|
HC NEG PRES WND THRPY DSG EXLGE
|
Facility
|
OP
|
$381.25
|
|
| Hospital Charge Code |
27200137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$381.25 |
| Rate for Payer: Aetna Commercial |
$343.12
|
| Rate for Payer: Aetna Medicare |
$190.62
|
| Rate for Payer: ASR ASR |
$369.81
|
| Rate for Payer: ASR Commercial |
$369.81
|
| Rate for Payer: BCBS Complete |
$152.50
|
| Rate for Payer: BCBS Trust/PPO |
$312.21
|
| Rate for Payer: BCN Commercial |
$295.58
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cofinity Commercial |
$358.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.00
|
| Rate for Payer: Healthscope Commercial |
$381.25
|
| Rate for Payer: Healthscope Whirlpool |
$369.81
|
| Rate for Payer: Mclaren Commercial |
$343.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.06
|
| Rate for Payer: Nomi Health Commercial |
$312.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.05
|
| Rate for Payer: Priority Health Narrow Network |
$267.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.50
|
|
|
HC NEG PRES WND THRPY DSG SET LAR
|
Facility
|
IP
|
$202.55
|
|
| Hospital Charge Code |
27200138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.66 |
| Max. Negotiated Rate |
$202.55 |
| Rate for Payer: Aetna Commercial |
$182.30
|
| Rate for Payer: ASR ASR |
$196.47
|
| Rate for Payer: ASR Commercial |
$196.47
|
| Rate for Payer: BCBS Trust/PPO |
$165.06
|
| Rate for Payer: BCN Commercial |
$157.04
|
| Rate for Payer: Cash Price |
$162.04
|
| Rate for Payer: Cofinity Commercial |
$190.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.04
|
| Rate for Payer: Healthscope Commercial |
$202.55
|
| Rate for Payer: Healthscope Whirlpool |
$196.47
|
| Rate for Payer: Mclaren Commercial |
$182.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.17
|
| Rate for Payer: Nomi Health Commercial |
$166.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.24
|
|
|
HC NEG PRES WND THRPY DSG SET LAR
|
Facility
|
OP
|
$202.55
|
|
| Hospital Charge Code |
27200138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$202.55 |
| Rate for Payer: Aetna Commercial |
$182.30
|
| Rate for Payer: Aetna Medicare |
$101.28
|
| Rate for Payer: ASR ASR |
$196.47
|
| Rate for Payer: ASR Commercial |
$196.47
|
| Rate for Payer: BCBS Complete |
$81.02
|
| Rate for Payer: BCBS Trust/PPO |
$165.87
|
| Rate for Payer: BCN Commercial |
$157.04
|
| Rate for Payer: Cash Price |
$162.04
|
| Rate for Payer: Cofinity Commercial |
$190.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.04
|
| Rate for Payer: Healthscope Commercial |
$202.55
|
| Rate for Payer: Healthscope Whirlpool |
$196.47
|
| Rate for Payer: Mclaren Commercial |
$182.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.17
|
| Rate for Payer: Nomi Health Commercial |
$166.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.47
|
| Rate for Payer: Priority Health Narrow Network |
$141.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.24
|
|
|
HC NEG PRES WND THRPY DSG SET MED
|
Facility
|
IP
|
$145.92
|
|
| Hospital Charge Code |
27200139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$131.33
|
| Rate for Payer: ASR ASR |
$141.54
|
| Rate for Payer: ASR Commercial |
$141.54
|
| Rate for Payer: BCBS Trust/PPO |
$118.91
|
| Rate for Payer: BCN Commercial |
$113.13
|
| Rate for Payer: Cash Price |
$116.74
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.74
|
| Rate for Payer: Healthscope Commercial |
$145.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.54
|
| Rate for Payer: Mclaren Commercial |
$131.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.03
|
| Rate for Payer: Nomi Health Commercial |
$119.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.41
|
|
|
HC NEG PRES WND THRPY DSG SET MED
|
Facility
|
OP
|
$145.92
|
|
| Hospital Charge Code |
27200139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$131.33
|
| Rate for Payer: Aetna Medicare |
$72.96
|
| Rate for Payer: ASR ASR |
$141.54
|
| Rate for Payer: ASR Commercial |
$141.54
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$119.49
|
| Rate for Payer: BCN Commercial |
$113.13
|
| Rate for Payer: Cash Price |
$116.74
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.74
|
| Rate for Payer: Healthscope Commercial |
$145.92
|
| Rate for Payer: Healthscope Whirlpool |
$141.54
|
| Rate for Payer: Mclaren Commercial |
$131.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.03
|
| Rate for Payer: Nomi Health Commercial |
$119.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.86
|
| Rate for Payer: Priority Health Narrow Network |
$102.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.41
|
|
|
HC NEG PRES WND THRPY DSG SET SIL
|
Facility
|
IP
|
