|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$70.75
|
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$26.18
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$58.33
|
| Rate for Payer: BCN Commercial |
$58.33
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$68.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.75
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.99
|
| Rate for Payer: Priority Health Narrow Network |
$49.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$70.75
|
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: BCBS Trust/PPO |
$58.10
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$68.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.75
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$83.23
|
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: BCBS Complete |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$68.62
|
| Rate for Payer: BCN Commercial |
$68.62
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$80.73
|
| Rate for Payer: Healthscope Whirlpool |
$83.23
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.93
|
| Rate for Payer: Priority Health Narrow Network |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$83.23
|
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$68.35
|
| Rate for Payer: BCN Commercial |
$68.35
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$80.73
|
| Rate for Payer: Healthscope Whirlpool |
$83.23
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$224.73
|
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.55 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: BCBS Trust/PPO |
$184.55
|
| Rate for Payer: BCN Commercial |
$184.55
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$217.99
|
| Rate for Payer: Healthscope Whirlpool |
$224.73
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$224.73
|
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna Medicare |
$83.15
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$185.29
|
| Rate for Payer: BCN Commercial |
$185.29
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$217.99
|
| Rate for Payer: Healthscope Whirlpool |
$224.73
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$196.91
|
| Rate for Payer: Priority Health Narrow Network |
$157.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$255.94
|
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$255.94 |
| Rate for Payer: Aetna Commercial |
$230.35
|
| Rate for Payer: Aetna Medicare |
$94.70
|
| Rate for Payer: ASR ASR |
$248.26
|
| Rate for Payer: BCBS Complete |
$102.38
|
| Rate for Payer: BCBS Trust/PPO |
$211.02
|
| Rate for Payer: BCN Commercial |
$211.02
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cofinity Commercial |
$240.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$248.26
|
| Rate for Payer: Healthscope Whirlpool |
$255.94
|
| Rate for Payer: Mclaren Commercial |
$230.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.55
|
| Rate for Payer: Nomi Health Commercial |
$209.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$224.25
|
| Rate for Payer: Priority Health Narrow Network |
$179.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.23
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$255.94
|
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.96 |
| Max. Negotiated Rate |
$255.94 |
| Rate for Payer: Aetna Commercial |
$230.35
|
| Rate for Payer: ASR ASR |
$248.26
|
| Rate for Payer: BCBS Trust/PPO |
$210.18
|
| Rate for Payer: BCN Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cofinity Commercial |
$240.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$248.26
|
| Rate for Payer: Healthscope Whirlpool |
$255.94
|
| Rate for Payer: Mclaren Commercial |
$230.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.55
|
| Rate for Payer: Nomi Health Commercial |
$209.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.23
|
|
|
HC POST-OP
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
HC POST-OP
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.45 |
| Max. Negotiated Rate |
$393.93 |
| Rate for Payer: Aetna Commercial |
$354.54
|
| Rate for Payer: ASR ASR |
$382.11
|
| Rate for Payer: BCBS Trust/PPO |
$323.50
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$370.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$382.11
|
| Rate for Payer: Healthscope Whirlpool |
$393.93
|
| Rate for Payer: Mclaren Commercial |
$354.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.66
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$354.54
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$382.11
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$324.80
|
| Rate for Payer: BCN Commercial |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$370.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$382.11
|
| Rate for Payer: Healthscope Whirlpool |
$393.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.16
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$276.14
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.76
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$4.76
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$2.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$5.24
|
| Rate for Payer: PHP Medicaid |
$2.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.98
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow Network |
$15.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.76
|
| Rate for Payer: UHC Exchange |
$7.38
|
| Rate for Payer: UHC Medicaid |
$2.49
|
| Rate for Payer: UHCCP DNSP |
$4.76
|
| Rate for Payer: UHCCP Medicaid |
$2.49
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$8.01
|
| Rate for Payer: ASR ASR |
$20.99
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.84
|
| Rate for Payer: BCN Commercial |
$17.84
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Healthscope Whirlpool |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$15.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.04
