|
HC PACER POCKET REVISION
|
Facility
|
IP
|
$2,755.73
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,791.22 |
| Max. Negotiated Rate |
$2,755.73 |
| Rate for Payer: Aetna Commercial |
$2,480.16
|
| Rate for Payer: ASR ASR |
$2,673.06
|
| Rate for Payer: ASR Commercial |
$2,673.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,245.64
|
| Rate for Payer: BCN Commercial |
$2,136.52
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,590.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,755.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,673.06
|
| Rate for Payer: Mclaren Commercial |
$2,480.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: Nomi Health Commercial |
$2,259.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,425.04
|
|
|
HC PACER POCKET REVISION
|
Facility
|
OP
|
$2,755.73
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$2,480.16
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$2,673.06
|
| Rate for Payer: ASR Commercial |
$2,673.06
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,256.67
|
| Rate for Payer: BCN Commercial |
$2,136.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,590.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$2,755.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,673.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$2,480.16
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: Nomi Health Commercial |
$2,259.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,414.57
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,931.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,425.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
OP
|
$765.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$688.50
|
| Rate for Payer: Aetna Medicare |
$382.50
|
| Rate for Payer: ASR ASR |
$742.05
|
| Rate for Payer: ASR Commercial |
$742.05
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS Trust/PPO |
$626.46
|
| Rate for Payer: BCN Commercial |
$593.10
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$719.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.00
|
| Rate for Payer: Healthscope Commercial |
$765.00
|
| Rate for Payer: Healthscope Whirlpool |
$742.05
|
| Rate for Payer: Mclaren Commercial |
$688.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.25
|
| Rate for Payer: Nomi Health Commercial |
$627.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$670.29
|
| Rate for Payer: Priority Health Narrow Network |
$536.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$673.20
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
IP
|
$765.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$688.50
|
| Rate for Payer: ASR ASR |
$742.05
|
| Rate for Payer: ASR Commercial |
$742.05
|
| Rate for Payer: BCBS Trust/PPO |
$623.40
|
| Rate for Payer: BCN Commercial |
$593.10
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$719.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.00
|
| Rate for Payer: Healthscope Commercial |
$765.00
|
| Rate for Payer: Healthscope Whirlpool |
$742.05
|
| Rate for Payer: Mclaren Commercial |
$688.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.25
|
| Rate for Payer: Nomi Health Commercial |
$627.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$673.20
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
IP
|
$825.28
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$536.43 |
| Max. Negotiated Rate |
$825.28 |
| Rate for Payer: Aetna Commercial |
$742.75
|
| Rate for Payer: ASR ASR |
$800.52
|
| Rate for Payer: ASR Commercial |
$800.52
|
| Rate for Payer: BCBS Trust/PPO |
$672.52
|
| Rate for Payer: BCN Commercial |
$639.84
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$775.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Healthscope Commercial |
$825.28
|
| Rate for Payer: Healthscope Whirlpool |
$800.52
|
| Rate for Payer: Mclaren Commercial |
$742.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$676.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.25
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$825.28
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$95.58 |
| Max. Negotiated Rate |
$825.28 |
| Rate for Payer: Aetna Commercial |
$742.75
|
| Rate for Payer: Aetna Medicare |
$178.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.90
|
| Rate for Payer: ASR ASR |
$800.52
|
| Rate for Payer: ASR Commercial |
$800.52
|
| Rate for Payer: BCBS Complete |
$100.36
|
| Rate for Payer: BCBS MAPPO |
$178.32
|
| Rate for Payer: BCBS Trust/PPO |
$675.82
|
| Rate for Payer: BCN Commercial |
$639.84
|
| Rate for Payer: BCN Medicare Advantage |
$178.32
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$775.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.32
|
| Rate for Payer: Healthscope Commercial |
$825.28
|
| Rate for Payer: Healthscope Whirlpool |
$800.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$178.32
|
| Rate for Payer: Mclaren Commercial |
$742.75
|
| Rate for Payer: Mclaren Medicaid |
$95.58
|
| Rate for Payer: Mclaren Medicare |
$178.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.24
|
| Rate for Payer: Meridian Medicaid |
$100.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$676.73
|
| Rate for Payer: PACE Medicare |
$169.40
|
