|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: ASR Commercial |
$30.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.01
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$30.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$31.92
|
| Rate for Payer: Healthscope Whirlpool |
$30.96
|
| Rate for Payer: Mclaren Commercial |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
|
|
HC OAT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC OAT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,634.61
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,362.50 |
| Max. Negotiated Rate |
$3,634.61 |
| Rate for Payer: Aetna Commercial |
$3,271.15
|
| Rate for Payer: ASR ASR |
$3,525.57
|
| Rate for Payer: ASR Commercial |
$3,525.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,961.84
|
| Rate for Payer: BCN Commercial |
$2,817.91
|
| Rate for Payer: Cash Price |
$2,907.69
|
| Rate for Payer: Cofinity Commercial |
$3,416.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,907.69
|
| Rate for Payer: Healthscope Commercial |
$3,634.61
|
| Rate for Payer: Healthscope Whirlpool |
$3,525.57
|
| Rate for Payer: Mclaren Commercial |
$3,271.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.42
|
| Rate for Payer: Nomi Health Commercial |
$2,980.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,362.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,198.46
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,176.97 |
| Max. Negotiated Rate |
$1,810.72 |
| Rate for Payer: Aetna Commercial |
$1,629.65
|
| Rate for Payer: ASR ASR |
$1,756.40
|
| Rate for Payer: ASR Commercial |
$1,756.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.56
|
| Rate for Payer: BCN Commercial |
$1,403.85
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,702.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Healthscope Commercial |
$1,810.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,756.40
|
| Rate for Payer: Mclaren Commercial |
$1,629.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: Nomi Health Commercial |
$1,484.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,593.43
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$3,983.98
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,589.59 |
| Max. Negotiated Rate |
$3,983.98 |
| Rate for Payer: Aetna Commercial |
$3,585.58
|
| Rate for Payer: ASR ASR |
$3,864.46
|
| Rate for Payer: ASR Commercial |
$3,864.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,246.55
|
| Rate for Payer: BCN Commercial |
$3,088.78
|
| Rate for Payer: Cash Price |
$3,187.18
|
| Rate for Payer: Cofinity Commercial |
$3,744.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,187.18
|
| Rate for Payer: Healthscope Commercial |
$3,983.98
|
| Rate for Payer: Healthscope Whirlpool |
$3,864.46
|
| Rate for Payer: Mclaren Commercial |
$3,585.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,386.38
|
| Rate for Payer: Nomi Health Commercial |
$3,266.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,589.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,505.90
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB POSTPARTUM R&B
|
Facility
|
IP
|
$2,560.29
|
|
| Hospital Charge Code |
11200002
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,664.19 |
| Max. Negotiated Rate |
$2,560.29 |
| Rate for Payer: Aetna Commercial |
$2,304.26
|
| Rate for Payer: ASR ASR |
$2,483.48
|
| Rate for Payer: ASR Commercial |
$2,483.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,086.38
|
| Rate for Payer: BCN Commercial |
$1,984.99
|
| Rate for Payer: Cash Price |
$2,048.23
|
| Rate for Payer: Cofinity Commercial |
$2,406.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.23
|
| Rate for Payer: Healthscope Commercial |
$2,560.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,483.48
|
| Rate for Payer: Mclaren Commercial |
$2,304.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.25
|
| Rate for Payer: Nomi Health Commercial |
$2,099.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,253.06
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
IP
|
$137.02
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: ASR ASR |
$132.91
|
| Rate for Payer: ASR Commercial |
$132.91
|
| Rate for Payer: BCBS Trust/PPO |
$111.66
|
| Rate for Payer: BCN Commercial |
$106.23
|
| Rate for Payer: Cash Price |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.62
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Healthscope Whirlpool |
$132.91
|
| Rate for Payer: Mclaren Commercial |
$123.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.47
|
| Rate for Payer: Nomi Health Commercial |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.58
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
OP
|
$137.02
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$68.51
|
| Rate for Payer: ASR ASR |
$132.91
|
| Rate for Payer: ASR Commercial |
$132.91
|
| Rate for Payer: BCBS Complete |
$54.81
|
| Rate for Payer: BCBS Trust/PPO |
$112.21
|
| Rate for Payer: BCN Commercial |
$106.23
|
| Rate for Payer: Cash Price |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.62
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Healthscope Whirlpool |
$132.91
|
| Rate for Payer: Mclaren Commercial |
$123.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.47
|
| Rate for Payer: Nomi Health Commercial |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.06
|
| Rate for Payer: Priority Health Narrow Network |
$96.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.58
