|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$231.65 |
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: ASR ASR |
$224.70
|
| Rate for Payer: ASR Commercial |
$224.70
|
| Rate for Payer: BCBS Trust/PPO |
$188.77
|
| Rate for Payer: BCN Commercial |
$179.60
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$217.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$231.65
|
| Rate for Payer: Healthscope Whirlpool |
$224.70
|
| Rate for Payer: Mclaren Commercial |
$208.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.85
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$231.65 |
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna Medicare |
$115.83
|
| Rate for Payer: ASR ASR |
$224.70
|
| Rate for Payer: ASR Commercial |
$224.70
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS Trust/PPO |
$189.70
|
| Rate for Payer: BCN Commercial |
$179.60
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$217.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$231.65
|
| Rate for Payer: Healthscope Whirlpool |
$224.70
|
| Rate for Payer: Mclaren Commercial |
$208.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.97
|
| Rate for Payer: Priority Health Narrow Network |
$162.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.85
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$162.57 |
| Rate for Payer: Aetna Commercial |
$146.31
|
| Rate for Payer: Aetna Medicare |
$81.28
|
| Rate for Payer: ASR ASR |
$157.69
|
| Rate for Payer: ASR Commercial |
$157.69
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCN Commercial |
$126.04
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$152.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$162.57
|
| Rate for Payer: Healthscope Whirlpool |
$157.69
|
| Rate for Payer: Mclaren Commercial |
$146.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.44
|
| Rate for Payer: Priority Health Narrow Network |
$113.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.06
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.67 |
| Max. Negotiated Rate |
$162.57 |
| Rate for Payer: Aetna Commercial |
$146.31
|
| Rate for Payer: ASR ASR |
$157.69
|
| Rate for Payer: ASR Commercial |
$157.69
|
| Rate for Payer: BCBS Trust/PPO |
$132.48
|
| Rate for Payer: BCN Commercial |
$126.04
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$152.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$162.57
|
| Rate for Payer: Healthscope Whirlpool |
$157.69
|
| Rate for Payer: Mclaren Commercial |
$146.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.06
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$129.54
|
| Rate for Payer: Aetna Medicare |
$71.97
|
| Rate for Payer: ASR ASR |
$139.61
|
| Rate for Payer: ASR Commercial |
$139.61
|
| Rate for Payer: BCBS Complete |
$57.57
|
| Rate for Payer: BCBS Trust/PPO |
$117.86
|
| Rate for Payer: BCN Commercial |
$111.59
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$135.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Healthscope Whirlpool |
$139.61
|
| Rate for Payer: Mclaren Commercial |
$129.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.11
|
| Rate for Payer: Priority Health Narrow Network |
$100.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.66
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.55 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$129.54
|
| Rate for Payer: ASR ASR |
$139.61
|
| Rate for Payer: ASR Commercial |
$139.61
|
| Rate for Payer: BCBS Trust/PPO |
$117.29
|
| Rate for Payer: BCN Commercial |
$111.59
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$135.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Healthscope Whirlpool |
$139.61
|
| Rate for Payer: Mclaren Commercial |
$129.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.66
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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 NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
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 NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
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 NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| 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: 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 |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
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 OAK IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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 OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: ASR Commercial |
$52.56
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.48
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: ASR ASR |
$52.56
|
| Rate for Payer: ASR Commercial |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$44.16
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$54.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.56
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
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 OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: ASR ASR |
$30.96
|
| Rate for Payer: ASR Commercial |
$30.96
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| 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: Priority Health HMO/PPO/Tiered Network |
$27.97
|
| Rate for Payer: Priority Health Narrow Network |
$22.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.09
|
|
|
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 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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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 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 |
$58.03 |
| 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: 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 |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| 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
|
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
|
|
