|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,004.03
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.61 |
| Max. Negotiated Rate |
$1,004.03 |
| Rate for Payer: Aetna Commercial |
$903.63
|
| Rate for Payer: ASR ASR |
$973.91
|
| Rate for Payer: BCBS Complete |
$401.61
|
| Rate for Payer: BCBS Trust/PPO |
$778.42
|
| Rate for Payer: BCN Commercial |
$778.42
|
| Rate for Payer: Cash Price |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$943.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.22
|
| Rate for Payer: Healthscope Commercial |
$1,004.03
|
| Rate for Payer: Healthscope Whirlpool |
$973.91
|
| Rate for Payer: Mclaren Commercial |
$903.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$853.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.67
|
| Rate for Payer: Priority Health Narrow Network |
$712.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$883.55
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,004.03
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.82 |
| Max. Negotiated Rate |
$1,004.03 |
| Rate for Payer: Aetna Commercial |
$903.63
|
| Rate for Payer: ASR ASR |
$973.91
|
| Rate for Payer: BCBS Trust/PPO |
$778.42
|
| Rate for Payer: BCN Commercial |
$778.42
|
| Rate for Payer: Cash Price |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$943.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.22
|
| Rate for Payer: Healthscope Commercial |
$1,004.03
|
| Rate for Payer: Healthscope Whirlpool |
$973.91
|
| Rate for Payer: Mclaren Commercial |
$903.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$853.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$883.55
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,252.58
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$501.03 |
| Max. Negotiated Rate |
$1,252.58 |
| Rate for Payer: Aetna Commercial |
$1,127.32
|
| Rate for Payer: ASR ASR |
$1,215.00
|
| Rate for Payer: BCBS Complete |
$501.03
|
| Rate for Payer: BCBS Trust/PPO |
$971.13
|
| Rate for Payer: BCN Commercial |
$971.13
|
| Rate for Payer: Cash Price |
$1,002.06
|
| Rate for Payer: Cofinity Commercial |
$1,177.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.06
|
| Rate for Payer: Healthscope Commercial |
$1,252.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.00
|
| Rate for Payer: Mclaren Commercial |
$1,127.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,064.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,139.85
|
| Rate for Payer: Priority Health Narrow Network |
$889.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.27
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,252.58
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$876.81 |
| Max. Negotiated Rate |
$1,252.58 |
| Rate for Payer: Aetna Commercial |
$1,127.32
|
| Rate for Payer: ASR ASR |
$1,215.00
|
| Rate for Payer: BCBS Trust/PPO |
$971.13
|
| Rate for Payer: BCN Commercial |
$971.13
|
| Rate for Payer: Cash Price |
$1,002.06
|
| Rate for Payer: Cofinity Commercial |
$1,177.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.06
|
| Rate for Payer: Healthscope Commercial |
$1,252.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.00
|
| Rate for Payer: Mclaren Commercial |
$1,127.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,064.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.27
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,624.52
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.16 |
| Max. Negotiated Rate |
$6,624.52 |
| Rate for Payer: Aetna Commercial |
$5,962.07
|
| Rate for Payer: ASR ASR |
$6,425.78
|
| Rate for Payer: BCBS Trust/PPO |
$5,135.99
|
| Rate for Payer: BCN Commercial |
$5,135.99
|
| Rate for Payer: Cash Price |
$5,299.62
|
| Rate for Payer: Cofinity Commercial |
$6,227.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,299.62
|
| Rate for Payer: Healthscope Commercial |
$6,624.52
|
| Rate for Payer: Healthscope Whirlpool |
$6,425.78
|
| Rate for Payer: Mclaren Commercial |
$5,962.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,630.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,637.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,829.58
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,624.52
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,649.81 |
| Max. Negotiated Rate |
$6,624.52 |
| Rate for Payer: Aetna Commercial |
$5,962.07
|
| Rate for Payer: ASR ASR |
$6,425.78
|
| Rate for Payer: BCBS Complete |
$2,649.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,135.99
|
| Rate for Payer: BCN Commercial |
$5,135.99
|
| Rate for Payer: Cash Price |
$5,299.62
|
| Rate for Payer: Cofinity Commercial |
$6,227.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,299.62
|
| Rate for Payer: Healthscope Commercial |
$6,624.52
|
| Rate for Payer: Healthscope Whirlpool |
$6,425.78
|
| Rate for Payer: Mclaren Commercial |
$5,962.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,630.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,637.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,028.31
|
| Rate for Payer: Priority Health Narrow Network |
$4,703.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,829.58
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$55,312.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38,718.40 |