$272.48
|
|
| Hospital Charge Code |
27200140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.11 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: ASR ASR |
$264.31
|
| Rate for Payer: ASR Commercial |
$264.31
|
| Rate for Payer: BCBS Trust/PPO |
$222.04
|
| Rate for Payer: BCN Commercial |
$211.25
|
| Rate for Payer: Cash Price |
$217.98
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.98
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Healthscope Whirlpool |
$264.31
|
| Rate for Payer: Mclaren Commercial |
$245.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.61
|
| Rate for Payer: Nomi Health Commercial |
$223.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.78
|
|
|
HC NEG PRES WND THRPY DSG SET SIL
|
Facility
|
OP
|
$272.48
|
|
| Hospital Charge Code |
27200140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.99 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Medicare |
$136.24
|
| Rate for Payer: ASR ASR |
$264.31
|
| Rate for Payer: ASR Commercial |
$264.31
|
| Rate for Payer: BCBS Complete |
$108.99
|
| Rate for Payer: BCBS Trust/PPO |
$223.13
|
| Rate for Payer: BCN Commercial |
$211.25
|
| Rate for Payer: Cash Price |
$217.98
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.98
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Healthscope Whirlpool |
$264.31
|
| Rate for Payer: Mclaren Commercial |
$245.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.61
|
| Rate for Payer: Nomi Health Commercial |
$223.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.75
|
| Rate for Payer: Priority Health Narrow Network |
$191.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.78
|
|
|
HC NEG PRES WND THRPY DSG SET SMA
|
Facility
|
OP
|
$115.99
|
|
| Hospital Charge Code |
27200141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: ASR ASR |
$112.51
|
| Rate for Payer: ASR Commercial |
$112.51
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS Trust/PPO |
$94.98
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.79
|
| Rate for Payer: Healthscope Commercial |
$115.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.51
|
| Rate for Payer: Mclaren Commercial |
$104.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.59
|
| Rate for Payer: Nomi Health Commercial |
$95.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.63
|
| Rate for Payer: Priority Health Narrow Network |
$81.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.07
|
|
|
HC NEG PRES WND THRPY DSG SET SMA
|
Facility
|
IP
|
$115.99
|
|
| Hospital Charge Code |
27200141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: ASR ASR |
$112.51
|
| Rate for Payer: ASR Commercial |
$112.51
|
| Rate for Payer: BCBS Trust/PPO |
$94.52
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.79
|
| Rate for Payer: Healthscope Commercial |
$115.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.51
|
| Rate for Payer: Mclaren Commercial |
$104.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.59
|
| Rate for Payer: Nomi Health Commercial |
$95.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.07
|
|
|
HC NEG PRES WOUND TX SET MED
|
Facility
|
IP
|
$79.99
|
|
| Hospital Charge Code |
27200127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$79.99 |
| Rate for Payer: Aetna Commercial |
$71.99
|
| Rate for Payer: ASR ASR |
$77.59
|
| Rate for Payer: ASR Commercial |
$77.59
|
| Rate for Payer: BCBS Trust/PPO |
$65.18
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.99
|
| Rate for Payer: Healthscope Commercial |
$79.99
|
| Rate for Payer: Healthscope Whirlpool |
$77.59
|
| Rate for Payer: Mclaren Commercial |
$71.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.99
|
| Rate for Payer: Nomi Health Commercial |
$65.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.39
|
|
|
HC NEG PRES WOUND TX SET MED
|
Facility
|
OP
|
$79.99
|
|
| Hospital Charge Code |
27200127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$79.99 |
| Rate for Payer: Aetna Commercial |
$71.99
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: ASR ASR |
$77.59
|
| Rate for Payer: ASR Commercial |
$77.59
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$65.50
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.99
|
| Rate for Payer: Healthscope Commercial |
$79.99
|
| Rate for Payer: Healthscope Whirlpool |
$77.59
|
| Rate for Payer: Mclaren Commercial |
$71.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.99
|
| Rate for Payer: Nomi Health Commercial |
$65.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.09
|
| Rate for Payer: Priority Health Narrow Network |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.39
|
|
|
HC NEG PRES WOUND TX SET SMALL
|
Facility
|
OP
|
$115.99
|
