|
HC NAIL BED REPAIR
|
Facility
|
IP
|
$757.63
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$492.46 |
| Max. Negotiated Rate |
$757.63 |
| Rate for Payer: Aetna Commercial |
$681.87
|
| Rate for Payer: ASR ASR |
$734.90
|
| Rate for Payer: ASR Commercial |
$734.90
|
| Rate for Payer: BCBS Trust/PPO |
$617.39
|
| Rate for Payer: BCN Commercial |
$587.39
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cofinity Commercial |
$712.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.10
|
| Rate for Payer: Healthscope Commercial |
$757.63
|
| Rate for Payer: Healthscope Whirlpool |
$734.90
|
| Rate for Payer: Mclaren Commercial |
$681.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$643.99
|
| Rate for Payer: Nomi Health Commercial |
$621.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.71
|
|
|
HC NAIL BED REPAIR
|
Facility
|
OP
|
$757.63
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.78 |
| Max. Negotiated Rate |
$929.61 |
| Rate for Payer: Aetna Commercial |
$681.87
|
| Rate for Payer: Aetna Medicare |
$599.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: ASR ASR |
$734.90
|
| Rate for Payer: ASR Commercial |
$734.90
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$620.42
|
| Rate for Payer: BCN Commercial |
$587.39
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cofinity Commercial |
$712.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$757.63
|
| Rate for Payer: Healthscope Whirlpool |
$734.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$599.75
|
| Rate for Payer: Mclaren Commercial |
$681.87
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$643.99
|
| Rate for Payer: Nomi Health Commercial |
$621.26
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$659.72
|
| Rate for Payer: PHP Medicaid |
$321.47
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$929.61
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP DNSP |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: VA VA |
$599.75
|
|
|
HC NAIL PROCEDURE
|
Facility
|
OP
|
$271.81
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$271.81 |
| Rate for Payer: Aetna Commercial |
$244.63
|
| Rate for Payer: Aetna Medicare |
$135.90
|
| Rate for Payer: ASR ASR |
$263.66
|
| Rate for Payer: ASR Commercial |
$263.66
|
| Rate for Payer: BCBS Complete |
$108.72
|
| Rate for Payer: BCBS Trust/PPO |
$222.59
|
| Rate for Payer: BCN Commercial |
$210.73
|
| Rate for Payer: Cash Price |
$217.45
|
| Rate for Payer: Cofinity Commercial |
$255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.45
|
| Rate for Payer: Healthscope Commercial |
$271.81
|
| Rate for Payer: Healthscope Whirlpool |
$263.66
|
| Rate for Payer: Mclaren Commercial |
$244.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.04
|
| Rate for Payer: Nomi Health Commercial |
$222.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.16
|
| Rate for Payer: Priority Health Narrow Network |
$190.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.19
|
|
|
HC NAIL PROCEDURE
|
Facility
|
IP
|
$271.81
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.68 |
| Max. Negotiated Rate |
$271.81 |
| Rate for Payer: Aetna Commercial |
$244.63
|
| Rate for Payer: ASR ASR |
$263.66
|
| Rate for Payer: ASR Commercial |
$263.66
|
| Rate for Payer: BCBS Trust/PPO |
$221.50
|
| Rate for Payer: BCN Commercial |
$210.73
|
| Rate for Payer: Cash Price |
$217.45
|
| Rate for Payer: Cofinity Commercial |
$255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.45
|
| Rate for Payer: Healthscope Commercial |
$271.81
|
| Rate for Payer: Healthscope Whirlpool |
$263.66
|
| Rate for Payer: Mclaren Commercial |
$244.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.04
|
| Rate for Payer: Nomi Health Commercial |
$222.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.19
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
OP
|
$328.09
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$96.01 |
| Max. Negotiated Rate |
$328.09 |
| Rate for Payer: Aetna Commercial |
$295.28
|
| Rate for Payer: Aetna Medicare |
$179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.90
|
| Rate for Payer: ASR ASR |
$318.25
|
| Rate for Payer: ASR Commercial |
$318.25
|
| Rate for Payer: BCBS Complete |
$100.81
|
| Rate for Payer: BCBS MAPPO |
$179.12
|
| Rate for Payer: BCBS Trust/PPO |
$268.67
|
| Rate for Payer: BCN Commercial |
$254.37
|
| Rate for Payer: BCN Medicare Advantage |
$179.12
|
| Rate for Payer: Cash Price |
$262.47
|
| Rate for Payer: Cash Price |
$262.47
|
| Rate for Payer: Cofinity Commercial |
$308.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.12
|
| Rate for Payer: Healthscope Commercial |
$328.09
|
| Rate for Payer: Healthscope Whirlpool |
$318.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$179.12
|
| Rate for Payer: Mclaren Commercial |
$295.28
|
| Rate for Payer: Mclaren Medicaid |
$96.01
|
| Rate for Payer: Mclaren Medicare |
$179.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.08
|
| Rate for Payer: Meridian Medicaid |
$100.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.88
|
| Rate for Payer: Nomi Health Commercial |
$269.03
|
| Rate for Payer: PACE Medicare |
$170.16
|
| Rate for Payer: PACE SWMI |
$179.12
|
| Rate for Payer: PHP Commercial |
$197.03
|
| Rate for Payer: PHP Medicaid |
$96.01
|
| Rate for Payer: PHP Medicare Advantage |
$179.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.97
|
| Rate for Payer: Priority Health Medicare |
$179.12
|
| Rate for Payer: Priority Health Narrow Network |
$248.78
|
| Rate for Payer: Railroad Medicare Medicare |
$179.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.12
|
| Rate for Payer: UHC Exchange |
$277.64
|
| Rate for Payer: UHC Medicare Advantage |
$179.12
|
| Rate for Payer: UHCCP DNSP |
$179.12
|
| Rate for Payer: UHCCP Medicaid |
$96.01
|
| Rate for Payer: VA VA |
$179.12
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
IP
|
$328.09
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$328.09 |
| Rate for Payer: Aetna Commercial |
$295.28
|
