|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$55.27
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$55.27 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: ASR ASR |
$53.61
|
| Rate for Payer: BCBS Trust/PPO |
$45.39
|
| Rate for Payer: BCN Commercial |
$45.39
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Commercial |
$51.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$53.61
|
| Rate for Payer: Healthscope Whirlpool |
$55.27
|
| Rate for Payer: Mclaren Commercial |
$49.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.98
|
| Rate for Payer: Nomi Health Commercial |
$45.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.64
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$32.56
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$32.56 |
| Rate for Payer: Aetna Commercial |
$29.30
|
| Rate for Payer: ASR ASR |
$31.58
|
| Rate for Payer: BCBS Trust/PPO |
$26.74
|
| Rate for Payer: BCN Commercial |
$26.74
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$30.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.05
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Healthscope Whirlpool |
$32.56
|
| Rate for Payer: Mclaren Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.68
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.65
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$32.56
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$29.30
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$31.58
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$26.85
|
| Rate for Payer: BCN Commercial |
$26.85
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$30.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Healthscope Whirlpool |
$32.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$29.30
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.68
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.42
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.60
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$24.48
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC OAT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC OAT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,707.30
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,780.47 |
| Max. Negotiated Rate |
$3,707.30 |
| Rate for Payer: Aetna Commercial |
$3,336.57
|
| Rate for Payer: ASR ASR |
$3,596.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,044.43
|
| Rate for Payer: BCN Commercial |
$3,044.43
|
| Rate for Payer: Cash Price |
$2,965.84
|
| Rate for Payer: Cofinity Commercial |
$3,484.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,965.84
|
| Rate for Payer: Healthscope Commercial |
$3,596.08
|
| Rate for Payer: Healthscope Whirlpool |
$3,707.30
|
| Rate for Payer: Mclaren Commercial |
$3,336.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,151.20
|
| Rate for Payer: Nomi Health Commercial |
$3,039.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,780.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,262.42
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,846.93
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,385.20 |
| Max. Negotiated Rate |
$1,846.93 |
| Rate for Payer: Aetna Commercial |
$1,662.24
|
| Rate for Payer: ASR ASR |
$1,791.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,516.70
|
| Rate for Payer: BCN Commercial |
$1,516.70
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cofinity Commercial |
$1,736.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.54
|
| Rate for Payer: Healthscope Commercial |
$1,791.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,846.93
|
| Rate for Payer: Mclaren Commercial |
$1,662.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.89
|
| Rate for Payer: Nomi Health Commercial |
$1,514.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,625.30
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$4,063.66
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$3,047.74 |
| Max. Negotiated Rate |
$4,063.66 |
| Rate for Payer: Aetna Commercial |
$3,657.29
|
| Rate for Payer: ASR ASR |
$3,941.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,337.08
|
| Rate for Payer: BCN Commercial |
$3,337.08
|
| Rate for Payer: Cash Price |
$3,250.93
|
| Rate for Payer: Cofinity Commercial |
$3,819.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,250.93
|
| Rate for Payer: Healthscope Commercial |
$3,941.75
|
| Rate for Payer: Healthscope Whirlpool |
$4,063.66
|
| Rate for Payer: Mclaren Commercial |
$3,657.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,454.11
|
| Rate for Payer: Nomi Health Commercial |
$3,332.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,576.02
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OB POSTPARTUM R&B
|
Facility
|
IP
|
$2,611.50
|
|
| Hospital Charge Code |
11200002
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,958.62 |
| Max. Negotiated Rate |
$2,611.50 |
| Rate for Payer: Aetna Commercial |
$2,350.35
|
| Rate for Payer: ASR ASR |
$2,533.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,144.56
|
| Rate for Payer: BCN Commercial |
$2,144.56
|
| Rate for Payer: Cash Price |
$2,089.20
|
| Rate for Payer: Cofinity Commercial |
$2,454.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,089.20
|
| Rate for Payer: Healthscope Commercial |
$2,533.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,611.50
|
| Rate for Payer: Mclaren Commercial |
$2,350.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,219.78
|
| Rate for Payer: Nomi Health Commercial |
$2,141.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,958.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,298.12
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.19
|
| Rate for Payer: Priority Health Narrow Network |
$112.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.19
|
| Rate for Payer: Priority Health Narrow Network |
$112.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$279.50
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$251.55
|
| Rate for Payer: Aetna Medicare |
$103.42
|
| Rate for Payer: ASR ASR |
$271.12
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: BCBS Trust/PPO |
$230.45
|
| Rate for Payer: BCN Commercial |
$230.45
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$271.12
|
| Rate for Payer: Healthscope Whirlpool |
$279.50
|
| Rate for Payer: Mclaren Commercial |
$251.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Nomi Health Commercial |
$229.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$244.90
|
