|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$370.34
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$76.61 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$333.31
|
| Rate for Payer: Aetna Medicare |
$140.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.08
|
| Rate for Payer: ASR ASR |
$359.23
|
| Rate for Payer: BCBS Complete |
$80.45
|
| Rate for Payer: BCBS MAPPO |
$140.06
|
| Rate for Payer: BCBS Trust/PPO |
$287.12
|
| Rate for Payer: BCN Commercial |
$287.12
|
| Rate for Payer: BCN Medicare Advantage |
$140.06
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cofinity Commercial |
$348.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.06
|
| Rate for Payer: Healthscope Commercial |
$370.34
|
| Rate for Payer: Healthscope Whirlpool |
$359.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$140.06
|
| Rate for Payer: Mclaren Commercial |
$333.31
|
| Rate for Payer: Mclaren Medicaid |
$76.61
|
| Rate for Payer: Mclaren Medicare |
$140.06
|
| Rate for Payer: Meridian Medicaid |
$80.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.79
|
| Rate for Payer: PACE Medicare |
$133.06
|
| Rate for Payer: PACE SWMI |
$140.06
|
| Rate for Payer: PHP Commercial |
$154.07
|
| Rate for Payer: PHP Medicaid |
$76.61
|
| Rate for Payer: PHP Medicare Advantage |
$140.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.57
|
| Rate for Payer: Priority Health Medicare |
$140.06
|
| Rate for Payer: Priority Health Narrow Network |
$128.46
|
| Rate for Payer: Railroad Medicare Medicare |
$140.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.90
|
| Rate for Payer: UHC Medicare Advantage |
$144.26
|
| Rate for Payer: VA VA |
$140.06
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: ASR ASR |
$92.34
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$73.81
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Healthscope Commercial |
$95.20
|
| Rate for Payer: Healthscope Whirlpool |
$92.34
|
| Rate for Payer: Mclaren Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.78
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$92.34
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$73.81
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$95.20
|
| Rate for Payer: Healthscope Whirlpool |
$92.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$85.68
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.63
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$67.59
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.78
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$22.80
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: ASR ASR |
$22.12
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$17.68
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$22.80
|
| Rate for Payer: Healthscope Whirlpool |
$22.12
|
| Rate for Payer: Mclaren Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.75
|
| Rate for Payer: Priority Health Narrow Network |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.06
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$22.80
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: ASR ASR |
$22.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$17.68
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$22.80
|
| Rate for Payer: Healthscope Whirlpool |
$22.12
|
| Rate for Payer: Mclaren Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.06
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,615.05
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$4,615.05 |
| Rate for Payer: Aetna Commercial |
$4,153.54
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$4,476.60
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,578.05
|
| Rate for Payer: BCN Commercial |
$3,578.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cofinity Commercial |
$4,338.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,692.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$4,615.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,476.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$4,153.54
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,922.79
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,199.70
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$3,276.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,061.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
IP
|
$4,615.05
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,230.54 |
| Max. Negotiated Rate |
$4,615.05 |
| Rate for Payer: Aetna Commercial |
$4,153.54
|
| Rate for Payer: ASR ASR |
$4,476.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,578.05
|
| Rate for Payer: BCN Commercial |
$3,578.05
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cofinity Commercial |
$4,338.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,692.04
|
| Rate for Payer: Healthscope Commercial |
$4,615.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,476.60
|
| Rate for Payer: Mclaren Commercial |
$4,153.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,922.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,061.24
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
OP
|
$3,693.58
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,365.19 |
| Max. Negotiated Rate |
$3,693.58 |
| Rate for Payer: Aetna Commercial |
$3,324.22
|
| Rate for Payer: Aetna Medicare |
$2,495.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: ASR ASR |
$3,582.77
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.63
|
| Rate for Payer: BCN Commercial |
$2,863.63
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cofinity Commercial |
$3,471.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Healthscope Commercial |
$3,693.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,495.78
|
| Rate for Payer: Mclaren Commercial |
$3,324.22
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.54
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Commercial |
$2,745.36
|
| Rate for Payer: PHP Medicaid |
$1,365.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,361.16
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,622.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
IP
|
$3,693.58
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,585.51 |
| Max. Negotiated Rate |
$3,693.58 |
| Rate for Payer: Aetna Commercial |
$3,324.22
|
| Rate for Payer: ASR ASR |
$3,582.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,863.63
