rate for Payer: PHP Medicaid |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.21
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$127.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Exchange |
$17.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.26
|
| Rate for Payer: UHCCP DNSP |
$11.26
|
| Rate for Payer: UHCCP Medicaid |
$6.04
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
|
|
HC LTC ROOM AND BOARD
|
Facility
|
IP
|
$377.40
|
|
| Hospital Charge Code |
11000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$245.31 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: ASR ASR |
$366.08
|
| Rate for Payer: ASR Commercial |
$366.08
|
| Rate for Payer: BCBS Trust/PPO |
$307.54
|
| Rate for Payer: BCN Commercial |
$292.60
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cofinity Commercial |
$354.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.92
|
| Rate for Payer: Healthscope Commercial |
$377.40
|
| Rate for Payer: Healthscope Whirlpool |
$366.08
|
| Rate for Payer: Mclaren Commercial |
$339.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.79
|
| Rate for Payer: Nomi Health Commercial |
$309.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.11
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.13 |
| Max. Negotiated Rate |
$12,357.92 |
| Rate for Payer: Aetna Commercial |
$11,122.13
|
| Rate for Payer: Aetna Medicare |
$3,151.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,939.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,939.21
|
| Rate for Payer: ASR ASR |
$11,987.18
|
| Rate for Payer: ASR Commercial |
$11,987.18
|
| Rate for Payer: BCBS Complete |
$1,773.59
|
| Rate for Payer: BCBS MAPPO |
$3,151.37
|
| Rate for Payer: BCBS Trust/PPO |
$10,119.90
|
| Rate for Payer: BCN Commercial |
$9,581.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,151.37
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$11,616.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,151.37
|
| Rate for Payer: Healthscope Commercial |
$12,357.92
|
| Rate for Payer: Healthscope Whirlpool |
$11,987.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,151.37
|
| Rate for Payer: Mclaren Commercial |
$11,122.13
|
| Rate for Payer: Mclaren Medicaid |
$1,689.13
|
| Rate for Payer: Mclaren Medicare |
$3,151.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,308.94
|
| Rate for Payer: Meridian Medicaid |
$1,773.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,624.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$10,133.49
|
| Rate for Payer: PACE Medicare |
$2,993.80
|
| Rate for Payer: PACE SWMI |
$3,151.37
|
| Rate for Payer: PHP Commercial |
$3,466.51
|
| Rate for Payer: PHP Medicaid |
$1,689.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,151.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,828.01
|
| Rate for Payer: Priority Health Medicare |
$3,151.37
|
| Rate for Payer: Priority Health Narrow Network |
$8,662.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,151.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,874.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,151.37
|
| Rate for Payer: UHC Exchange |
$4,884.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,151.37
|
| Rate for Payer: UHCCP DNSP |
$3,151.37
|
| Rate for Payer: UHCCP Medicaid |
$1,689.13
|
| Rate for Payer: VA VA |
$3,151.37
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,032.65 |
| Max. Negotiated Rate |
$12,357.92 |
| Rate for Payer: Aetna Commercial |
$11,122.13
|
| Rate for Payer: ASR ASR |
$11,987.18
|
| Rate for Payer: ASR Commercial |
$11,987.18
|
| Rate for Payer: BCBS Trust/PPO |
$10,070.47
|
| Rate for Payer: BCN Commercial |
$9,581.10
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$11,616.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Healthscope Commercial |
$12,357.92
|
| Rate for Payer: Healthscope Whirlpool |
$11,987.18
|
| Rate for Payer: Mclaren Commercial |
$11,122.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$10,133.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,874.97
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.68 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Aetna Commercial |
$71.55
|
| Rate for Payer: ASR ASR |
$77.12
|
| Rate for Payer: ASR Commercial |
$77.12
|
| Rate for Payer: BCBS Trust/PPO |
$64.78
|
| Rate for Payer: BCN Commercial |
$61.64
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$74.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$79.50
|
| Rate for Payer: Healthscope Whirlpool |
$77.12
|
| Rate for Payer: Mclaren Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: Nomi Health Commercial |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.96
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Aetna Commercial |
$71.55
|
| Rate for Payer: Aetna Medicare |
$39.75
|
| Rate for Payer: ASR ASR |
$77.12
|
| Rate for Payer: ASR Commercial |
$77.12
|
| Rate for Payer: BCBS Complete |
$31.80
|
| Rate for Payer: BCBS Trust/PPO |
$65.10
|
| Rate for Payer: BCN Commercial |
$61.64
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$74.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$79.50
|
| Rate for Payer: Healthscope Whirlpool |
$77.12
|
| Rate for Payer: Mclaren Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: Nomi Health Commercial |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.43
|
| Rate for Payer: Priority Health Narrow Network |
$15.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.96
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: ASR Commercial |
$726.08
|
| Rate for Payer: BCBS Trust/PPO |
$609.99
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$748.54 |
| Rate for Payer: Aetna Commercial |
$673.69
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: ASR ASR |
$726.08
|
| Rate for Payer: ASR Commercial |
$726.08
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS Trust/PPO |
$612.98
|
| Rate for Payer: BCN Commercial |
$580.34
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$703.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$748.54
|
| Rate for Payer: Healthscope Whirlpool |
$726.08
|
| Rate for Payer: Mclaren Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.87
|
| Rate for Payer: Priority Health Narrow Network |
$524.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$658.72
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.65 |
| Max. Negotiated Rate |
$916.38 |
| Rate for Payer: Aetna Commercial |
$824.74
|
| Rate for Payer: ASR ASR |
$888.89
|
| Rate for Payer: ASR Commercial |
$888.89
|
| Rate for Payer: BCBS Trust/PPO |
$746.76
|
| Rate for Payer: BCN Commercial |
$710.47
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$861.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Healthscope Commercial |
$916.38
|
| Rate for Payer: Healthscope Whirlpool |
$888.89
|
| Rate for Payer: Mclaren Commercial |
$824.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$751.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.41
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$824.74
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$888.89
|
| Rate for Payer: ASR Commercial |
$888.89
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$750.42
|
| Rate for Payer: BCN Commercial |
$710.47
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$861.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$916.38
|
| Rate for Payer: Healthscope Whirlpool |
$888.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$824.74
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$751.43
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.44
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$469.95
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$771.00 |
| Rate for Payer: Aetna Commercial |
$693.90
|
| Rate for Payer: ASR ASR |
$747.87
|
| Rate for Payer: ASR Commercial |
$747.87
|
| Rate for Payer: BCBS Trust/PPO |
$628.29
|
| Rate for Payer: BCN Commercial |
$597.76
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$724.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Healthscope Commercial |
$771.00
|
| Rate for Payer: Healthscope Whirlpool |
$747.87
|
| Rate for Payer: Mclaren Commercial |
$693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$632.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.48
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$693.90
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$747.87
|
| Rate for Payer: ASR Commercial |
$747.87
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$631.37
|
| Rate for Payer: BCN Commercial |
$597.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$724.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$771.00
|
| Rate for Payer: Healthscope Whirlpool |
$747.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$693.90
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$632.22
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$675.55
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$540.47
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$850.89 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$1,897.14
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$2,044.69
|
| Rate for Payer: ASR Commercial |
$2,044.69
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.18
|
| Rate for Payer: BCN Commercial |
$1,634.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,981.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,107.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,044.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$1,897.14
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: Nomi Health Commercial |
$1,728.50
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,846.97
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,477.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,854.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
