|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.24
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.24
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,589.55
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,271.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: ASR ASR |
$126.10
|
| Rate for Payer: BCBS Trust/PPO |
$100.79
|
| Rate for Payer: BCN Commercial |
$100.79
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$122.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.00
|
| Rate for Payer: Healthscope Commercial |
$130.00
|
| Rate for Payer: Healthscope Whirlpool |
$126.10
|
| Rate for Payer: Mclaren Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.40
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.02
|
| Rate for Payer: ASR ASR |
$126.10
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$100.79
|
| Rate for Payer: BCN Commercial |
$100.79
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$122.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$130.00
|
| Rate for Payer: Healthscope Whirlpool |
$126.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.02
|
| Rate for Payer: Mclaren Commercial |
$117.00
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.50
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow Network |
$92.30
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.40
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$7,950.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Medicare |
$2,861.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: ASR ASR |
$7,711.50
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,163.64
|
| Rate for Payer: BCN Commercial |
$6,163.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$7,473.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Healthscope Commercial |
$7,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,711.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,861.84
|
| Rate for Payer: Mclaren Commercial |
$7,155.00
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Commercial |
$3,148.02
|
| Rate for Payer: PHP Medicaid |
$1,565.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,234.50
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,644.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,996.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
IP
|
$7,950.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,565.00 |
| Max. Negotiated Rate |
$7,950.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: ASR ASR |
$7,711.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,163.64
|
| Rate for Payer: BCN Commercial |
$6,163.64
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$7,473.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,360.00
|
| Rate for Payer: Healthscope Commercial |
$7,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,711.50
|
| Rate for Payer: Mclaren Commercial |
$7,155.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,996.00
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,925.00 |
| Rate for Payer: Aetna Commercial |
$10,732.50
|
| Rate for Payer: Aetna Medicare |
$2,861.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: ASR ASR |
$11,567.25
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$9,245.45
|
| Rate for Payer: BCN Commercial |
$9,245.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Cash Price |
$9,540.00
|
| Rate for Payer: Cash Price |
$9,540.00
|
| Rate for Payer: Cofinity Commercial |
$11,209.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,540.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Healthscope Commercial |
$11,925.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,567.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,861.84
|
| Rate for Payer: Mclaren Commercial |
$10,732.50
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,136.25
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Commercial |
$3,148.02
|
| Rate for Payer: PHP Medicaid |
$1,565.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,851.75
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$8,466.75
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,494.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,347.50 |
| Max. Negotiated Rate |
$11,925.00 |
| Rate for Payer: Aetna Commercial |
$10,732.50
|
| Rate for Payer: ASR ASR |
$11,567.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,245.45
|
| Rate for Payer: BCN Commercial |
$9,245.45
|
| Rate for Payer: Cash Price |
$9,540.00
|
| Rate for Payer: Cofinity Commercial |
$11,209.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,540.00
|
| Rate for Payer: Healthscope Commercial |
$11,925.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,567.25
|
| Rate for Payer: Mclaren Commercial |
$10,732.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,136.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,494.00
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$31.50
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$28.35
|
| Rate for Payer: ASR ASR |
$30.56
|
| Rate for Payer: BCBS Trust/PPO |
$24.42
|
| Rate for Payer: BCN Commercial |
$24.42
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$29.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Healthscope Whirlpool |
$30.56
|
| Rate for Payer: Mclaren Commercial |
$28.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.72
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$31.50
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$28.35
|
| Rate for Payer: ASR ASR |
$30.56
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$24.42
|
| Rate for Payer: BCN Commercial |
$24.42
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$29.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Healthscope Whirlpool |
$30.56
|
| Rate for Payer: Mclaren Commercial |
$28.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.66
|
| Rate for Payer: Priority Health Narrow Network |
$22.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.72
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$43.50
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Aetna Commercial |
$39.15
|
| Rate for Payer: ASR ASR |
$42.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: BCN Commercial |
$33.73
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$40.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$43.50
|
| Rate for Payer: Healthscope Whirlpool |
$42.20
|
| Rate for Payer: Mclaren Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.28
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$43.50