| Rate for Payer: PACE SWMI |
$178.32
|
| Rate for Payer: PHP Commercial |
$196.15
|
| Rate for Payer: PHP Medicaid |
$95.58
|
| Rate for Payer: PHP Medicare Advantage |
$178.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.14
|
| Rate for Payer: Priority Health Medicare |
$178.32
|
| Rate for Payer: Priority Health Narrow Network |
$252.11
|
| Rate for Payer: Railroad Medicare Medicare |
$178.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.32
|
| Rate for Payer: UHC Exchange |
$276.40
|
| Rate for Payer: UHC Medicare Advantage |
$178.32
|
| Rate for Payer: UHCCP DNSP |
$178.32
|
| Rate for Payer: UHCCP Medicaid |
$95.58
|
| Rate for Payer: VA VA |
$178.32
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.34 |
| Max. Negotiated Rate |
$1,257.09 |
| Rate for Payer: Aetna Commercial |
$1,131.38
|
| Rate for Payer: Aetna Medicare |
$250.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$313.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$313.29
|
| Rate for Payer: ASR ASR |
$1,219.38
|
| Rate for Payer: ASR Commercial |
$1,219.38
|
| Rate for Payer: BCBS Complete |
$141.05
|
| Rate for Payer: BCBS MAPPO |
$250.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.43
|
| Rate for Payer: BCN Commercial |
$974.62
|
| Rate for Payer: BCN Medicare Advantage |
$250.63
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.63
|
| Rate for Payer: Healthscope Commercial |
$1,257.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,219.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$250.63
|
| Rate for Payer: Mclaren Commercial |
$1,131.38
|
| Rate for Payer: Mclaren Medicaid |
$134.34
|
| Rate for Payer: Mclaren Medicare |
$250.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.16
|
| Rate for Payer: Meridian Medicaid |
$141.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: Nomi Health Commercial |
$1,030.81
|
| Rate for Payer: PACE Medicare |
$238.10
|
| Rate for Payer: PACE SWMI |
$250.63
|
| Rate for Payer: PHP Commercial |
$275.69
|
| Rate for Payer: PHP Medicaid |
$134.34
|
| Rate for Payer: PHP Medicare Advantage |
$250.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.62
|
| Rate for Payer: Priority Health Medicare |
$250.63
|
| Rate for Payer: Priority Health Narrow Network |
$435.70
|
| Rate for Payer: Railroad Medicare Medicare |
$250.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.63
|
| Rate for Payer: UHC Exchange |
$388.48
|
| Rate for Payer: UHC Medicare Advantage |
$250.63
|
| Rate for Payer: UHCCP DNSP |
$250.63
|
| Rate for Payer: UHCCP Medicaid |
$134.34
|
| Rate for Payer: VA VA |
$250.63
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$817.11 |
| Max. Negotiated Rate |
$1,257.09 |
| Rate for Payer: Aetna Commercial |
$1,131.38
|
| Rate for Payer: ASR ASR |
$1,219.38
|
| Rate for Payer: ASR Commercial |
$1,219.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.40
|
| Rate for Payer: BCN Commercial |
$974.62
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Healthscope Commercial |
$1,257.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,219.38
|
| Rate for Payer: Mclaren Commercial |
$1,131.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: Nomi Health Commercial |
$1,030.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.24
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$97.92
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$88.13
|
| Rate for Payer: ASR ASR |
$94.98
|
| Rate for Payer: ASR Commercial |
$94.98
|
| Rate for Payer: BCBS Trust/PPO |
$79.80
|
| Rate for Payer: BCN Commercial |
$75.92
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$97.92
|
| Rate for Payer: Healthscope Whirlpool |
$94.98
|
| Rate for Payer: Mclaren Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: Nomi Health Commercial |
$80.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.17
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$97.92
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$88.13
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: ASR ASR |
$94.98
|
| Rate for Payer: ASR Commercial |
$94.98
|
| Rate for Payer: BCBS Complete |
$39.17
|
| Rate for Payer: BCBS Trust/PPO |
$80.19
|
| Rate for Payer: BCN Commercial |
$75.92
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$97.92
|
| Rate for Payer: Healthscope Whirlpool |
$94.98
|
| Rate for Payer: Mclaren Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: Nomi Health Commercial |
$80.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.80
|
| Rate for Payer: Priority Health Narrow Network |
$68.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.17
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$688.50
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Aetna Commercial |
$619.65
|
| Rate for Payer: Aetna Medicare |
$344.25
|
| Rate for Payer: ASR ASR |
$667.84
|
| Rate for Payer: ASR Commercial |
$667.84
|
| Rate for Payer: BCBS Complete |
$275.40
|
| Rate for Payer: BCBS Trust/PPO |
$563.81
|
| Rate for Payer: BCN Commercial |
$533.79
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$647.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$688.50
|
| Rate for Payer: Healthscope Whirlpool |
$667.84
|
| Rate for Payer: Mclaren Commercial |
$619.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.22