| Max. Negotiated Rate |
$55,312.00 |
| Rate for Payer: Aetna Commercial |
$49,780.80
|
| Rate for Payer: ASR ASR |
$53,652.64
|
| Rate for Payer: BCBS Trust/PPO |
$42,883.39
|
| Rate for Payer: BCN Commercial |
$42,883.39
|
| Rate for Payer: Cash Price |
$44,249.60
|
| Rate for Payer: Cofinity Commercial |
$51,993.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,249.60
|
| Rate for Payer: Healthscope Commercial |
$55,312.00
|
| Rate for Payer: Healthscope Whirlpool |
$53,652.64
|
| Rate for Payer: Mclaren Commercial |
$49,780.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47,015.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38,718.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48,674.56
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$55,312.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,124.80 |
| Max. Negotiated Rate |
$55,312.00 |
| Rate for Payer: Aetna Commercial |
$49,780.80
|
| Rate for Payer: ASR ASR |
$53,652.64
|
| Rate for Payer: BCBS Complete |
$22,124.80
|
| Rate for Payer: BCBS Trust/PPO |
$42,883.39
|
| Rate for Payer: BCN Commercial |
$42,883.39
|
| Rate for Payer: Cash Price |
$44,249.60
|
| Rate for Payer: Cofinity Commercial |
$51,993.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,249.60
|
| Rate for Payer: Healthscope Commercial |
$55,312.00
|
| Rate for Payer: Healthscope Whirlpool |
$53,652.64
|
| Rate for Payer: Mclaren Commercial |
$49,780.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47,015.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38,718.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,333.92
|
| Rate for Payer: Priority Health Narrow Network |
$39,271.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48,674.56
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,375.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,062.50 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna Commercial |
$12,937.50
|
| Rate for Payer: ASR ASR |
$13,943.75
|
| Rate for Payer: BCBS Trust/PPO |
$11,144.94
|
| Rate for Payer: BCN Commercial |
$11,144.94
|
| Rate for Payer: Cash Price |
$11,500.00
|
| Rate for Payer: Cofinity Commercial |
$13,512.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,500.00
|
| Rate for Payer: Healthscope Commercial |
$14,375.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,943.75
|
| Rate for Payer: Mclaren Commercial |
$12,937.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,218.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,062.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,650.00
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,375.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,750.00 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna Commercial |
$12,937.50
|
| Rate for Payer: ASR ASR |
$13,943.75
|
| Rate for Payer: BCBS Complete |
$5,750.00
|
| Rate for Payer: BCBS Trust/PPO |
$11,144.94
|
| Rate for Payer: BCN Commercial |
$11,144.94
|
| Rate for Payer: Cash Price |
$11,500.00
|
| Rate for Payer: Cofinity Commercial |
$13,512.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,500.00
|
| Rate for Payer: Healthscope Commercial |
$14,375.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,943.75
|
| Rate for Payer: Mclaren Commercial |
$12,937.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,218.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,062.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,081.25
|
| Rate for Payer: Priority Health Narrow Network |
$10,206.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,650.00
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$226.16
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$158.31 |
| Max. Negotiated Rate |
$226.16 |
| Rate for Payer: Aetna Commercial |
$203.54
|
| Rate for Payer: ASR ASR |
$219.38
|
| Rate for Payer: BCBS Trust/PPO |
$175.34
|
| Rate for Payer: BCN Commercial |
$175.34
|
| Rate for Payer: Cash Price |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$212.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.93
|
| Rate for Payer: Healthscope Commercial |
$226.16
|
| Rate for Payer: Healthscope Whirlpool |
$219.38
|
| Rate for Payer: Mclaren Commercial |
$203.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.02
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$226.16
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$226.16 |
| Rate for Payer: Aetna Commercial |
$203.54
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$219.38
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$175.34
|
| Rate for Payer: BCN Commercial |
$175.34
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$180.93
|
| Rate for Payer: Cash Price |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$212.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$226.16
|
| Rate for Payer: Healthscope Whirlpool |
$219.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$203.54
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.24
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.94
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$60.75
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.02
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
IP
|
$470.70
