|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$89.05
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$80.14
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$86.38
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cofinity Commercial |
$83.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$86.38
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$80.14
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.69
|
| Rate for Payer: Nomi Health Commercial |
$73.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.79
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.03
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$62.42
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,519.13
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.48 |
| Max. Negotiated Rate |
$2,519.13 |
| Rate for Payer: Aetna Commercial |
$2,267.22
|
| Rate for Payer: Aetna Medicare |
$1,213.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,516.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,516.45
|
| Rate for Payer: ASR ASR |
$2,443.56
|
| Rate for Payer: BCBS Complete |
$666.27
|
| Rate for Payer: BCBS MAPPO |
$1,213.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.02
|
| Rate for Payer: BCN Commercial |
$2,077.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,213.16
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cofinity Commercial |
$2,367.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,015.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,213.16
|
| Rate for Payer: Healthscope Commercial |
$2,443.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,519.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,213.16
|
| Rate for Payer: Mclaren Commercial |
$2,267.22
|
| Rate for Payer: Mclaren Medicaid |
$1,213.16
|
| Rate for Payer: Mclaren Medicare |
$1,213.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.82
|
| Rate for Payer: Meridian Medicaid |
$666.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,395.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,141.26
|
| Rate for Payer: Nomi Health Commercial |
$2,065.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,889.35
|
| Rate for Payer: PACE Medicare |
$1,152.50
|
| Rate for Payer: PACE SWMI |
$1,213.16
|
| Rate for Payer: PHP Commercial |
$1,334.48
|
| Rate for Payer: PHP Medicaid |
$650.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,213.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,207.26
|
| Rate for Payer: Priority Health Medicare |
$1,213.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,765.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,213.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,216.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,213.16
|
| Rate for Payer: UHC Exchange |
$1,880.40
|
| Rate for Payer: UHC Medicaid |
$634.48
|
| Rate for Payer: UHCCP DNSP |
$1,213.16
|
| Rate for Payer: UHCCP Medicaid |
$634.48
|
| Rate for Payer: VA VA |
$1,213.16
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,519.13
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,889.35 |
| Max. Negotiated Rate |
$2,519.13 |
| Rate for Payer: Aetna Commercial |
$2,267.22
|
| Rate for Payer: ASR ASR |
$2,443.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,068.71
|
| Rate for Payer: BCN Commercial |
$2,068.71
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cofinity Commercial |
$2,367.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,015.30
|
| Rate for Payer: Healthscope Commercial |
$2,443.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,519.13
|
| Rate for Payer: Mclaren Commercial |
$2,267.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,141.26
|
| Rate for Payer: Nomi Health Commercial |
$2,065.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,889.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,216.83
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,155.32
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$866.49 |
| Max. Negotiated Rate |
$1,155.32 |
| Rate for Payer: Aetna Commercial |
$1,039.79
|
| Rate for Payer: ASR ASR |
$1,120.66
|
| Rate for Payer: BCBS Trust/PPO |
$948.75
|
| Rate for Payer: BCN Commercial |
$948.75
|
| Rate for Payer: Cash Price |
$924.26
|
| Rate for Payer: Cofinity Commercial |
$1,086.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.26
|
| Rate for Payer: Healthscope Commercial |
$1,120.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,155.32
|
| Rate for Payer: Mclaren Commercial |
$1,039.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.02
|
| Rate for Payer: Nomi Health Commercial |
$947.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.68
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,155.32
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$427.47 |
| Max. Negotiated Rate |
$1,155.32 |
| Rate for Payer: Aetna Commercial |
$1,039.79
|
| Rate for Payer: Aetna Medicare |
$427.47
|
| Rate for Payer: ASR ASR |
$1,120.66
|
| Rate for Payer: BCBS Complete |
$462.13
|
| Rate for Payer: BCBS Trust/PPO |
$952.56
|
| Rate for Payer: BCN Commercial |
$952.56
|
| Rate for Payer: Cash Price |
$924.26
|
| Rate for Payer: Cofinity Commercial |
$1,086.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.26
|
| Rate for Payer: Healthscope Commercial |
$1,120.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,155.32
|
| Rate for Payer: Mclaren Commercial |
$1,039.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$924.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.02
|
| Rate for Payer: Nomi Health Commercial |
$947.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,012.29
|
| Rate for Payer: Priority Health Narrow Network |
$809.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.68
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$942.80
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.84 |
| Max. Negotiated Rate |
$942.80 |
| Rate for Payer: Aetna Commercial |
$848.52
|
| Rate for Payer: Aetna Medicare |
$348.84
|
| Rate for Payer: ASR ASR |
$914.52
|
| Rate for Payer: BCBS Complete |
$377.12
|
| Rate for Payer: BCBS Trust/PPO |
$777.34
|
| Rate for Payer: BCN Commercial |
$777.34
|
| Rate for Payer: Cash Price |
$754.24
|
| Rate for Payer: Cofinity Commercial |
$886.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.24
|
| Rate for Payer: Healthscope Commercial |
$914.52
|
| Rate for Payer: Healthscope Whirlpool |
$942.80
|
| Rate for Payer: Mclaren Commercial |
$848.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$754.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.38
|
| Rate for Payer: Nomi Health Commercial |