|
| Rate for Payer: Nomi Health Commercial |
$564.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$603.26
|
| Rate for Payer: Priority Health Narrow Network |
$482.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.88
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$688.50
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.52 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Aetna Commercial |
$619.65
|
| Rate for Payer: ASR ASR |
$667.84
|
| Rate for Payer: ASR Commercial |
$667.84
|
| Rate for Payer: BCBS Trust/PPO |
$561.06
|
| Rate for Payer: BCN Commercial |
$533.79
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$647.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$688.50
|
| Rate for Payer: Healthscope Whirlpool |
$667.84
|
| Rate for Payer: Mclaren Commercial |
$619.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.22
|
| Rate for Payer: Nomi Health Commercial |
$564.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.88
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$205.02
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$205.02 |
| Rate for Payer: Aetna Commercial |
$184.52
|
| Rate for Payer: Aetna Medicare |
$102.51
|
| Rate for Payer: ASR ASR |
$198.87
|
| Rate for Payer: ASR Commercial |
$198.87
|
| Rate for Payer: BCBS Complete |
$82.01
|
| Rate for Payer: BCBS Trust/PPO |
$167.89
|
| Rate for Payer: BCN Commercial |
$158.95
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$192.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.02
|
| Rate for Payer: Healthscope Commercial |
$205.02
|
| Rate for Payer: Healthscope Whirlpool |
$198.87
|
| Rate for Payer: Mclaren Commercial |
$184.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.27
|
| Rate for Payer: Nomi Health Commercial |
$168.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.64
|
| Rate for Payer: Priority Health Narrow Network |
$143.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.42
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$205.02
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.26 |
| Max. Negotiated Rate |
$205.02 |
| Rate for Payer: Aetna Commercial |
$184.52
|
| Rate for Payer: ASR ASR |
$198.87
|
| Rate for Payer: ASR Commercial |
$198.87
|
| Rate for Payer: BCBS Trust/PPO |
$167.07
|
| Rate for Payer: BCN Commercial |
$158.95
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$192.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.02
|
| Rate for Payer: Healthscope Commercial |
$205.02
|
| Rate for Payer: Healthscope Whirlpool |
$198.87
|
| Rate for Payer: Mclaren Commercial |
$184.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.27
|
| Rate for Payer: Nomi Health Commercial |
$168.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.42
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$841.50
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna Commercial |
$757.35
|
| Rate for Payer: ASR ASR |
$816.26
|
| Rate for Payer: ASR Commercial |
$816.26
|
| Rate for Payer: BCBS Trust/PPO |
$685.74
|
| Rate for Payer: BCN Commercial |
$652.41
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$791.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$841.50
|
| Rate for Payer: Healthscope Whirlpool |
$816.26
|
| Rate for Payer: Mclaren Commercial |
$757.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.28
|
| Rate for Payer: Nomi Health Commercial |
$690.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.52
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$841.50
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna Commercial |
$757.35
|
| Rate for Payer: Aetna Medicare |
$420.75
|
| Rate for Payer: ASR ASR |
$816.26
|
| Rate for Payer: ASR Commercial |
$816.26
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: BCBS Trust/PPO |
$689.10
|
| Rate for Payer: BCN Commercial |
$652.41
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$791.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$841.50
|
| Rate for Payer: Healthscope Whirlpool |
$816.26
|
| Rate for Payer: Mclaren Commercial |
$757.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.28
|
| Rate for Payer: Nomi Health Commercial |
$690.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.32
|
| Rate for Payer: Priority Health Narrow Network |
$589.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.52
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
IP
|
$164.38
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.85 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Aetna Commercial |
$147.94
|
| Rate for Payer: ASR ASR |
$159.45
|
| Rate for Payer: ASR Commercial |
$159.45
|
| Rate for Payer: BCBS Trust/PPO |
$133.95
|
| Rate for Payer: BCN Commercial |
$127.44
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$154.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$164.38
|
| Rate for Payer: Healthscope Whirlpool |
$159.45
|
| Rate for Payer: Mclaren Commercial |
$147.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$134.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.65
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$164.38
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Aetna Commercial |
$147.94
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$159.45