| Rate for Payer: Priority Health Narrow Network |
$195.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.96
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$279.50
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.62 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$251.55
|
| Rate for Payer: ASR ASR |
$271.12
|
| Rate for Payer: BCBS Trust/PPO |
$229.53
|
| Rate for Payer: BCN Commercial |
$229.53
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$271.12
|
| Rate for Payer: Healthscope Whirlpool |
$279.50
|
| Rate for Payer: Mclaren Commercial |
$251.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Nomi Health Commercial |
$229.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.96
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,482.63
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,111.97 |
| Max. Negotiated Rate |
$1,482.63 |
| Rate for Payer: Aetna Commercial |
$1,334.37
|
| Rate for Payer: ASR ASR |
$1,438.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.54
|
| Rate for Payer: BCN Commercial |
$1,217.54
|
| Rate for Payer: Cash Price |
$1,186.10
|
| Rate for Payer: Cofinity Commercial |
$1,393.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.10
|
| Rate for Payer: Healthscope Commercial |
$1,438.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,482.63
|
| Rate for Payer: Mclaren Commercial |
$1,334.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.24
|
| Rate for Payer: Nomi Health Commercial |
$1,215.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,111.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.71
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,482.63
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$548.57 |
| Max. Negotiated Rate |
$1,482.63 |
| Rate for Payer: Aetna Commercial |
$1,334.37
|
| Rate for Payer: Aetna Medicare |
$548.57
|
| Rate for Payer: ASR ASR |
$1,438.15
|
| Rate for Payer: BCBS Complete |
$593.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.43
|
| Rate for Payer: BCN Commercial |
$1,222.43
|
| Rate for Payer: Cash Price |
$1,186.10
|
| Rate for Payer: Cofinity Commercial |
$1,393.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.10
|
| Rate for Payer: Healthscope Commercial |
$1,438.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,482.63
|
| Rate for Payer: Mclaren Commercial |
$1,334.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,186.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.24
|
| Rate for Payer: Nomi Health Commercial |
$1,215.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,111.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,299.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,039.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.71
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$262.93
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$262.93 |
| Rate for Payer: Aetna Commercial |
$236.64
|
| Rate for Payer: ASR ASR |
$255.04
|
| Rate for Payer: BCBS Trust/PPO |
$215.92
|
| Rate for Payer: BCN Commercial |
$215.92
|
| Rate for Payer: Cash Price |
$210.34
|
| Rate for Payer: Cofinity Commercial |
$247.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.34
|
| Rate for Payer: Healthscope Commercial |
$255.04
|
| Rate for Payer: Healthscope Whirlpool |
$262.93
|
| Rate for Payer: Mclaren Commercial |
$236.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.49
|
| Rate for Payer: Nomi Health Commercial |
$215.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.38
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$262.93
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$262.93 |
| Rate for Payer: Aetna Commercial |
$236.64
|
| Rate for Payer: Aetna Medicare |
$97.28
|
| Rate for Payer: ASR ASR |
$255.04
|
| Rate for Payer: BCBS Complete |
$105.17
|
| Rate for Payer: BCBS Trust/PPO |
$216.79
|
| Rate for Payer: BCN Commercial |
$216.79
|
| Rate for Payer: Cash Price |
$210.34
|
| Rate for Payer: Cofinity Commercial |
$247.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.34
|
| Rate for Payer: Healthscope Commercial |
$255.04
|
| Rate for Payer: Healthscope Whirlpool |
$262.93
|
| Rate for Payer: Mclaren Commercial |
$236.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.49
|
| Rate for Payer: Nomi Health Commercial |
$215.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.38
|
| Rate for Payer: Priority Health Narrow Network |
$184.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.38
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,849.72
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,794.40 |
| Max. Negotiated Rate |
$4,849.72 |
| Rate for Payer: Aetna Commercial |
$4,364.75
|
| Rate for Payer: Aetna Medicare |
$1,794.40
|
| Rate for Payer: ASR ASR |
$4,704.23
|
| Rate for Payer: BCBS Complete |
$1,939.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,998.59
|
| Rate for Payer: BCN Commercial |
$3,998.59
|
| Rate for Payer: Cash Price |
$3,879.78
|
| Rate for Payer: Cofinity Commercial |
$4,558.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,879.78
|
| Rate for Payer: Healthscope Commercial |
$4,704.23
|
| Rate for Payer: Healthscope Whirlpool |
$4,849.72
|
| Rate for Payer: Mclaren Commercial |
$4,364.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,879.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,122.26
|
| Rate for Payer: Nomi Health Commercial |
$3,976.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,637.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,249.32
|
| Rate for Payer: Priority Health Narrow Network |
$3,399.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,267.75
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,849.72
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,637.29 |
| Max. Negotiated Rate |
$4,849.72 |
| Rate for Payer: Aetna Commercial |
$4,364.75
|
| Rate for Payer: ASR ASR |
$4,704.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,982.59
|
| Rate for Payer: BCN Commercial |
$3,982.59
|
| Rate for Payer: Cash Price |
$3,879.78
|
| Rate for Payer: Cofinity Commercial |
$4,558.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,879.78
|
| Rate for Payer: Healthscope Commercial |
$4,704.23
|
| Rate for Payer: Healthscope Whirlpool |
$4,849.72
|
| Rate for Payer: Mclaren Commercial |
$4,364.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,122.26
|
| Rate for Payer: Nomi Health Commercial |
$3,976.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,637.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,267.75
|
|