|
| Hospital Charge Code |
27200128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: ASR ASR |
$112.51
|
| Rate for Payer: ASR Commercial |
$112.51
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS Trust/PPO |
$94.98
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.79
|
| Rate for Payer: Healthscope Commercial |
$115.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.51
|
| Rate for Payer: Mclaren Commercial |
$104.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.59
|
| Rate for Payer: Nomi Health Commercial |
$95.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.63
|
| Rate for Payer: Priority Health Narrow Network |
$81.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.07
|
|
|
HC NEG PRES WOUND TX SET SMALL
|
Facility
|
IP
|
$115.99
|
|
| Hospital Charge Code |
27200128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: ASR ASR |
$112.51
|
| Rate for Payer: ASR Commercial |
$112.51
|
| Rate for Payer: BCBS Trust/PPO |
$94.52
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.79
|
| Rate for Payer: Cofinity Commercial |
$109.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.79
|
| Rate for Payer: Healthscope Commercial |
$115.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.51
|
| Rate for Payer: Mclaren Commercial |
$104.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.59
|
| Rate for Payer: Nomi Health Commercial |
$95.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.07
|
|
|
HC NEG PRES Y CONNECTOR
|
Facility
|
IP
|
$7.86
|
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: ASR ASR |
$7.62
|
| Rate for Payer: ASR Commercial |
$7.62
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$7.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.86
|
| Rate for Payer: Healthscope Whirlpool |
$7.62
|
| Rate for Payer: Mclaren Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.92
|
|
|
HC NEG PRES Y CONNECTOR
|
Facility
|
OP
|
$7.86
|
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: ASR ASR |
$7.62
|
| Rate for Payer: ASR Commercial |
$7.62
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$7.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.86
|
| Rate for Payer: Healthscope Whirlpool |
$7.62
|
| Rate for Payer: Mclaren Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.89
|
| Rate for Payer: Priority Health Narrow Network |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.92
|
|
|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.11
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$131.77 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| 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 |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$55.38
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.77
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$105.42
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
IP
|
$1,569.06
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,019.89 |
| Max. Negotiated Rate |
$1,569.06 |
| Rate for Payer: Aetna Commercial |
$1,412.15
|
| Rate for Payer: ASR ASR |
$1,521.99
|
| Rate for Payer: ASR Commercial |
$1,521.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.63
|
| Rate for Payer: BCN Commercial |
$1,216.49
|
| Rate for Payer: Cash Price |
$1,255.25
|
| Rate for Payer: Cofinity Commercial |
$1,474.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.25
|
| Rate for Payer: Healthscope Commercial |
$1,569.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.99
|
| Rate for Payer: Mclaren Commercial |
$1,412.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.70
|
| Rate for Payer: Nomi Health Commercial |
$1,286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.77
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
OP
|
$1,569.06
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$347.18 |
| Max. Negotiated Rate |
$4,040.68 |
| Rate for Payer: Aetna Commercial |
$1,412.15
|
| Rate for Payer: Aetna Medicare |
$647.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: ASR ASR |
$1,521.99
|
| Rate for Payer: ASR Commercial |
$1,521.99
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.90
|
| Rate for Payer: BCN Commercial |
$1,216.49
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,255.25
|
| Rate for Payer: Cash Price |
$1,255.25
|
| Rate for Payer: Cofinity Commercial |
$1,474.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,569.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$647.73
|
| Rate for Payer: Mclaren Commercial |
$1,412.15
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.70
|
| Rate for Payer: Nomi Health Commercial |
$1,286.63
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$712.50
|
| Rate for Payer: PHP Medicaid |
