|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
OP
|
$317.85
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Aetna Commercial |
$286.06
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$308.31
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$246.43
|
| Rate for Payer: BCN Commercial |
$246.43
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$254.28
|
| Rate for Payer: Cash Price |
$254.28
|
| Rate for Payer: Cofinity Commercial |
$298.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$317.85
|
| Rate for Payer: Healthscope Whirlpool |
$308.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$286.06
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.17
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.24
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$225.67
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.71
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
IP
|
$317.85
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.50 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Aetna Commercial |
$286.06
|
| Rate for Payer: ASR ASR |
$308.31
|
| Rate for Payer: BCBS Trust/PPO |
$246.43
|
| Rate for Payer: BCN Commercial |
$246.43
|
| Rate for Payer: Cash Price |
$254.28
|
| Rate for Payer: Cofinity Commercial |
$298.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.28
|
| Rate for Payer: Healthscope Commercial |
$317.85
|
| Rate for Payer: Healthscope Whirlpool |
$308.31
|
| Rate for Payer: Mclaren Commercial |
$286.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.71
|
|
|
HC US MFM AMNIOCENTESIS W GUIDANCE
|
Facility
|
IP
|
$580.55
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$406.38 |
| Max. Negotiated Rate |
$580.55 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: ASR ASR |
$563.13
|
| Rate for Payer: BCBS Trust/PPO |
$450.10
|
| Rate for Payer: BCN Commercial |
$450.10
|
| Rate for Payer: Cash Price |
$464.44
|
| Rate for Payer: Cofinity Commercial |
$545.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.44
|
| Rate for Payer: Healthscope Commercial |
$580.55
|
| Rate for Payer: Healthscope Whirlpool |
$563.13
|
| Rate for Payer: Mclaren Commercial |
$522.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.88
|
|
|
HC US MFM AMNIOCENTESIS W GUIDANCE
|
Facility
|
OP
|
$580.55
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$232.22 |
| Max. Negotiated Rate |
$580.55 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: ASR ASR |
$563.13
|
| Rate for Payer: BCBS Complete |
$232.22
|
| Rate for Payer: BCBS Trust/PPO |
$450.10
|
| Rate for Payer: BCN Commercial |
$450.10
|
| Rate for Payer: Cash Price |
$464.44
|
| Rate for Payer: Cash Price |
$464.44
|
| Rate for Payer: Cofinity Commercial |
$545.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.44
|
| Rate for Payer: Healthscope Commercial |
$580.55
|
| Rate for Payer: Healthscope Whirlpool |
$563.13
|
| Rate for Payer: Mclaren Commercial |
$522.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.44
|
| Rate for Payer: Priority Health Narrow Network |
$311.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.88
|
|
|
HC US MFM CORDOCENTESIS GUIDE
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$400.29 |
| Max. Negotiated Rate |
$571.84 |
| Rate for Payer: Aetna Commercial |
$514.66
|
| Rate for Payer: ASR ASR |
$554.68
|
| Rate for Payer: BCBS Trust/PPO |
$443.35
|
| Rate for Payer: BCN Commercial |
$443.35
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$537.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Healthscope Commercial |
$571.84
|
| Rate for Payer: Healthscope Whirlpool |
$554.68
|
| Rate for Payer: Mclaren Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.22
|
|
|
HC US MFM CORDOCENTESIS GUIDE
|
Facility
|
OP
|
$571.84
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.74 |
| Max. Negotiated Rate |
$571.84 |
| Rate for Payer: Aetna Commercial |
$514.66
|
| Rate for Payer: ASR ASR |
$554.68
|
| Rate for Payer: BCBS Complete |
$228.74
|
| Rate for Payer: BCBS Trust/PPO |
$443.35
|
| Rate for Payer: BCN Commercial |
$443.35
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$537.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Healthscope Commercial |
$571.84
|
| Rate for Payer: Healthscope Whirlpool |
$554.68
|
| Rate for Payer: Mclaren Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.37
|
| Rate for Payer: Priority Health Narrow Network |
$406.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.22
|
|
|
HC US OB BPP WO NON STRESS
|
Facility
|
IP
|
$630.27
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.19 |
| Max. Negotiated Rate |
$630.27 |
| Rate for Payer: Aetna Commercial |
$567.24
|
| Rate for Payer: ASR ASR |
$611.36
|
| Rate for Payer: BCBS Trust/PPO |
$488.65
|
| Rate for Payer: BCN Commercial |
$488.65
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cofinity Commercial |
$592.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.22
|
| Rate for Payer: Healthscope Commercial |
$630.27
|
| Rate for Payer: Healthscope Whirlpool |
$611.36
|
| Rate for Payer: Mclaren Commercial |
$567.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.64
|
|
|
HC US OB BPP WO NON STRESS
|
Facility
|
OP
|
$630.27
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200027
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$630.27 |
| Rate for Payer: Aetna Commercial |
$567.24
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$611.36
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$488.65
|
| Rate for Payer: BCN Commercial |
$488.65
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cofinity Commercial |
$592.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$630.27
|
