|
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
|
|
|
HC STACLOT LA.
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: ASR ASR |
$141.62
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$113.19
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.80
|
| Rate for Payer: Healthscope Commercial |
$146.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.62
|
| Rate for Payer: Mclaren Commercial |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
|
|
HC STACLOT LA.
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: ASR ASR |
$141.62
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$113.19
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$137.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$146.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.98
|
| Rate for Payer: Mclaren Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$9.84
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$10.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Medicaid |
$9.84
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.86
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$103.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC STANDBY OPEN HEART
|
Facility
|
IP
|
$2,370.24
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,659.17 |
| Max. Negotiated Rate |
$2,370.24 |
| Rate for Payer: Aetna Commercial |
$2,133.22
|
| Rate for Payer: ASR ASR |
$2,299.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,837.65
|
| Rate for Payer: BCN Commercial |
$1,837.65
|
| Rate for Payer: Cash Price |
$1,896.19
|
| Rate for Payer: Cofinity Commercial |
$2,228.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.19
|
| Rate for Payer: Healthscope Commercial |
$2,370.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.13
|
| Rate for Payer: Mclaren Commercial |
$2,133.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,014.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,659.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,085.81
|
|
|
HC STANDBY OPEN HEART
|
Facility
|
OP
|
$2,370.24
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$948.10 |
| Max. Negotiated Rate |
$2,370.24 |
| Rate for Payer: Aetna Commercial |
$2,133.22
|
| Rate for Payer: ASR ASR |
$2,299.13
|
| Rate for Payer: BCBS Complete |
$948.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,837.65
|
| Rate for Payer: BCN Commercial |
$1,837.65
|
| Rate for Payer: Cash Price |
$1,896.19
|
| Rate for Payer: Cofinity Commercial |
$2,228.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.19
|
| Rate for Payer: Healthscope Commercial |
$2,370.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,299.13
|
| Rate for Payer: Mclaren Commercial |
$2,133.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,014.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,659.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,156.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,682.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,085.81
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$53.35
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.64
|
| Rate for Payer: BCN Commercial |
$42.64
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$55.00
|
| Rate for Payer: Healthscope Whirlpool |
$53.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$49.50
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$39.05
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.40
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: ASR ASR |
$53.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.64
|
| Rate for Payer: BCN Commercial |
$42.64
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$55.00
|
| Rate for Payer: Healthscope Whirlpool |
$53.35
|
| Rate for Payer: Mclaren Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.40
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
OP
|
$60.48
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$54.43
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$58.67
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$46.89
|
| Rate for Payer: BCN Commercial |
$46.89
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.48
|
| Rate for Payer: Healthscope Whirlpool |
$58.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$54.43
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.41
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.04
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.94
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.22
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
IP
|
$60.48
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$54.43
|
| Rate for Payer: ASR ASR |
$58.67
|
| Rate for Payer: BCBS Trust/PPO |
$46.89
|
| Rate for Payer: BCN Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$60.48
|
| Rate for Payer: Healthscope Whirlpool |
$58.67
|
| Rate for Payer: Mclaren Commercial |
$54.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.22
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$140.87
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$126.78
|
| Rate for Payer: ASR ASR |
$136.64
|
| Rate for Payer: BCBS Complete |
$56.35
|
| Rate for Payer: BCBS Trust/PPO |
$109.22
|
| Rate for Payer: BCN Commercial |
$109.22
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$132.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$140.87
|
| Rate for Payer: Healthscope Whirlpool |
$136.64
|
| Rate for Payer: Mclaren Commercial |
$126.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.19
|
| Rate for Payer: Priority Health Narrow Network |
$100.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.97
|
|
|
HC STATLOCK
|
Facility
|
IP
|
$140.87
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.61 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna Commercial |