$347.18
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,040.68
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$3,232.54
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$1,003.98
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP DNSP |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$347.18
|
| Rate for Payer: VA VA |
$647.73
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
IP
|
$1,197.45
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$778.34 |
| Max. Negotiated Rate |
$1,197.45 |
| Rate for Payer: Aetna Commercial |
$1,077.70
|
| Rate for Payer: ASR ASR |
$1,161.53
|
| Rate for Payer: ASR Commercial |
$1,161.53
|
| Rate for Payer: BCBS Trust/PPO |
$975.80
|
| Rate for Payer: BCN Commercial |
$928.38
|
| Rate for Payer: Cash Price |
$957.96
|
| Rate for Payer: Cofinity Commercial |
$1,125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.96
|
| Rate for Payer: Healthscope Commercial |
$1,197.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.53
|
| Rate for Payer: Mclaren Commercial |
$1,077.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.83
|
| Rate for Payer: Nomi Health Commercial |
$981.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.76
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
OP
|
$1,197.45
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$347.18 |
| Max. Negotiated Rate |
$3,535.60 |
| Rate for Payer: Aetna Commercial |
$1,077.70
|
| Rate for Payer: Aetna Medicare |
$647.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: ASR ASR |
$1,161.53
|
| Rate for Payer: ASR Commercial |
$1,161.53
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$980.59
|
| Rate for Payer: BCN Commercial |
$928.38
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$957.96
|
| Rate for Payer: Cash Price |
$957.96
|
| Rate for Payer: Cofinity Commercial |
$1,125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,197.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$647.73
|
| Rate for Payer: Mclaren Commercial |
$1,077.70
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.83
|
| Rate for Payer: Nomi Health Commercial |
$981.91
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$712.50
|
| Rate for Payer: PHP Medicaid |
$347.18
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,535.60
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$2,828.48
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$1,003.98
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP DNSP |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$347.18
|
| Rate for Payer: VA VA |
$647.73
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
OP
|
$1,363.87
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$1,363.87 |
| Rate for Payer: Aetna Commercial |
$1,227.48
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: ASR ASR |
$1,322.95
|
| Rate for Payer: ASR Commercial |
$1,322.95
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.87
|
| Rate for Payer: BCN Commercial |
$1,057.41
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cofinity Commercial |
$1,282.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,091.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$1,363.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$653.97
|
| Rate for Payer: Mclaren Commercial |
$1,227.48
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,159.29
|
| Rate for Payer: Nomi Health Commercial |
$1,118.37
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$719.37
|
| Rate for Payer: PHP Medicaid |
$350.53
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.02
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$956.07
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,200.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,013.65
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP DNSP |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
IP
|
$1,363.87
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.52 |
| Max. Negotiated Rate |
$1,363.87 |
| Rate for Payer: Aetna Commercial |
$1,227.48
|
| Rate for Payer: ASR ASR |
$1,322.95
|
| Rate for Payer: ASR Commercial |
$1,322.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.42
|
| Rate for Payer: BCN Commercial |
$1,057.41
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cofinity Commercial |
$1,282.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,091.10
|
| Rate for Payer: Healthscope Commercial |
$1,363.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.95
|
| Rate for Payer: Mclaren Commercial |
$1,227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,159.29
|
| Rate for Payer: Nomi Health Commercial |
$1,118.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,200.21
|
|