| Rate for Payer: Healthscope Whirlpool |
$611.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$567.24
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.73
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.77
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$275.02
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.64
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB DETAILED
|
Facility
|
OP
|
$571.84
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$577.22 |
| Rate for Payer: Aetna Commercial |
$514.66
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$554.68
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$443.35
|
| Rate for Payer: BCN Commercial |
$443.35
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$537.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$571.84
|
| Rate for Payer: Healthscope Whirlpool |
$554.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$514.66
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.22
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$461.78
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.22
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC US OB DETAILED
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
40200019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$400.29 |
| Max. Negotiated Rate |
$571.84 |
| Rate for Payer: Aetna Commercial |
$514.66
|
| Rate for Payer: ASR ASR |
$554.68
|
| Rate for Payer: BCBS Trust/PPO |
$443.35
|
| Rate for Payer: BCN Commercial |
$443.35
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$537.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Healthscope Commercial |
$571.84
|
| Rate for Payer: Healthscope Whirlpool |
$554.68
|
| Rate for Payer: Mclaren Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.22
|
|
|
HC US OB DETAILED EACH ADDTL FETUS
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$486.41 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.41
|
| Rate for Payer: Priority Health Narrow Network |
$389.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC US OB DETAILED EACH ADDTL FETUS
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC US OB FETAL CARDIOVASCULAR FU
|
Facility
|
IP
|
$678.34
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$474.84 |
| Max. Negotiated Rate |
$678.34 |
| Rate for Payer: Aetna Commercial |
$610.51
|
| Rate for Payer: ASR ASR |
$657.99
|
| Rate for Payer: BCBS Trust/PPO |
$525.92
|
| Rate for Payer: BCN Commercial |
$525.92
|
| Rate for Payer: Cash Price |
$542.67
|
| Rate for Payer: Cofinity Commercial |
$637.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.67
|
| Rate for Payer: Healthscope Commercial |
$678.34
|
| Rate for Payer: Healthscope Whirlpool |
$657.99
|
| Rate for Payer: Mclaren Commercial |
$610.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.94
|
|
|
HC US OB FETAL CARDIOVASCULAR FU
|
Facility
|
OP
|
$678.34
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$678.34 |
| Rate for Payer: Aetna Commercial |
$610.51
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$657.99
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$525.92
|
| Rate for Payer: BCN Commercial |
$525.92
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$542.67
|
| Rate for Payer: Cash Price |
$542.67
|
| Rate for Payer: Cofinity Commercial |
$637.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$678.34
|
| Rate for Payer: Healthscope Whirlpool |
$657.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$610.51
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.59
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.29
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$481.62
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.94
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC US OB FU
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$333.53 |
| Max. Negotiated Rate |
$476.47 |
| Rate for Payer: Aetna Commercial |
$428.82
|
| Rate for Payer: ASR ASR |
$462.18
|
| Rate for Payer: BCBS Trust/PPO |
$369.41
|
| Rate for Payer: BCN Commercial |
$369.41
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$447.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Healthscope Commercial |
$476.47
|
| Rate for Payer: Healthscope Whirlpool |
$462.18
|
| Rate for Payer: Mclaren Commercial |
$428.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.29
|
|
|
HC US OB FU
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
40200024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$476.47 |
| Rate for Payer: Aetna Commercial |
$428.82
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$462.18
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$369.41
|
| Rate for Payer: BCN Commercial |
$369.41
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$447.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$476.47
|
| Rate for Payer: Healthscope Whirlpool |
$462.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$428.82
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.03
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$204.82
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.29
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
IP
|
$570.58
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$399.41 |
| Max. Negotiated Rate |
$570.58 |
| Rate for Payer: Aetna Commercial |
$513.52
|
| Rate for Payer: ASR ASR |
$553.46
|
| Rate for Payer: BCBS Trust/PPO |
$442.37
|
| Rate for Payer: BCN Commercial |
$442.37
|
| Rate for Payer: Cash Price |
$456.46
|
| Rate for Payer: Cofinity Commercial |
$536.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.46
|
| Rate for Payer: Healthscope Commercial |
$570.58
|
| Rate for Payer: Healthscope Whirlpool |
