|
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 PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 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 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 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 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
|
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 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 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 |
$26.09
|
| 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 |
$19.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.90
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health Narrow Network |
$21.52
|
| 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 |
$19.95 |
| 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 |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.02
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,677.19 |
| Max. Negotiated Rate |
$2,580.29 |
| Rate for Payer: Aetna Commercial |
$2,322.26
|
| Rate for Payer: ASR ASR |
$2,502.88
|
| Rate for Payer: ASR Commercial |
$2,502.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.68
|
| Rate for Payer: BCN Commercial |
$2,000.50
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$2,425.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,580.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.88
|
| Rate for Payer: Mclaren Commercial |
$2,322.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: Nomi Health Commercial |
$2,115.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,270.66
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.12 |
| Max. Negotiated Rate |
$2,580.29 |
| Rate for Payer: Aetna Commercial |
$2,322.26
|
| Rate for Payer: Aetna Medicare |
$1,290.14
|
| Rate for Payer: ASR ASR |
$2,502.88
|
| Rate for Payer: ASR Commercial |
$2,502.88
|
| Rate for Payer: BCBS Complete |
$1,032.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.00
|
| Rate for Payer: BCN Commercial |
$2,000.50
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$2,425.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,580.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.88
|
| Rate for Payer: Mclaren Commercial |
$2,322.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: Nomi Health Commercial |
$2,115.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,260.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,808.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,270.66
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: ASR Commercial |
$44.52
|
| Rate for Payer: BCBS Trust/PPO |
$37.40
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: ASR Commercial |
$44.52
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.22
|
| Rate for Payer: Priority Health Narrow Network |
$32.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| 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 OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| 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: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Complete |
$15.42
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.69
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Mclaren Medicaid |
$14.68
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.25
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$31.40
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicare Advantage |
$27.39
|
| Rate for Payer: UHCCP DNSP |
$27.39
|
| Rate for Payer: UHCCP Medicaid |
$14.68
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Trust/PPO |
$36.51
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Trust/PPO |
$36.51
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Complete |
$15.42
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.69
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Mclaren Medicaid |
$14.68
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.25
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$31.40
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicare Advantage |
$27.39
|
| Rate for Payer: UHCCP DNSP |
$27.39
|
| Rate for Payer: UHCCP Medicaid |
$14.68
|
| Rate for Payer: VA VA |
$27.39
|
|