| Rate for Payer: ASR ASR |
$318.25
|
| Rate for Payer: ASR Commercial |
$318.25
|
| Rate for Payer: BCBS Trust/PPO |
$267.36
|
| Rate for Payer: BCN Commercial |
$254.37
|
| Rate for Payer: Cash Price |
$262.47
|
| Rate for Payer: Cofinity Commercial |
$308.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.47
|
| Rate for Payer: Healthscope Commercial |
$328.09
|
| Rate for Payer: Healthscope Whirlpool |
$318.25
|
| Rate for Payer: Mclaren Commercial |
$295.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.88
|
| Rate for Payer: Nomi Health Commercial |
$269.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.72
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
OP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$178.93
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$192.85
|
| Rate for Payer: ASR Commercial |
$192.85
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$162.81
|
| Rate for Payer: BCN Commercial |
$154.14
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$186.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Healthscope Whirlpool |
$192.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$178.93
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: Nomi Health Commercial |
$163.02
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.54
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$112.43
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
IP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.23 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$178.93
|
| Rate for Payer: ASR ASR |
$192.85
|
| Rate for Payer: ASR Commercial |
$192.85
|
| Rate for Payer: BCBS Trust/PPO |
$162.01
|
| Rate for Payer: BCN Commercial |
$154.14
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$186.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Healthscope Whirlpool |
$192.85
|
| Rate for Payer: Mclaren Commercial |
$178.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: Nomi Health Commercial |
$163.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.95
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$255.90 |
| Rate for Payer: Aetna Commercial |
$230.31
|
| Rate for Payer: ASR ASR |
$248.22
|
| Rate for Payer: ASR Commercial |
$248.22
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$240.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$255.90
|
| Rate for Payer: Healthscope Whirlpool |
$248.22
|
| Rate for Payer: Mclaren Commercial |
$230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.19
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$294.83 |
| Rate for Payer: Aetna Commercial |
$230.31
|
| Rate for Payer: Aetna Medicare |
$190.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$248.22
|
| Rate for Payer: ASR Commercial |
$248.22
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$240.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Healthscope Commercial |
$255.90
|
| Rate for Payer: Healthscope Whirlpool |
$248.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.21
|
| Rate for Payer: Mclaren Commercial |
$230.31
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$209.23
|
| Rate for Payer: PHP Medicaid |
$101.95
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.22
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$179.39
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$294.83
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP DNSP |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: VA VA |
$190.21
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$905.63 |
| Max. Negotiated Rate |
$4,437.00 |
| Rate for Payer: Aetna Commercial |
$3,993.30
|
| Rate for Payer: Aetna Medicare |
$1,689.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: ASR ASR |
$4,303.89
|
| Rate for Payer: ASR Commercial |
$4,303.89
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,633.46
|
| Rate for Payer: BCN Commercial |
$3,440.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$4,170.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Healthscope Commercial |
$4,437.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,303.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,689.60
|
| Rate for Payer: Mclaren Commercial |
$3,993.30
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,638.34
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Commercial |
$1,858.56
|
| Rate for Payer: PHP Medicaid |
$905.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,887.70
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,110.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,904.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$2,618.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP DNSP |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,884.05 |
| Max. Negotiated Rate |
$4,437.00 |
| Rate for Payer: Aetna Commercial |
$3,993.30
|
| Rate for Payer: ASR ASR |
$4,303.89
|
| Rate for Payer: ASR Commercial |
$4,303.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,615.71
|
| Rate for Payer: BCN Commercial |
$3,440.01
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$4,170.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Healthscope Commercial |
$4,437.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,303.89
|
| Rate for Payer: Mclaren Commercial |
$3,993.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,638.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,904.56
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$255.90 |
| Rate for Payer: Aetna Commercial |
$230.31
|
| Rate for Payer: ASR ASR |
$248.22
|
| Rate for Payer: ASR Commercial |
$248.22
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$240.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$255.90
|
| Rate for Payer: Healthscope Whirlpool |
$248.22
|
| Rate for Payer: Mclaren Commercial |
$230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.19
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$294.83 |
| Rate for Payer: Aetna Commercial |
$230.31
|
| Rate for Payer: Aetna Medicare |