|
| Rate for Payer: BCN Commercial |
$2,863.63
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cofinity Commercial |
$3,471.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.86
|
| Rate for Payer: Healthscope Commercial |
$3,693.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,582.77
|
| Rate for Payer: Mclaren Commercial |
$3,324.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,250.35
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
OP
|
$4,195.50
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$4,195.50 |
| Rate for Payer: Aetna Commercial |
$3,775.95
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$4,069.64
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,252.77
|
| Rate for Payer: BCN Commercial |
$3,252.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cofinity Commercial |
$3,943.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,356.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$4,195.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,069.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,775.95
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,566.18
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,936.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,817.90
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,978.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,692.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
IP
|
$4,195.50
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,936.85 |
| Max. Negotiated Rate |
$4,195.50 |
| Rate for Payer: Aetna Commercial |
$3,775.95
|
| Rate for Payer: ASR ASR |
$4,069.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,252.77
|
| Rate for Payer: BCN Commercial |
$3,252.77
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cofinity Commercial |
$3,943.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,356.40
|
| Rate for Payer: Healthscope Commercial |
$4,195.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,069.64
|
| Rate for Payer: Mclaren Commercial |
$3,775.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,566.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,936.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,692.04
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
IP
|
$682.65
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$682.65 |
| Rate for Payer: Aetna Commercial |
$614.38
|
| Rate for Payer: ASR ASR |
$662.17
|
| Rate for Payer: BCBS Trust/PPO |
$529.26
|
| Rate for Payer: BCN Commercial |
$529.26
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cofinity Commercial |
$641.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.12
|
| Rate for Payer: Healthscope Commercial |
$682.65
|
| Rate for Payer: Healthscope Whirlpool |
$662.17
|
| Rate for Payer: Mclaren Commercial |
$614.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$600.73
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$682.65
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.26 |
| Max. Negotiated Rate |
$682.65 |
| Rate for Payer: Aetna Commercial |
$614.38
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$662.17
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$529.26
|
| Rate for Payer: BCN Commercial |
$529.26
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cofinity Commercial |
$641.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$682.65
|
| Rate for Payer: Healthscope Whirlpool |
$662.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$614.38
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.25
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.57
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$49.26
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$600.73
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
OP
|
$1,053.73
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$421.49 |
| Max. Negotiated Rate |
$1,053.73 |
| Rate for Payer: Aetna Commercial |
$948.36
|
| Rate for Payer: ASR ASR |
$1,022.12
|
| Rate for Payer: BCBS Complete |
$421.49
|
| Rate for Payer: BCBS Trust/PPO |
$816.96
|
| Rate for Payer: BCN Commercial |
$816.96
|
| Rate for Payer: Cash Price |
$842.98
|
| Rate for Payer: Cofinity Commercial |
$990.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.98
|
| Rate for Payer: Healthscope Commercial |
$1,053.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.12
|
| Rate for Payer: Mclaren Commercial |
$948.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.89
|
| Rate for Payer: Priority Health Narrow Network |
$748.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$927.28
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
IP
|
$1,053.73
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.61 |
| Max. Negotiated Rate |
$1,053.73 |
| Rate for Payer: Aetna Commercial |
$948.36
|
| Rate for Payer: ASR ASR |
$1,022.12
|
| Rate for Payer: BCBS Trust/PPO |
$816.96
|
| Rate for Payer: BCN Commercial |
$816.96
|
| Rate for Payer: Cash Price |
$842.98
|
| Rate for Payer: Cofinity Commercial |
$990.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.98
|
| Rate for Payer: Healthscope Commercial |
$1,053.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.12
|
| Rate for Payer: Mclaren Commercial |
$948.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$927.28
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,140.07
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,298.05 |
| Max. Negotiated Rate |
$6,140.07 |
| Rate for Payer: Aetna Commercial |
$5,526.06
|
| Rate for Payer: ASR ASR |
$5,955.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,760.40
|
| Rate for Payer: BCN Commercial |
$4,760.40
|
| Rate for Payer: Cash Price |
$4,912.06
|
| Rate for Payer: Cofinity Commercial |
$5,771.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.06
|
| Rate for Payer: Healthscope Commercial |
$6,140.07
|
| Rate for Payer: Healthscope Whirlpool |
$5,955.87
|
| Rate for Payer: Mclaren Commercial |
$5,526.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,403.26
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,140.07
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,456.03 |
| Max. Negotiated Rate |
$6,140.07 |
| Rate for Payer: Aetna Commercial |
$5,526.06
|
| Rate for Payer: ASR ASR |
$5,955.87
|
| Rate for Payer: BCBS Complete |
$2,456.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,760.40