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$329.49 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Aetna Commercial |
$423.63
|
| Rate for Payer: ASR ASR |
$456.58
|
| Rate for Payer: BCBS Trust/PPO |
$364.93
|
| Rate for Payer: BCN Commercial |
$364.93
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cofinity Commercial |
$442.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.56
|
| Rate for Payer: Healthscope Commercial |
$470.70
|
| Rate for Payer: Healthscope Whirlpool |
$456.58
|
| Rate for Payer: Mclaren Commercial |
$423.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.22
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$470.70
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Aetna Commercial |
$423.63
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$456.58
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$364.93
|
| Rate for Payer: BCN Commercial |
$364.93
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cofinity Commercial |
$442.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$470.70
|
| Rate for Payer: Healthscope Whirlpool |
$456.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$423.63
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.10
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.94
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$60.75
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.22
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$146.85
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$146.85 |
| Rate for Payer: Aetna Commercial |
$132.16
|
| Rate for Payer: ASR ASR |
$142.44
|
| Rate for Payer: BCBS Trust/PPO |
$113.85
|
| Rate for Payer: BCN Commercial |
$113.85
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$138.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.48
|
| Rate for Payer: Healthscope Commercial |
$146.85
|
| Rate for Payer: Healthscope Whirlpool |
$142.44
|
| Rate for Payer: Mclaren Commercial |
$132.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.23
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$146.85
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$146.85 |
| Rate for Payer: Aetna Commercial |
$132.16
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$142.44
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$113.85
|
| Rate for Payer: BCN Commercial |
$113.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$138.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$146.85
|
| Rate for Payer: Healthscope Whirlpool |
$142.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$132.16
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.39
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$43.51
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.23
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC SRA, LMWH
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$316.61
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$253.06
|
| Rate for Payer: BCN Commercial |
$253.06
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$306.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$326.40
|
| Rate for Payer: Healthscope Whirlpool |
$316.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$293.76
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$10.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.48
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$187.58
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.23
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SRA, LMWH
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.48 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: ASR ASR |
$316.61
|
| Rate for Payer: BCBS Trust/PPO |
$253.06
|
| Rate for Payer: BCN Commercial |
$253.06
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$306.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Healthscope Commercial |
$326.40
|
| Rate for Payer: Healthscope Whirlpool |
$316.61
|
| Rate for Payer: Mclaren Commercial |
$293.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.23
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
OP
|
$7,990.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,786.30 |
| Max. Negotiated Rate |
$8,652.41 |
| Rate for Payer: Aetna Commercial |
$7,191.00
|
| Rate for Payer: Aetna Commercial |
$2,736.56
|
| Rate for Payer: Aetna Medicare |
$6,921.93
|
| Rate for Payer: Aetna Medicare |
$6,921.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,652.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,652.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,652.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,652.41
|
| Rate for Payer: ASR ASR |
$7,750.30
|
| Rate for Payer: ASR ASR |
$2,949.40
|
| Rate for Payer: BCBS Complete |
$3,975.96
|
| Rate for Payer: BCBS Complete |
$3,975.96
|
| Rate for Payer: BCBS MAPPO |
$6,921.93
|
| Rate for Payer: BCBS MAPPO |
$6,921.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,357.39
|
| Rate for Payer: BCBS Trust/PPO |
$6,194.65
|
| Rate for Payer: BCN Commercial |
$6,194.65
|
| Rate for Payer: BCN Commercial |
$2,357.39
|
| Rate for Payer: BCN Medicare Advantage |
$6,921.93
|
| Rate for Payer: BCN Medicare Advantage |
$6,921.93
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cofinity Commercial |
$2,858.18
|