$126.78
|
| Rate for Payer: ASR ASR |
$136.64
|
| Rate for Payer: BCBS Trust/PPO |
$109.22
|
| Rate for Payer: BCN Commercial |
$109.22
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$132.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$140.87
|
| Rate for Payer: Healthscope Whirlpool |
$136.64
|
| Rate for Payer: Mclaren Commercial |
$126.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.97
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: ASR ASR |
$32.98
|
| Rate for Payer: BCBS Trust/PPO |
$26.36
|
| Rate for Payer: BCN Commercial |
$26.36
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Healthscope Whirlpool |
$32.98
|
| Rate for Payer: Mclaren Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.92
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| 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 |
$32.98
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$26.36
|
| Rate for Payer: BCN Commercial |
$26.36
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Healthscope Whirlpool |
$32.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$30.60
|
| 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 |
$28.90
|
| 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 |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.94
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$24.14
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.70 |
| Max. Negotiated Rate |
$1,421.00 |
| Rate for Payer: Aetna Commercial |
$1,278.90
|
| Rate for Payer: ASR ASR |
$1,378.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.70
|
| Rate for Payer: BCN Commercial |
$1,101.70
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,335.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.80
|
| Rate for Payer: Healthscope Commercial |
$1,421.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,378.37
|
| Rate for Payer: Mclaren Commercial |
$1,278.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,250.48
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,421.00 |
| Rate for Payer: Aetna Commercial |
$1,278.90
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$1,378.37
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.70
|
| Rate for Payer: BCN Commercial |
$1,101.70
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,335.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,421.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,378.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$1,278.90
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.85
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,293.11
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,008.91
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,250.48
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC STENT
|
Facility
|
IP
|
$934.47
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.13 |
| Max. Negotiated Rate |
$934.47 |
| Rate for Payer: Aetna Commercial |
$841.02
|
| Rate for Payer: ASR ASR |
$906.44
|
| Rate for Payer: BCBS Trust/PPO |
$724.49
|
| Rate for Payer: BCN Commercial |
$724.49
|
| Rate for Payer: Cash Price |
$747.58
|
| Rate for Payer: Cofinity Commercial |
$878.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.58
|
| Rate for Payer: Healthscope Commercial |
$934.47
|
| Rate for Payer: Healthscope Whirlpool |
$906.44
|
| Rate for Payer: Mclaren Commercial |
$841.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$794.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$822.33
|
|
|
HC STENT
|
Facility
|
OP
|
$934.47
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.79 |
| Max. Negotiated Rate |
$934.47 |
| Rate for Payer: Aetna Commercial |
$841.02
|
| Rate for Payer: ASR ASR |
$906.44
|
| Rate for Payer: BCBS Complete |
$373.79
|
| Rate for Payer: BCBS Trust/PPO |
$724.49
|
| Rate for Payer: BCN Commercial |
$724.49
|
| Rate for Payer: Cash Price |
$747.58
|
| Rate for Payer: Cofinity Commercial |
$878.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.58
|
| Rate for Payer: Healthscope Commercial |
$934.47
|
| Rate for Payer: Healthscope Whirlpool |
$906.44
|
| Rate for Payer: Mclaren Commercial |
$841.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$794.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.37
|
| Rate for Payer: Priority Health Narrow Network |
$663.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$822.33
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$16,677.03
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,673.92 |
| Max. Negotiated Rate |
$16,677.03 |
| Rate for Payer: Aetna Commercial |
$15,009.33
|
| Rate for Payer: ASR ASR |
$16,176.72
|
| Rate for Payer: BCBS Trust/PPO |
$12,929.70
|
| Rate for Payer: BCN Commercial |
$12,929.70
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cofinity Commercial |
$15,676.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,341.62
|
| Rate for Payer: Healthscope Commercial |
$16,677.03
|
| Rate for Payer: Healthscope Whirlpool |
$16,176.72
|
| Rate for Payer: Mclaren Commercial |
$15,009.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,175.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,673.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,675.79
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$16,677.03
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$16,677.03 |
| Rate for Payer: Aetna Commercial |
$15,009.33
|
| Rate for Payer: ASR ASR |
$16,176.72
|
| Rate for Payer: BCBS Complete |
$6,670.81
|
| Rate for Payer: BCBS Trust/PPO |
$12,929.70
|
| Rate for Payer: BCN Commercial |
$12,929.70
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cofinity Commercial |
$15,676.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,341.62
|