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: ASR ASR |
$20.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Healthscope Whirlpool |
$21.64
|
| Rate for Payer: Mclaren Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.04
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$37.66
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$37.66 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.91
|
| Rate for Payer: ASR ASR |
$36.53
|
| Rate for Payer: BCBS Complete |
$2.60
|
| Rate for Payer: BCBS MAPPO |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$31.05
|
| Rate for Payer: BCN Commercial |
$31.05
|
| Rate for Payer: BCN Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Commercial |
$35.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$36.53
|
| Rate for Payer: Healthscope Whirlpool |
$37.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.73
|
| Rate for Payer: Mclaren Commercial |
$33.89
|
| Rate for Payer: Mclaren Medicaid |
$4.73
|
| Rate for Payer: Mclaren Medicare |
$4.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.97
|
| Rate for Payer: Meridian Medicaid |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$30.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: PACE Medicare |
$4.49
|
| Rate for Payer: PACE SWMI |
$4.73
|
| Rate for Payer: PHP Commercial |
$5.20
|
| Rate for Payer: PHP Medicaid |
$2.54
|
| Rate for Payer: PHP Medicare Advantage |
$4.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$28.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.73
|
| Rate for Payer: UHC Exchange |
$7.33
|
| Rate for Payer: UHC Medicaid |
$2.47
|
| Rate for Payer: UHCCP DNSP |
$4.73
|
| Rate for Payer: UHCCP Medicaid |
$2.47
|
| Rate for Payer: VA VA |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$37.66
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$37.66 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: ASR ASR |
$36.53
|
| Rate for Payer: BCBS Trust/PPO |
$30.93
|
| Rate for Payer: BCN Commercial |
$30.93
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Commercial |
$35.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Healthscope Commercial |
$36.53
|
| Rate for Payer: Healthscope Whirlpool |
$37.66
|
| Rate for Payer: Mclaren Commercial |
$33.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$30.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.14
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.40
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.40
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.40
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$3.85
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.57
|
| Rate for Payer: BCN Commercial |
$8.57
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.40
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.63
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$17.63 |
| Rate for Payer: Aetna Commercial |
$15.87
|
| Rate for Payer: ASR ASR |
$17.10
|
| Rate for Payer: BCBS Trust/PPO |
$14.48
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Whirlpool |
$17.63
|
| Rate for Payer: Mclaren Commercial |
$15.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.99
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.51
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.63
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$17.63 |
| Rate for Payer: Aetna Commercial |
$15.87
|
| Rate for Payer: Aetna Medicare |
$6.52
|
| Rate for Payer: ASR ASR |
$17.10
|
| Rate for Payer: BCBS Complete |
$7.05
|
| Rate for Payer: BCBS Trust/PPO |
$14.54
|
| Rate for Payer: BCN Commercial |
$14.54
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Whirlpool |
$17.63
|
| Rate for Payer: Mclaren Commercial |
$15.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.99
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.45
|
| Rate for Payer: Priority Health Narrow Network |
$12.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.51
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$115.13
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$115.13 |
| Rate for Payer: Aetna Commercial |
$103.62
|
| Rate for Payer: ASR ASR |
$111.68
|
| Rate for Payer: BCBS Trust/PPO |
$94.54
|
| Rate for Payer: BCN Commercial |
$94.54
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Commercial |
$108.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$111.68
|
| Rate for Payer: Healthscope Whirlpool |
$115.13
|
| Rate for Payer: Mclaren Commercial |
$103.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.31
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$115.13
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$115.13 |
| Rate for Payer: Aetna Commercial |
$103.62
|
| Rate for Payer: Aetna Medicare |
$42.60
|
| Rate for Payer: ASR ASR |
$111.68
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS Trust/PPO |
$94.92
|
| Rate for Payer: BCN Commercial |
$94.92
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Commercial |
$108.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$111.68
|
| Rate for Payer: Healthscope Whirlpool |
$115.13
|
| Rate for Payer: Mclaren Commercial |
$103.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.88
|
| Rate for Payer: Priority Health Narrow Network |
$80.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.31
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$31.06
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: ASR ASR |
$30.13
|
| Rate for Payer: BCBS Trust/PPO |
$25.51
|
| Rate for Payer: BCN Commercial |
$25.51
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$29.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.85
|
| Rate for Payer: Healthscope Commercial |
$30.13
|
| Rate for Payer: Healthscope Whirlpool |
$31.06
|
| Rate for Payer: Mclaren Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.40
|
| Rate for Payer: Nomi Health Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.33
|
|