$773.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$826.08
|
| Rate for Payer: Priority Health Narrow Network |
$660.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.66
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$942.80
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$707.10 |
| Max. Negotiated Rate |
$942.80 |
| Rate for Payer: Aetna Commercial |
$848.52
|
| Rate for Payer: ASR ASR |
$914.52
|
| Rate for Payer: BCBS Trust/PPO |
$774.23
|
| Rate for Payer: BCN Commercial |
$774.23
|
| Rate for Payer: Cash Price |
$754.24
|
| Rate for Payer: Cofinity Commercial |
$886.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.24
|
| Rate for Payer: Healthscope Commercial |
$914.52
|
| Rate for Payer: Healthscope Whirlpool |
$942.80
|
| Rate for Payer: Mclaren Commercial |
$848.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.38
|
| Rate for Payer: Nomi Health Commercial |
$773.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.66
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$366.12
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$366.12 |
| Rate for Payer: Aetna Commercial |
$329.51
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$355.14
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$301.87
|
| Rate for Payer: BCN Commercial |
$301.87
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cofinity Commercial |
$344.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$355.14
|
| Rate for Payer: Healthscope Whirlpool |
$366.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$329.51
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.20
|
| Rate for Payer: Nomi Health Commercial |
$300.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.59
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$366.12
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.59 |
| Max. Negotiated Rate |
$366.12 |
| Rate for Payer: Aetna Commercial |
$329.51
|
| Rate for Payer: ASR ASR |
$355.14
|
| Rate for Payer: BCBS Trust/PPO |
$300.66
|
| Rate for Payer: BCN Commercial |
$300.66
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cofinity Commercial |
$344.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.90
|
| Rate for Payer: Healthscope Commercial |
$355.14
|
| Rate for Payer: Healthscope Whirlpool |
$366.12
|
| Rate for Payer: Mclaren Commercial |
$329.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.20
|
| Rate for Payer: Nomi Health Commercial |
$300.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.19
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,630.86
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,913.26
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,326.27
|
| Rate for Payer: BCN Commercial |
$3,326.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Commercial |
$3,792.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,913.26
|
| Rate for Payer: Healthscope Whirlpool |
$4,034.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,630.86
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Nomi Health Commercial |
$3,308.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,801.97
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,241.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,550.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,025.72 |
| Max. Negotiated Rate |
$4,034.29 |
| Rate for Payer: Aetna Commercial |
$3,630.86
|
| Rate for Payer: ASR ASR |
$3,913.26
|
| Rate for Payer: BCBS Trust/PPO |
$3,312.96
|
| Rate for Payer: BCN Commercial |
$3,312.96
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Commercial |
$3,792.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Healthscope Commercial |
$3,913.26
|
| Rate for Payer: Healthscope Whirlpool |
$4,034.29
|
| Rate for Payer: Mclaren Commercial |
$3,630.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Nomi Health Commercial |
$3,308.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,550.18
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,303.52 |
| Max. Negotiated Rate |
$9,738.02 |
| Rate for Payer: Aetna Commercial |
$8,764.22
|
| Rate for Payer: ASR ASR |
$9,445.88
|
| Rate for Payer: BCBS Trust/PPO |
$7,996.86
|
| Rate for Payer: BCN Commercial |
$7,996.86
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$9,153.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Healthscope Commercial |
$9,445.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,738.02
|
| Rate for Payer: Mclaren Commercial |
$8,764.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,569.46
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$9,738.02 |
| Rate for Payer: Aetna Commercial |
$8,764.22
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$9,445.88
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$8,029.00
|
| Rate for Payer: BCN Commercial |
$8,029.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$9,153.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$9,445.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,738.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$8,764.22
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,801.97
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,241.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,569.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$269.62 |
| Max. Negotiated Rate |
$359.49 |
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: ASR ASR |
$348.71
|
| Rate for Payer: BCBS Trust/PPO |
$295.21
|
| Rate for Payer: BCN Commercial |
$295.21
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Commercial |
$337.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Healthscope Commercial |
$348.71
|
| Rate for Payer: Healthscope Whirlpool |
$359.49
|
| Rate for Payer: Mclaren Commercial |
$323.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Nomi Health Commercial |
$294.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.35
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$359.49 |
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna Medicare |
$201.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: ASR ASR |
$348.71
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$296.40
|
| Rate for Payer: BCN Commercial |
$296.40
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Commercial |
$337.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$348.71
|
| Rate for Payer: Healthscope Whirlpool |
$359.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$201.44
|
| Rate for Payer: Mclaren Commercial |
$323.54
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$110.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Nomi Health Commercial |