$553.46
|
| Rate for Payer: Mclaren Commercial |
$513.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.11
|
|
|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
OP
|
$570.58
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$570.58 |
| Rate for Payer: Aetna Commercial |
$513.52
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$553.46
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$442.37
|
| Rate for Payer: BCN Commercial |
$442.37
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$456.46
|
| Rate for Payer: Cash Price |
$456.46
|
| Rate for Payer: Cofinity Commercial |
$536.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$570.58
|
| Rate for Payer: Healthscope Whirlpool |
$553.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$513.52
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.99
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.66
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$350.13
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.11
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
IP
|
$570.45
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$399.32 |
| Max. Negotiated Rate |
$570.45 |
| Rate for Payer: Aetna Commercial |
$513.40
|
| Rate for Payer: ASR ASR |
$553.34
|
| Rate for Payer: BCBS Trust/PPO |
$442.27
|
| Rate for Payer: BCN Commercial |
$442.27
|
| Rate for Payer: Cash Price |
$456.36
|
| Rate for Payer: Cofinity Commercial |
$536.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.36
|
| Rate for Payer: Healthscope Commercial |
$570.45
|
| Rate for Payer: Healthscope Whirlpool |
$553.34
|
| Rate for Payer: Mclaren Commercial |
$513.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.00
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
OP
|
$570.45
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$570.45 |
| Rate for Payer: Aetna Commercial |
$513.40
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$553.34
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$442.27
|
| Rate for Payer: BCN Commercial |
$442.27
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$456.36
|
| Rate for Payer: Cash Price |
$456.36
|
| Rate for Payer: Cofinity Commercial |
$536.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$570.45
|
| Rate for Payer: Healthscope Whirlpool |
$553.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$513.40
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.88
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.81
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$291.85
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$502.00
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB LTD
|
Facility
|
IP
|
$476.58
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$333.61 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$428.92
|
| Rate for Payer: ASR ASR |
$462.28
|
| Rate for Payer: BCBS Trust/PPO |
$369.49
|
| Rate for Payer: BCN Commercial |
$369.49
|
| Rate for Payer: Cash Price |
$381.26
|
| Rate for Payer: Cofinity Commercial |
$447.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.26
|
| Rate for Payer: Healthscope Commercial |
$476.58
|
| Rate for Payer: Healthscope Whirlpool |
$462.28
|
| Rate for Payer: Mclaren Commercial |
$428.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.39
|
|
|
HC US OB LTD
|
Facility
|
OP
|
$476.58
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$428.92
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$462.28
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$369.49
|
| Rate for Payer: BCN Commercial |
$369.49
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$381.26
|
| Rate for Payer: Cash Price |
$381.26
|
| Rate for Payer: Cofinity Commercial |
$447.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$476.58
|
| Rate for Payer: Healthscope Whirlpool |
$462.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$428.92
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.09
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.03
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$204.82
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.39
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$173.03
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$121.12 |
| Max. Negotiated Rate |
$173.03 |
| Rate for Payer: Aetna Commercial |
$155.73
|
| Rate for Payer: ASR ASR |
$167.84
|
| Rate for Payer: BCBS Trust/PPO |
$134.15
|
| Rate for Payer: BCN Commercial |
$134.15
|
| Rate for Payer: Cash Price |
$138.42
|
| Rate for Payer: Cofinity Commercial |
$162.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.42
|
| Rate for Payer: Healthscope Commercial |
$173.03
|
| Rate for Payer: Healthscope Whirlpool |
$167.84
|
| Rate for Payer: Mclaren Commercial |
$155.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.27
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
OP
|
$173.03
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$343.77 |
| Rate for Payer: Aetna Commercial |
$155.73
|
| Rate for Payer: ASR ASR |
$167.84
|
| Rate for Payer: BCBS Complete |
$69.21
|
| Rate for Payer: BCBS Trust/PPO |
$134.15
|
| Rate for Payer: BCN Commercial |
$134.15
|
| Rate for Payer: Cash Price |
$138.42
|
| Rate for Payer: Cash Price |
$138.42
|
| Rate for Payer: Cofinity Commercial |
$162.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.42
|
| Rate for Payer: Healthscope Commercial |
$173.03
|
| Rate for Payer: Healthscope Whirlpool |
$167.84
|
| Rate for Payer: Mclaren Commercial |
$155.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.77
|
| Rate for Payer: Priority Health Narrow Network |
$275.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.27
|
|