| Rate for Payer: Cofinity Commercial |
$7,510.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,392.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,921.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,921.93
|
| Rate for Payer: Healthscope Commercial |
$7,990.00
|
| Rate for Payer: Healthscope Commercial |
$3,040.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,949.40
|
| Rate for Payer: Healthscope Whirlpool |
$7,750.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,921.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,921.93
|
| Rate for Payer: Mclaren Commercial |
$7,191.00
|
| Rate for Payer: Mclaren Commercial |
$2,736.56
|
| Rate for Payer: Mclaren Medicaid |
$3,786.30
|
| Rate for Payer: Mclaren Medicaid |
$3,786.30
|
| Rate for Payer: Mclaren Medicare |
$6,921.93
|
| Rate for Payer: Mclaren Medicare |
$6,921.93
|
| Rate for Payer: Meridian Medicaid |
$3,975.96
|
| Rate for Payer: Meridian Medicaid |
$3,975.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,268.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,268.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,960.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,960.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,584.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,791.50
|
| Rate for Payer: PACE Medicare |
$6,575.83
|
| Rate for Payer: PACE Medicare |
$6,575.83
|
| Rate for Payer: PACE SWMI |
$6,921.93
|
| Rate for Payer: PACE SWMI |
$6,921.93
|
| Rate for Payer: PHP Commercial |
$7,614.12
|
| Rate for Payer: PHP Commercial |
$7,614.12
|
| Rate for Payer: PHP Medicaid |
$3,786.30
|
| Rate for Payer: PHP Medicaid |
$3,786.30
|
| Rate for Payer: PHP Medicare Advantage |
$6,921.93
|
| Rate for Payer: PHP Medicare Advantage |
$6,921.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,786.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,786.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,593.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,270.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,766.96
|
| Rate for Payer: Priority Health Medicare |
$6,921.93
|
| Rate for Payer: Priority Health Medicare |
$6,921.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,158.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,672.90
|
| Rate for Payer: Railroad Medicare Medicare |
$6,921.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6,921.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,031.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,675.75
|
| Rate for Payer: UHC Medicare Advantage |
$7,129.59
|
| Rate for Payer: UHC Medicare Advantage |
$7,129.59
|
| Rate for Payer: VA VA |
$6,921.93
|
| Rate for Payer: VA VA |
$6,921.93
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
IP
|
$3,040.62
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,128.43 |
| Max. Negotiated Rate |
$3,040.62 |
| Rate for Payer: Aetna Commercial |
$2,736.56
|
| Rate for Payer: Aetna Commercial |
$7,191.00
|
| Rate for Payer: ASR ASR |
$2,949.40
|
| Rate for Payer: ASR ASR |
$7,750.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,194.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,357.39
|
| Rate for Payer: BCN Commercial |
$6,194.65
|
| Rate for Payer: BCN Commercial |
$2,357.39
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cofinity Commercial |
$2,858.18
|
| Rate for Payer: Cofinity Commercial |
$7,510.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.50
|
| Rate for Payer: Healthscope Commercial |
$7,990.00
|
| Rate for Payer: Healthscope Commercial |
$3,040.62
|
| Rate for Payer: Healthscope Whirlpool |
$7,750.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,949.40
|
| Rate for Payer: Mclaren Commercial |
$7,191.00
|
| Rate for Payer: Mclaren Commercial |
$2,736.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,584.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,791.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,593.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,675.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,031.20
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
IP
|
$14,900.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$10,430.00 |
| Max. Negotiated Rate |
$14,900.00 |
| Rate for Payer: Aetna Commercial |
$13,410.00
|
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: ASR ASR |
$14,453.00
|
| Rate for Payer: ASR ASR |
$5,045.94
|
| Rate for Payer: BCBS Trust/PPO |
$4,033.11
|
| Rate for Payer: BCBS Trust/PPO |
$11,551.97
|
| Rate for Payer: BCN Commercial |
$4,033.11
|
| Rate for Payer: BCN Commercial |
$11,551.97
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cofinity Commercial |
$14,006.00
|
| Rate for Payer: Cofinity Commercial |
$4,889.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,920.00
|
| Rate for Payer: Healthscope Commercial |
$14,900.00
|
| Rate for Payer: Healthscope Commercial |
$5,202.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,045.94
|
| Rate for Payer: Healthscope Whirlpool |
$14,453.00
|
| Rate for Payer: Mclaren Commercial |
$4,681.80
|
| Rate for Payer: Mclaren Commercial |