$294.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$221.58
|
| Rate for Payer: PHP Medicaid |
$107.97
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$313.53
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$250.82
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$312.23
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP DNSP |
$201.44
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,249.98 |
| Max. Negotiated Rate |
$3,378.32 |
| Rate for Payer: Aetna Commercial |
$3,040.49
|
| Rate for Payer: Aetna Medicare |
$1,249.98
|
| Rate for Payer: ASR ASR |
$3,276.97
|
| Rate for Payer: BCBS Complete |
$1,351.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.42
|
| Rate for Payer: BCN Commercial |
$2,785.42
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Commercial |
$3,175.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,276.97
|
| Rate for Payer: Healthscope Whirlpool |
$3,378.32
|
| Rate for Payer: Mclaren Commercial |
$3,040.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,702.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Nomi Health Commercial |
$2,770.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,960.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,368.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,972.92
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,533.74 |
| Max. Negotiated Rate |
$3,378.32 |
| Rate for Payer: Aetna Commercial |
$3,040.49
|
| Rate for Payer: ASR ASR |
$3,276.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,774.28
|
| Rate for Payer: BCN Commercial |
$2,774.28
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Commercial |
$3,175.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,276.97
|
| Rate for Payer: Healthscope Whirlpool |
$3,378.32
|
| Rate for Payer: Mclaren Commercial |
$3,040.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Nomi Health Commercial |
$2,770.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,972.92
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,704.52 |
| Max. Negotiated Rate |
$4,606.81 |
| Rate for Payer: Aetna Commercial |
$4,146.13
|
| Rate for Payer: Aetna Medicare |
$1,704.52
|
| Rate for Payer: ASR ASR |
$4,468.61
|
| Rate for Payer: BCBS Complete |
$1,842.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,798.31
|
| Rate for Payer: BCN Commercial |
$3,798.31
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Commercial |
$4,330.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,468.61
|
| Rate for Payer: Healthscope Whirlpool |
$4,606.81
|
| Rate for Payer: Mclaren Commercial |
$4,146.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,685.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Nomi Health Commercial |
$3,777.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,036.49
|
| Rate for Payer: Priority Health Narrow Network |
$3,229.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,053.99
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,455.11 |
| Max. Negotiated Rate |
$4,606.81 |
| Rate for Payer: Aetna Commercial |
$4,146.13
|
| Rate for Payer: ASR ASR |
$4,468.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,783.11
|
| Rate for Payer: BCN Commercial |
$3,783.11
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Commercial |
$4,330.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,468.61
|
| Rate for Payer: Healthscope Whirlpool |
$4,606.81
|
| Rate for Payer: Mclaren Commercial |
$4,146.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Nomi Health Commercial |
$3,777.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,053.99
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: ASR ASR |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$20.92
|
| Rate for Payer: BCN Commercial |
$20.92
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$24.71
|
| Rate for Payer: Healthscope Whirlpool |
$25.47
|
| Rate for Payer: Mclaren Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.41
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$24.71
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$21.00
|
| Rate for Payer: BCN Commercial |
$21.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$24.71
|
| Rate for Payer: Healthscope Whirlpool |
$25.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$22.92
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: BCBS Trust/PPO |
$36.74
|
| Rate for Payer: BCN Commercial |
$36.74
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$43.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.74
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$44.74 |
| Rate for Payer: Aetna Commercial |
$40.27
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: ASR ASR |
$43.40
|
| Rate for Payer: BCBS Complete |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$36.89
|
| Rate for Payer: BCN Commercial |
$36.89
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$43.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.74
|
| Rate for Payer: Mclaren Commercial |
$40.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.20
|
| Rate for Payer: Priority Health Narrow Network |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.37
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.12 |
| Max. Negotiated Rate |
$422.82 |
| Rate for Payer: Aetna Commercial |
$380.54
|
| Rate for Payer: ASR ASR |
$410.14
|
| Rate for Payer: BCBS Trust/PPO |
$347.22
|
| Rate for Payer: BCN Commercial |
$347.22
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Commercial |
$397.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$410.14
|
| Rate for Payer: Healthscope Whirlpool |
$422.82
|
| Rate for Payer: Mclaren Commercial |
$380.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Nomi Health Commercial |
$346.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.08
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$422.82 |
| Rate for Payer: Aetna Commercial |
$380.54
|
| Rate for Payer: Aetna Medicare |
$156.44
|
| Rate for Payer: ASR ASR |
$410.14
|
| Rate for Payer: BCBS Complete |
$169.13
|
| Rate for Payer: BCBS Trust/PPO |
$348.62
|
| Rate for Payer: BCN Commercial |
$348.62
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Commercial |
$397.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$410.14
|
| Rate for Payer: Healthscope Whirlpool |
$422.82
|
| Rate for Payer: Mclaren Commercial |
$380.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Nomi Health Commercial |
$346.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$370.47
|
| Rate for Payer: Priority Health Narrow Network |
$296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.08
|
|