|
| Rate for Payer: ASR Commercial |
$159.45
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$134.61
|
| Rate for Payer: BCN Commercial |
$127.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$154.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$164.38
|
| Rate for Payer: Healthscope Whirlpool |
$159.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$147.94
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$134.79
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.03
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$115.23
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$151.79 |
| Rate for Payer: Aetna Commercial |
$136.61
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: ASR ASR |
$147.24
|
| Rate for Payer: ASR Commercial |
$147.24
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$124.30
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$117.68
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$151.79
|
| Rate for Payer: Healthscope Whirlpool |
$147.24
|
| Rate for Payer: Mclaren Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Nomi Health Commercial |
$124.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.58
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.66 |
| Max. Negotiated Rate |
$151.79 |
| Rate for Payer: Aetna Commercial |
$136.61
|
| Rate for Payer: ASR ASR |
$147.24
|
| Rate for Payer: ASR Commercial |
$147.24
|
| Rate for Payer: BCBS Trust/PPO |
$123.69
|
| Rate for Payer: BCN Commercial |
$117.68
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$151.79
|
| Rate for Payer: Healthscope Whirlpool |
$147.24
|
| Rate for Payer: Mclaren Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Nomi Health Commercial |
$124.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.58
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
IP
|
$923.62
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$600.35 |
| Max. Negotiated Rate |
$923.62 |
| Rate for Payer: Aetna Commercial |
$831.26
|
| Rate for Payer: ASR ASR |
$895.91
|
| Rate for Payer: ASR Commercial |
$895.91
|
| Rate for Payer: BCBS Trust/PPO |
$752.66
|
| Rate for Payer: BCN Commercial |
$716.08
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cofinity Commercial |
$868.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.90
|
| Rate for Payer: Healthscope Commercial |
$923.62
|
| Rate for Payer: Healthscope Whirlpool |
$895.91
|
| Rate for Payer: Mclaren Commercial |
$831.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.08
|
| Rate for Payer: Nomi Health Commercial |
$757.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$812.79
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
OP
|
$923.62
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.45 |
| Max. Negotiated Rate |
$923.62 |
| Rate for Payer: Aetna Commercial |
$831.26
|
| Rate for Payer: Aetna Medicare |
$461.81
|
| Rate for Payer: ASR ASR |
$895.91
|
| Rate for Payer: ASR Commercial |
$895.91
|
| Rate for Payer: BCBS Complete |
$369.45
|
| Rate for Payer: BCBS Trust/PPO |
$756.35
|
| Rate for Payer: BCN Commercial |
$716.08
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cofinity Commercial |
$868.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.90
|
| Rate for Payer: Healthscope Commercial |
$923.62
|
| Rate for Payer: Healthscope Whirlpool |
$895.91
|
| Rate for Payer: Mclaren Commercial |
$831.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.08
|
| Rate for Payer: Nomi Health Commercial |
$757.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$809.28
|
| Rate for Payer: Priority Health Narrow Network |
$647.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$812.79
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$110.89 |
| Rate for Payer: Aetna Commercial |
$60.59
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$65.30
|
| Rate for Payer: ASR Commercial |
$65.30
|
| Rate for Payer: BCBS Complete |
$3.65
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.13
|
| Rate for Payer: BCN Commercial |
$52.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$67.32
|
| Rate for Payer: Healthscope Whirlpool |
$65.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$60.59
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: Nomi Health Commercial |
$55.20
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$7.13
|
| Rate for Payer: PHP Medicaid |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.89
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$88.71
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.48
|
| Rate for Payer: UHC Exchange |
$10.04
|
| Rate for Payer: UHC Medicare Advantage |
$6.48
|
| Rate for Payer: UHCCP DNSP |
$6.48
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: Aetna Commercial |
$60.59
|
| Rate for Payer: ASR ASR |
$65.30
|
| Rate for Payer: ASR Commercial |
$65.30
|
| Rate for Payer: BCBS Trust/PPO |
$54.86
|
| Rate for Payer: BCN Commercial |
$52.19
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$67.32
|
| Rate for Payer: Healthscope Whirlpool |
$65.30
|
| Rate for Payer: Mclaren Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: Nomi Health Commercial |
$55.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.24
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
