|
HC PORTAL FILMS
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$267.38 |
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: ASR ASR |
$259.36
|
| Rate for Payer: ASR Commercial |
$259.36
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Trust/PPO |
$218.96
|
| Rate for Payer: BCN Commercial |
$207.30
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$267.38
|
| Rate for Payer: Healthscope Whirlpool |
$259.36
|
| Rate for Payer: Mclaren Commercial |
$240.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Nomi Health Commercial |
$219.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.28
|
| Rate for Payer: Priority Health Narrow Network |
$187.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.29
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$267.38 |
| Rate for Payer: Aetna Commercial |
$240.64
|
| Rate for Payer: ASR ASR |
$259.36
|
| Rate for Payer: ASR Commercial |
$259.36
|
| Rate for Payer: BCBS Trust/PPO |
$217.89
|
| Rate for Payer: BCN Commercial |
$207.30
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$267.38
|
| Rate for Payer: Healthscope Whirlpool |
$259.36
|
| Rate for Payer: Mclaren Commercial |
$240.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Nomi Health Commercial |
$219.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.29
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$553.49 |
| Rate for Payer: Aetna Commercial |
$498.14
|
| Rate for Payer: ASR ASR |
$536.89
|
| Rate for Payer: ASR Commercial |
$536.89
|
| Rate for Payer: BCBS Trust/PPO |
$451.04
|
| Rate for Payer: BCN Commercial |
$429.12
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Healthscope Commercial |
$553.49
|
| Rate for Payer: Healthscope Whirlpool |
$536.89
|
| Rate for Payer: Mclaren Commercial |
$498.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.07
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna Commercial |
$498.14
|
| Rate for Payer: Aetna Medicare |
$358.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$448.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$448.34
|
| Rate for Payer: ASR ASR |
$536.89
|
| Rate for Payer: ASR Commercial |
$536.89
|
| Rate for Payer: BCBS Complete |
$201.86
|
| Rate for Payer: BCBS MAPPO |
$358.67
|
| Rate for Payer: BCBS Trust/PPO |
$453.25
|
| Rate for Payer: BCN Commercial |
$429.12
|
| Rate for Payer: BCN Medicare Advantage |
$358.67
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$358.67
|
| Rate for Payer: Healthscope Commercial |
$553.49
|
| Rate for Payer: Healthscope Whirlpool |
$536.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$358.67
|
| Rate for Payer: Mclaren Commercial |
$498.14
|
| Rate for Payer: Mclaren Medicaid |
$192.25
|
| Rate for Payer: Mclaren Medicare |
$358.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.60
|
| Rate for Payer: Meridian Medicaid |
$201.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$412.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: PACE Medicare |
$340.74
|
| Rate for Payer: PACE SWMI |
$358.67
|
| Rate for Payer: PHP Commercial |
$394.54
|
| Rate for Payer: PHP Medicaid |
$192.25
|
| Rate for Payer: PHP Medicare Advantage |
$358.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$484.97
|
| Rate for Payer: Priority Health Medicare |
$358.67
|
| Rate for Payer: Priority Health Narrow Network |
$388.00
|
| Rate for Payer: Railroad Medicare Medicare |
$358.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$487.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$358.67
|
| Rate for Payer: UHC Exchange |
$555.94
|
| Rate for Payer: UHC Medicare Advantage |
$358.67
|
| Rate for Payer: UHCCP DNSP |
$358.67
|
| Rate for Payer: UHCCP Medicaid |
$192.25
|
| Rate for Payer: VA VA |
$358.67
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,058.93 |
| Max. Negotiated Rate |
$1,629.13 |
| Rate for Payer: Aetna Commercial |
$1,466.22
|
| Rate for Payer: ASR ASR |
$1,580.26
|
| Rate for Payer: ASR Commercial |
$1,580.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.58
|
| Rate for Payer: BCN Commercial |
$1,263.06
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,531.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Healthscope Commercial |
$1,629.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,580.26
|
| Rate for Payer: Mclaren Commercial |
$1,466.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: Nomi Health Commercial |
$1,335.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,433.63
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$349.30 |
| Max. Negotiated Rate |
$1,629.13 |
| Rate for Payer: Aetna Commercial |
$1,466.22
|
| Rate for Payer: Aetna Medicare |
$651.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$814.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$814.59
|
| Rate for Payer: ASR ASR |
$1,580.26
|
| Rate for Payer: ASR Commercial |
$1,580.26
|
| Rate for Payer: BCBS Complete |
$366.76
|
| Rate for Payer: BCBS MAPPO |
$651.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,334.09
|
| Rate for Payer: BCN Commercial |
$1,263.06
|
| Rate for Payer: BCN Medicare Advantage |
$651.67
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,531.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$651.67
|
| Rate for Payer: Healthscope Commercial |
$1,629.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,580.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$651.67
|
| Rate for Payer: Mclaren Commercial |
$1,466.22
|
| Rate for Payer: Mclaren Medicaid |
$349.30
|
| Rate for Payer: Mclaren Medicare |
$651.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.25
|
| Rate for Payer: Meridian Medicaid |
$366.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$749.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: Nomi Health Commercial |
$1,335.89
|
| Rate for Payer: PACE Medicare |
$619.09
|
| Rate for Payer: PACE SWMI |
$651.67
|
| Rate for Payer: PHP Commercial |
$716.84
|
| Rate for Payer: PHP Medicaid |
$349.30
|
| Rate for Payer: PHP Medicare Advantage |
$651.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,427.44
|
| Rate for Payer: Priority Health Medicare |
$651.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.02
|
| Rate for Payer: Railroad Medicare Medicare |
$651.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,433.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$651.67
|
| Rate for Payer: UHC Exchange |
$1,010.09