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Aetna Commercial |
$39.15
|
| Rate for Payer: ASR ASR |
$42.20
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: BCN Commercial |
$33.73
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$40.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.80
|
| Rate for Payer: Healthscope Commercial |
$43.50
|
| Rate for Payer: Healthscope Whirlpool |
$42.20
|
| Rate for Payer: Mclaren Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.58
|
| Rate for Payer: Priority Health Narrow Network |
$30.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.28
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.22
|
| Rate for Payer: Priority Health Narrow Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Commercial |
$138.62
|
| Rate for Payer: ASR ASR |
$149.40
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCBS Trust/PPO |
$119.41
|
| Rate for Payer: BCN Commercial |
$130.25
|
| Rate for Payer: BCN Commercial |
$119.41
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$154.02
|
| Rate for Payer: Healthscope Whirlpool |
$149.40
|
| Rate for Payer: Healthscope Whirlpool |
$162.96
|
| Rate for Payer: Mclaren Commercial |
$138.62
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
OP
|
$154.02
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Aetna Commercial |
$138.62
|
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: ASR ASR |
$149.40
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Complete |
$61.61
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCBS Trust/PPO |
$119.41
|
| Rate for Payer: BCN Commercial |
$119.41
|
| Rate for Payer: BCN Commercial |
$130.25
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$154.02
|
| Rate for Payer: Healthscope Whirlpool |
$162.96
|
| Rate for Payer: Healthscope Whirlpool |
$149.40
|
| Rate for Payer: Mclaren Commercial |
$138.62
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.88
|
| Rate for Payer: Priority Health Narrow Network |
$109.35
|
| Rate for Payer: Priority Health Narrow Network |
$119.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.54
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: ASR ASR |
$82.45
|
| Rate for Payer: BCBS Trust/PPO |
$65.90
|
| Rate for Payer: BCN Commercial |
$65.90
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.00
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.45
|
| Rate for Payer: Mclaren Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.80
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$145.71 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: ASR ASR |
$82.45
|
| Rate for Payer: BCBS Complete |
$13.85
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$65.90
|
| Rate for Payer: BCN Commercial |
$65.90
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$13.19
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.25
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$26.52
|
| Rate for Payer: PHP Medicaid |
$13.19
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.71
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$116.57
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.83
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$116.64
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$116.64 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: ASR ASR |
$113.14
|
| Rate for Payer: BCBS Complete |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$90.43
|
| Rate for Payer: BCN Commercial |
$90.43
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cofinity Commercial |
$109.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Healthscope Commercial |
$116.64
|
| Rate for Payer: Healthscope Whirlpool |
$113.14
|
| Rate for Payer: Mclaren Commercial |
$104.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.14
|
| Rate for Payer: Priority Health Narrow Network |
$82.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.64
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$116.64
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.65 |
| Max. Negotiated Rate |
$116.64 |
| Rate for Payer: Aetna Commercial |
$104.98
|
| Rate for Payer: ASR ASR |
$113.14
|
| Rate for Payer: BCBS Trust/PPO |
$90.43
|
| Rate for Payer: BCN Commercial |
$90.43
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cofinity Commercial |
$109.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Healthscope Commercial |
$116.64
|
| Rate for Payer: Healthscope Whirlpool |
$113.14
|
| Rate for Payer: Mclaren Commercial |
$104.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.64
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$73.24
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.27 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: ASR ASR |
$71.04
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$68.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.59
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$71.04
|
| Rate for Payer: Mclaren Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.45
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
OP
|
$73.24
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: ASR ASR |
$71.04
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCCCP Commercial |
$55.41
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$68.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.59
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Healthscope Whirlpool |
$71.04
|
| Rate for Payer: Mclaren Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.65
|
| Rate for Payer: Priority Health Narrow Network |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.45
|
|
|
HC SURGICAL HAND
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.43 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: BCBS Trust/PPO |
$535.43
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC SURGICAL HAND
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS Trust/PPO |
$535.43
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.46
|
| Rate for Payer: Priority Health Narrow Network |
$490.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
IP
|
$84.74
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$84.74 |
| Rate for Payer: Aetna Commercial |
$76.27
|
| Rate for Payer: ASR ASR |
$82.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.70
|
| Rate for Payer: BCN Commercial |
$65.70
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$79.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$84.74
|
| Rate for Payer: Healthscope Whirlpool |
$82.20
|
| Rate for Payer: Mclaren Commercial |
$76.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.57
|
|