$190.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$248.22
|
| Rate for Payer: ASR Commercial |
$248.22
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$240.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Healthscope Commercial |
$255.90
|
| Rate for Payer: Healthscope Whirlpool |
$248.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.21
|
| Rate for Payer: Mclaren Commercial |
$230.31
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$209.23
|
| Rate for Payer: PHP Medicaid |
$101.95
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.22
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$179.39
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$294.83
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP DNSP |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: VA VA |
$190.21
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,106.68 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: Aetna Medicare |
$5,796.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$13,429.96
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,796.05
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Commercial |
$6,375.66
|
| Rate for Payer: PHP Medicaid |
$3,106.68
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,369.68
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$11,496.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$8,983.88
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP DNSP |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,660.00 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,364.36
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,660.00 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,364.36
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,106.68 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: Aetna Medicare |
$5,796.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$13,429.96
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,796.05
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Commercial |
$6,375.66
|
| Rate for Payer: PHP Medicaid |
$3,106.68
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,369.68
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$11,496.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$8,983.88
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP DNSP |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$251.03
|
| Rate for Payer: Aetna Medicare |
$199.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: ASR ASR |
$270.55
|
| Rate for Payer: ASR Commercial |
$270.55
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$228.41
|
| Rate for Payer: BCN Commercial |
$216.25
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$262.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$278.92
|
| Rate for Payer: Healthscope Whirlpool |
$270.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.28
|
| Rate for Payer: Mclaren Commercial |
$251.03
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$228.71
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$219.21
|
| Rate for Payer: PHP Medicaid |
$106.81
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.47
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$57.98
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP DNSP |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$278.92 |
| Rate for Payer: Aetna Commercial |
$251.03
|
| Rate for Payer: ASR ASR |
$270.55
|
| Rate for Payer: ASR Commercial |
$270.55
|
| Rate for Payer: BCBS Trust/PPO |
$227.29
|
| Rate for Payer: BCN Commercial |
$216.25
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$262.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Healthscope Commercial |
$278.92
|
| Rate for Payer: Healthscope Whirlpool |
$270.55
|
| Rate for Payer: Mclaren Commercial |
$251.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$228.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.45
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$2,277.10 |
| Rate for Payer: Aetna Commercial |
$2,049.39
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$2,208.79
|
| Rate for Payer: ASR Commercial |
$2,208.79
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.72
|
| Rate for Payer: BCN Commercial |
$1,765.44
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$2,140.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,277.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,208.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$2,049.39
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,867.22
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.40
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$73.12
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,480.12 |
| Max. Negotiated Rate |
$2,277.10 |
| Rate for Payer: Aetna Commercial |
$2,049.39
|
| Rate for Payer: ASR ASR |
$2,208.79
|
| Rate for Payer: ASR Commercial |
$2,208.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.61
|
| Rate for Payer: BCN Commercial |
$1,765.44
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$2,140.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Healthscope Commercial |
$2,277.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,208.79
|
| Rate for Payer: Mclaren Commercial |
$2,049.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,867.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.85
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$494.34 |
| Rate for Payer: Aetna Commercial |
$444.91
|
| Rate for Payer: ASR ASR |
$479.51
|
| Rate for Payer: ASR Commercial |
$479.51
|
| Rate for Payer: BCBS Trust/PPO |
$402.84
|
| Rate for Payer: BCN Commercial |
$383.26
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$464.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Healthscope Commercial |
$494.34
|
| Rate for Payer: Healthscope Whirlpool |
$479.51
|
| Rate for Payer: Mclaren Commercial |
$444.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: Nomi Health Commercial |
$405.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.02
|
|