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBS OVERFLOW PER HR
|
Facility
|
IP
|
$137.02
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: ASR ASR |
$132.91
|
| Rate for Payer: ASR Commercial |
$132.91
|
| Rate for Payer: BCBS Trust/PPO |
$111.66
|
| Rate for Payer: BCN Commercial |
$106.23
|
| Rate for Payer: Cash Price |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.62
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Healthscope Whirlpool |
$132.91
|
| Rate for Payer: Mclaren Commercial |
$123.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.47
|
| Rate for Payer: Nomi Health Commercial |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.58
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
OP
|
$137.02
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$68.51
|
| Rate for Payer: ASR ASR |
$132.91
|
| Rate for Payer: ASR Commercial |
$132.91
|
| Rate for Payer: BCBS Complete |
$54.81
|
| Rate for Payer: BCBS Trust/PPO |
$112.21
|
| Rate for Payer: BCN Commercial |
$106.23
|
| Rate for Payer: Cash Price |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.62
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Healthscope Whirlpool |
$132.91
|
| Rate for Payer: Mclaren Commercial |
$123.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.47
|
| Rate for Payer: Nomi Health Commercial |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.06
|
| Rate for Payer: Priority Health Narrow Network |
$96.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.58
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$274.02
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.11 |
| Max. Negotiated Rate |
$274.02 |
| Rate for Payer: Aetna Commercial |
$246.62
|
| Rate for Payer: ASR ASR |
$265.80
|
| Rate for Payer: ASR Commercial |
$265.80
|
| Rate for Payer: BCBS Trust/PPO |
$223.30
|
| Rate for Payer: BCN Commercial |
$212.45
|
| Rate for Payer: Cash Price |
$219.22
|
| Rate for Payer: Cofinity Commercial |
$257.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.22
|
| Rate for Payer: Healthscope Commercial |
$274.02
|
| Rate for Payer: Healthscope Whirlpool |
$265.80
|
| Rate for Payer: Mclaren Commercial |
$246.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.92
|
| Rate for Payer: Nomi Health Commercial |
$224.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.14
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$274.02
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$274.02 |
| Rate for Payer: Aetna Commercial |
$246.62
|
| Rate for Payer: Aetna Medicare |
$137.01
|
| Rate for Payer: ASR ASR |
$265.80
|
| Rate for Payer: ASR Commercial |
$265.80
|
| Rate for Payer: BCBS Complete |
$109.61
|
| Rate for Payer: BCBS Trust/PPO |
$224.39
|
| Rate for Payer: BCN Commercial |
$212.45
|
| Rate for Payer: Cash Price |
$219.22
|
| Rate for Payer: Cofinity Commercial |
$257.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.22
|
| Rate for Payer: Healthscope Commercial |
$274.02
|
| Rate for Payer: Healthscope Whirlpool |
$265.80
|
| Rate for Payer: Mclaren Commercial |
$246.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.92
|
| Rate for Payer: Nomi Health Commercial |
$224.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.10
|
| Rate for Payer: Priority Health Narrow Network |
$192.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.14
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,453.56
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$944.81 |
| Max. Negotiated Rate |
$1,453.56 |
| Rate for Payer: Aetna Commercial |
$1,308.20
|
| Rate for Payer: ASR ASR |
$1,409.95
|
| Rate for Payer: ASR Commercial |
$1,409.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.51
|
| Rate for Payer: BCN Commercial |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,162.85
|
| Rate for Payer: Cofinity Commercial |
$1,366.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.85
|
| Rate for Payer: Healthscope Commercial |
$1,453.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,409.95
|
| Rate for Payer: Mclaren Commercial |
$1,308.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.53
|
| Rate for Payer: Nomi Health Commercial |
$1,191.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,279.13
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,453.56
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.42 |
| Max. Negotiated Rate |
$1,453.56 |
| Rate for Payer: Aetna Commercial |
$1,308.20
|
| Rate for Payer: Aetna Medicare |
$726.78
|
| Rate for Payer: ASR ASR |
$1,409.95
|
| Rate for Payer: ASR Commercial |
$1,409.95
|
| Rate for Payer: BCBS Complete |
$581.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.32
|
| Rate for Payer: BCN Commercial |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,162.85
|
| Rate for Payer: Cofinity Commercial |
$1,366.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.85
|
| Rate for Payer: Healthscope Commercial |
$1,453.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,409.95
|
| Rate for Payer: Mclaren Commercial |
$1,308.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.53
|
| Rate for Payer: Nomi Health Commercial |
$1,191.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,273.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,279.13
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$257.77
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.55 |
| Max. Negotiated Rate |
$257.77 |
| Rate for Payer: Aetna Commercial |
$231.99