|
| Rate for Payer: BCN Commercial |
$4,760.40
|
| Rate for Payer: Cash Price |
$4,912.06
|
| Rate for Payer: Cofinity Commercial |
$5,771.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.06
|
| Rate for Payer: Healthscope Commercial |
$6,140.07
|
| Rate for Payer: Healthscope Whirlpool |
$5,955.87
|
| Rate for Payer: Mclaren Commercial |
$5,526.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,587.46
|
| Rate for Payer: Priority Health Narrow Network |
$4,359.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,403.26
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,396.89
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,677.82 |
| Max. Negotiated Rate |
$2,396.89 |
| Rate for Payer: Aetna Commercial |
$2,157.20
|
| Rate for Payer: ASR ASR |
$2,324.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.31
|
| Rate for Payer: BCN Commercial |
$1,858.31
|
| Rate for Payer: Cash Price |
$1,917.51
|
| Rate for Payer: Cofinity Commercial |
$2,253.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.51
|
| Rate for Payer: Healthscope Commercial |
$2,396.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,324.98
|
| Rate for Payer: Mclaren Commercial |
$2,157.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,037.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.26
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,396.89
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$958.76 |
| Max. Negotiated Rate |
$2,396.89 |
| Rate for Payer: Aetna Commercial |
$2,157.20
|
| Rate for Payer: ASR ASR |
$2,324.98
|
| Rate for Payer: BCBS Complete |
$958.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.31
|
| Rate for Payer: BCN Commercial |
$1,858.31
|
| Rate for Payer: Cash Price |
$1,917.51
|
| Rate for Payer: Cofinity Commercial |
$2,253.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.51
|
| Rate for Payer: Healthscope Commercial |
$2,396.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,324.98
|
| Rate for Payer: Mclaren Commercial |
$2,157.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,037.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,181.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,701.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.26
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,641.80 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna Commercial |
$3,396.60
|
| Rate for Payer: ASR ASR |
$3,660.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.98
|
| Rate for Payer: BCN Commercial |
$2,925.98
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,547.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Healthscope Commercial |
$3,774.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.78
|
| Rate for Payer: Mclaren Commercial |
$3,396.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.12
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna Commercial |
$3,396.60
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$3,660.78
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.98
|
| Rate for Payer: BCN Commercial |
$2,925.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,547.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,774.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$3,396.60
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,434.34
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,679.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.12
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,641.80 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna Commercial |
$3,396.60
|
| Rate for Payer: ASR ASR |
$3,660.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.98
|
| Rate for Payer: BCN Commercial |
$2,925.98
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,547.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Healthscope Commercial |
$3,774.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.78
|
| Rate for Payer: Mclaren Commercial |
$3,396.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.12
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,641.80 |
| Max. Negotiated Rate |
$6,105.86 |
| Rate for Payer: Aetna Commercial |
$3,396.60
|
| Rate for Payer: Aetna Medicare |
$4,884.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: ASR ASR |
$3,660.78
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.98
|
| Rate for Payer: BCN Commercial |
$2,925.98
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,547.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Healthscope Commercial |
$3,774.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,884.69
|
| Rate for Payer: Mclaren Commercial |
$3,396.60
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Commercial |
$5,373.16
|
| Rate for Payer: PHP Medicaid |
$2,671.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,434.34
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,679.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.12
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$406.40
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$406.40 |
| Rate for Payer: Aetna Commercial |
$365.76
|
| Rate for Payer: ASR ASR |
$394.21
|
| Rate for Payer: BCBS Trust/PPO |
$315.08
|
| Rate for Payer: BCN Commercial |
$315.08
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$382.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.12
|
| Rate for Payer: Healthscope Commercial |
$406.40
|
| Rate for Payer: Healthscope Whirlpool |
$394.21
|
| Rate for Payer: Mclaren Commercial |
$365.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.63
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$406.40
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$406.40 |
| Rate for Payer: Aetna Commercial |
$365.76
|
| Rate for Payer: ASR ASR |
$394.21
|
| Rate for Payer: BCBS Complete |
$162.56
|
| Rate for Payer: BCBS Trust/PPO |
$315.08
|
| Rate for Payer: BCN Commercial |
$315.08
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$382.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.12
|
| Rate for Payer: Healthscope Commercial |
$406.40
|
| Rate for Payer: Healthscope Whirlpool |
$394.21
|
| Rate for Payer: Mclaren Commercial |
$365.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.82
|
| Rate for Payer: Priority Health Narrow Network |
$288.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.63
|
|