| Rate for Payer: Healthscope Commercial |
$16,677.03
|
| Rate for Payer: Healthscope Whirlpool |
$16,176.72
|
| Rate for Payer: Mclaren Commercial |
$15,009.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,175.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,673.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,675.79
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$11,642.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,656.98 |
| Max. Negotiated Rate |
$11,642.46 |
| Rate for Payer: Aetna Commercial |
$10,478.21
|
| Rate for Payer: ASR ASR |
$11,293.19
|
| Rate for Payer: BCBS Complete |
$4,656.98
|
| Rate for Payer: BCBS Trust/PPO |
$9,026.40
|
| Rate for Payer: BCN Commercial |
$9,026.40
|
| Rate for Payer: Cash Price |
$9,313.97
|
| Rate for Payer: Cofinity Commercial |
$10,943.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,313.97
|
| Rate for Payer: Healthscope Commercial |
$11,642.46
|
| Rate for Payer: Healthscope Whirlpool |
$11,293.19
|
| Rate for Payer: Mclaren Commercial |
$10,478.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,896.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,149.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,594.64
|
| Rate for Payer: Priority Health Narrow Network |
$8,266.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,245.36
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$11,642.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,149.72 |
| Max. Negotiated Rate |
$11,642.46 |
| Rate for Payer: Aetna Commercial |
$10,478.21
|
| Rate for Payer: ASR ASR |
$11,293.19
|
| Rate for Payer: BCBS Trust/PPO |
$9,026.40
|
| Rate for Payer: BCN Commercial |
$9,026.40
|
| Rate for Payer: Cash Price |
$9,313.97
|
| Rate for Payer: Cofinity Commercial |
$10,943.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,313.97
|
| Rate for Payer: Healthscope Commercial |
$11,642.46
|
| Rate for Payer: Healthscope Whirlpool |
$11,293.19
|
| Rate for Payer: Mclaren Commercial |
$10,478.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,896.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,149.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,245.36
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,463.15
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.20 |
| Max. Negotiated Rate |
$5,463.15 |
| Rate for Payer: Aetna Commercial |
$4,916.84
|
| Rate for Payer: ASR ASR |
$5,299.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,235.58
|
| Rate for Payer: BCN Commercial |
$4,235.58
|
| Rate for Payer: Cash Price |
$4,370.52
|
| Rate for Payer: Cofinity Commercial |
$5,135.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,370.52
|
| Rate for Payer: Healthscope Commercial |
$5,463.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,299.26
|
| Rate for Payer: Mclaren Commercial |
$4,916.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,824.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,807.57
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,463.15
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.26 |
| Max. Negotiated Rate |
$5,463.15 |
| Rate for Payer: Aetna Commercial |
$4,916.84
|
| Rate for Payer: ASR ASR |
$5,299.26
|
| Rate for Payer: BCBS Complete |
$2,185.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,235.58
|
| Rate for Payer: BCN Commercial |
$4,235.58
|
| Rate for Payer: Cash Price |
$4,370.52
|
| Rate for Payer: Cofinity Commercial |
$5,135.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,370.52
|
| Rate for Payer: Healthscope Commercial |
$5,463.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,299.26
|
| Rate for Payer: Mclaren Commercial |
$4,916.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,824.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,971.47
|
| Rate for Payer: Priority Health Narrow Network |
$3,878.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,807.57
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,349.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,539.99 |
| Max. Negotiated Rate |
$6,349.98 |
| Rate for Payer: Aetna Commercial |
$5,714.98
|
| Rate for Payer: ASR ASR |
$6,159.48
|
| Rate for Payer: BCBS Complete |
$2,539.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,923.14
|
| Rate for Payer: BCN Commercial |
$4,923.14
|
| Rate for Payer: Cash Price |
$5,079.98
|
| Rate for Payer: Cofinity Commercial |
$5,968.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,079.98
|
| Rate for Payer: Healthscope Commercial |
$6,349.98
|
| Rate for Payer: Healthscope Whirlpool |
$6,159.48
|
| Rate for Payer: Mclaren Commercial |
$5,714.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,397.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,444.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,778.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,508.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,587.98
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,349.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,444.99 |
| Max. Negotiated Rate |
$6,349.98 |
| Rate for Payer: Aetna Commercial |
$5,714.98
|
| Rate for Payer: ASR ASR |
$6,159.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,923.14
|
| Rate for Payer: BCN Commercial |
$4,923.14
|
| Rate for Payer: Cash Price |
$5,079.98
|
| Rate for Payer: Cofinity Commercial |
$5,968.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,079.98
|
| Rate for Payer: Healthscope Commercial |
$6,349.98
|
| Rate for Payer: Healthscope Whirlpool |
$6,159.48
|
| Rate for Payer: Mclaren Commercial |
$5,714.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,397.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,444.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,587.98
|
|