|
| Rate for Payer: ASR ASR |
$250.04
|
| Rate for Payer: ASR Commercial |
$250.04
|
| Rate for Payer: BCBS Trust/PPO |
$210.06
|
| Rate for Payer: BCN Commercial |
$199.85
|
| Rate for Payer: Cash Price |
$206.22
|
| Rate for Payer: Cofinity Commercial |
$242.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.22
|
| Rate for Payer: Healthscope Commercial |
$257.77
|
| Rate for Payer: Healthscope Whirlpool |
$250.04
|
| Rate for Payer: Mclaren Commercial |
$231.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: Nomi Health Commercial |
$211.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.84
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$257.77
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$257.77 |
| Rate for Payer: Aetna Commercial |
$231.99
|
| Rate for Payer: Aetna Medicare |
$128.88
|
| Rate for Payer: ASR ASR |
$250.04
|
| Rate for Payer: ASR Commercial |
$250.04
|
| Rate for Payer: BCBS Complete |
$103.11
|
| Rate for Payer: BCBS Trust/PPO |
$211.09
|
| Rate for Payer: BCN Commercial |
$199.85
|
| Rate for Payer: Cash Price |
$206.22
|
| Rate for Payer: Cofinity Commercial |
$242.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.22
|
| Rate for Payer: Healthscope Commercial |
$257.77
|
| Rate for Payer: Healthscope Whirlpool |
$250.04
|
| Rate for Payer: Mclaren Commercial |
$231.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: Nomi Health Commercial |
$211.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.86
|
| Rate for Payer: Priority Health Narrow Network |
$180.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.84
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,754.63
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,090.51 |
| Max. Negotiated Rate |
$4,754.63 |
| Rate for Payer: Aetna Commercial |
$4,279.17
|
| Rate for Payer: ASR ASR |
$4,611.99
|
| Rate for Payer: ASR Commercial |
$4,611.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,874.55
|
| Rate for Payer: BCN Commercial |
$3,686.26
|
| Rate for Payer: Cash Price |
$3,803.70
|
| Rate for Payer: Cofinity Commercial |
$4,469.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.70
|
| Rate for Payer: Healthscope Commercial |
$4,754.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,611.99
|
| Rate for Payer: Mclaren Commercial |
$4,279.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,041.44
|
| Rate for Payer: Nomi Health Commercial |
$3,898.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,184.07
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,754.63
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,901.85 |
| Max. Negotiated Rate |
$4,754.63 |
| Rate for Payer: Aetna Commercial |
$4,279.17
|
| Rate for Payer: Aetna Medicare |
$2,377.32
|
| Rate for Payer: ASR ASR |
$4,611.99
|
| Rate for Payer: ASR Commercial |
$4,611.99
|
| Rate for Payer: BCBS Complete |
$1,901.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,893.57
|
| Rate for Payer: BCN Commercial |
$3,686.26
|
| Rate for Payer: Cash Price |
$3,803.70
|
| Rate for Payer: Cofinity Commercial |
$4,469.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.70
|
| Rate for Payer: Healthscope Commercial |
$4,754.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,611.99
|
| Rate for Payer: Mclaren Commercial |
$4,279.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,041.44
|
| Rate for Payer: Nomi Health Commercial |
$3,898.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,166.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,333.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,184.07
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$30.70
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Aetna Commercial |
$27.63
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.65
|
| Rate for Payer: ASR ASR |
$29.78
|
| Rate for Payer: ASR Commercial |
$29.78
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$25.14
|
| Rate for Payer: BCN Commercial |
$23.80
|
| Rate for Payer: BCN Medicare Advantage |
$5.32
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$30.70
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.32
|
| Rate for Payer: Mclaren Commercial |
$27.63
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Mclaren Medicare |
$5.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.59
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Nomi Health Commercial |
$25.17
|
| Rate for Payer: PACE Medicare |
$5.05
|
| Rate for Payer: PACE SWMI |
$5.32
|
| Rate for Payer: PHP Commercial |
$5.85
|
| Rate for Payer: PHP Medicaid |
$2.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.51
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health Narrow Network |
$18.01
|
| Rate for Payer: Railroad Medicare Medicare |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.32
|
| Rate for Payer: UHC Exchange |
$8.25
|
| Rate for Payer: UHC Medicare Advantage |
$5.32
|
| Rate for Payer: UHCCP DNSP |
$5.32
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: VA VA |
$5.32
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Aetna Commercial |
$27.63
|
| Rate for Payer: ASR ASR |
$29.78
|
| Rate for Payer: ASR Commercial |
$29.78
|
| Rate for Payer: BCBS Trust/PPO |
$25.02
|
| Rate for Payer: BCN Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$30.70
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Mclaren Commercial |
$27.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Nomi Health Commercial |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
|