$13,410.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,665.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,421.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,430.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,641.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,577.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,112.00
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$867.59 |
| Max. Negotiated Rate |
$5,202.00 |
| Rate for Payer: Aetna Commercial |
$4,681.80
|
| Rate for Payer: Aetna Commercial |
$13,410.00
|
| Rate for Payer: Aetna Medicare |
$1,586.08
|
| Rate for Payer: Aetna Medicare |
$1,586.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,982.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,982.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,982.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,982.60
|
| Rate for Payer: ASR ASR |
$5,045.94
|
| Rate for Payer: ASR ASR |
$14,453.00
|
| Rate for Payer: BCBS Complete |
$911.04
|
| Rate for Payer: BCBS Complete |
$911.04
|
| Rate for Payer: BCBS MAPPO |
$1,586.08
|
| Rate for Payer: BCBS MAPPO |
$1,586.08
|
| Rate for Payer: BCBS Trust/PPO |
$4,033.11
|
| Rate for Payer: BCBS Trust/PPO |
$11,551.97
|
| Rate for Payer: BCN Commercial |
$11,551.97
|
| Rate for Payer: BCN Commercial |
$4,033.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.08
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cofinity Commercial |
$4,889.88
|
| Rate for Payer: Cofinity Commercial |
$14,006.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,920.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.08
|
| Rate for Payer: Healthscope Commercial |
$14,900.00
|
| Rate for Payer: Healthscope Commercial |
$5,202.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,045.94
|
| Rate for Payer: Healthscope Whirlpool |
$14,453.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,586.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,586.08
|
| Rate for Payer: Mclaren Commercial |
$4,681.80
|
| Rate for Payer: Mclaren Commercial |
$13,410.00
|
| Rate for Payer: Mclaren Medicaid |
$867.59
|
| Rate for Payer: Mclaren Medicaid |
$867.59
|
| Rate for Payer: Mclaren Medicare |
$1,586.08
|
| Rate for Payer: Mclaren Medicare |
$1,586.08
|
| Rate for Payer: Meridian Medicaid |
$911.04
|
| Rate for Payer: Meridian Medicaid |
$911.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,665.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,665.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,823.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,823.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,665.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,421.70
|
| Rate for Payer: PACE Medicare |
$1,506.78
|
| Rate for Payer: PACE Medicare |
$1,506.78
|
| Rate for Payer: PACE SWMI |
$1,586.08
|
| Rate for Payer: PACE SWMI |
$1,586.08
|
| Rate for Payer: PHP Commercial |
$1,744.69
|
| Rate for Payer: PHP Commercial |
$1,744.69
|
| Rate for Payer: PHP Medicaid |
$867.59
|
| Rate for Payer: PHP Medicaid |
$867.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$867.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$867.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,641.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,430.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,559.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,733.82
|
| Rate for Payer: Priority Health Medicare |
$1,586.08
|
| Rate for Payer: Priority Health Medicare |
$1,586.08
|
| Rate for Payer: Priority Health Narrow Network |
$10,579.00
|
| Rate for Payer: Priority Health Narrow Network |
$3,693.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,586.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,586.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,577.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,112.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,633.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,633.66
|
| Rate for Payer: VA VA |
$1,586.08
|
| Rate for Payer: VA VA |
$1,586.08
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: ASR ASR |
$106.70
|
| Rate for Payer: BCBS Trust/PPO |
$85.28
|
| Rate for Payer: BCN Commercial |
$85.28
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Healthscope Whirlpool |
$106.70
|
| Rate for Payer: Mclaren Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.80
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$106.70
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$85.28
|
| Rate for Payer: BCN Commercial |
$85.28
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Healthscope Whirlpool |
$106.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$99.00
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.80
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$640.50 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: ASR ASR |
$887.55
|
| Rate for Payer: BCBS Trust/PPO |
$709.40
|
| Rate for Payer: BCN Commercial |
$709.40
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cofinity Commercial |
$860.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.00
|
| Rate for Payer: Healthscope Commercial |
$915.00
|
| Rate for Payer: Healthscope Whirlpool |
$887.55
|
| Rate for Payer: Mclaren Commercial |
$823.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$777.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$805.20
|
|