|
| Rate for Payer: UHC Medicare Advantage |
$651.67
|
| Rate for Payer: UHCCP DNSP |
$651.67
|
| Rate for Payer: UHCCP Medicaid |
$349.30
|
| Rate for Payer: VA VA |
$651.67
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.52
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.77
|
| Rate for Payer: Priority Health Narrow Network |
$48.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$66.82
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: Aetna Medicare |
$110.16
|
| Rate for Payer: ASR ASR |
$213.71
|
| Rate for Payer: ASR Commercial |
$213.71
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS Trust/PPO |
$180.42
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$207.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Healthscope Whirlpool |
$213.71
|
| Rate for Payer: Mclaren Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.27
|
| Rate for Payer: Nomi Health Commercial |
$180.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Narrow Network |
$154.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.88
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: ASR ASR |
$213.71
|
| Rate for Payer: ASR Commercial |
$213.71
|
| Rate for Payer: BCBS Trust/PPO |
$179.54
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$207.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Healthscope Whirlpool |
$213.71
|
| Rate for Payer: Mclaren Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.27
|
| Rate for Payer: Nomi Health Commercial |
$180.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.88
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$250.92
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$250.92 |
| Rate for Payer: Aetna Commercial |
$225.83
|
| Rate for Payer: ASR ASR |
$243.39
|
| Rate for Payer: ASR Commercial |
$243.39
|
| Rate for Payer: BCBS Trust/PPO |
$204.47
|
| Rate for Payer: BCN Commercial |
$194.54
|
| Rate for Payer: Cash Price |
$200.74
|
| Rate for Payer: Cofinity Commercial |
$235.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.74
|
| Rate for Payer: Healthscope Commercial |
$250.92
|
| Rate for Payer: Healthscope Whirlpool |
$243.39
|
| Rate for Payer: Mclaren Commercial |
$225.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.28
|
| Rate for Payer: Nomi Health Commercial |
$205.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.81
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$250.92
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.37 |
| Max. Negotiated Rate |
$250.92 |
| Rate for Payer: Aetna Commercial |
$225.83
|
| Rate for Payer: Aetna Medicare |
$125.46
|
| Rate for Payer: ASR ASR |
$243.39
|
| Rate for Payer: ASR Commercial |
$243.39
|
| Rate for Payer: BCBS Complete |
$100.37
|
| Rate for Payer: BCBS Trust/PPO |
$205.48
|
| Rate for Payer: BCN Commercial |
$194.54
|
| Rate for Payer: Cash Price |
$200.74
|
| Rate for Payer: Cofinity Commercial |
$235.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.74
|
| Rate for Payer: Healthscope Commercial |
$250.92
|
| Rate for Payer: Healthscope Whirlpool |
$243.39
|
| Rate for Payer: Mclaren Commercial |
$225.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.28
|
| Rate for Payer: Nomi Health Commercial |
$205.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.86
|
| Rate for Payer: Priority Health Narrow Network |
$175.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.81
|
|
|
HC POST-OP
|
Facility
|
IP
|
$18.07
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: ASR ASR |
$17.53
|
| Rate for Payer: ASR Commercial |
$17.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Healthscope Whirlpool |
$17.53
|
| Rate for Payer: Mclaren Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: Nomi Health Commercial |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.90
|
|
|
HC POST-OP
|
Facility
|
OP
|
$18.07
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: ASR ASR |
$17.53
|
| Rate for Payer: ASR Commercial |
$17.53
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.80
|
| Rate for Payer: BCN Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$18.07
|
| Rate for Payer: Healthscope Whirlpool |
$17.53
|
| Rate for Payer: Mclaren Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: Nomi Health Commercial |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$12.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.90
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$386.21 |
| Rate for Payer: Aetna Commercial |
$347.59
|
| Rate for Payer: ASR ASR |
$374.62
|
| Rate for Payer: ASR Commercial |
$374.62
|
| Rate for Payer: BCBS Trust/PPO |
$314.72
|
| Rate for Payer: BCN Commercial |
$299.43
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$363.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Healthscope Whirlpool |
$374.62
|
| Rate for Payer: Mclaren Commercial |
$347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.86
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$347.59
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$374.62
|
| Rate for Payer: ASR Commercial |
$374.62
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$316.27
|
| Rate for Payer: BCN Commercial |
$299.43
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$363.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Healthscope Whirlpool |
$374.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.40
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$270.73
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| 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 |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.76
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| 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 |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| 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 |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.12
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow Network |
$14.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.76
|
| Rate for Payer: UHC Exchange |
$7.38
|
| Rate for Payer: UHC Medicare Advantage |
$4.76
|
| Rate for Payer: UHCCP DNSP |
$4.76
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: ASR Commercial |
$20.58
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.59
|
| Rate for Payer: Priority Health Narrow Network |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: ASR ASR |
$20.58
|
| Rate for Payer: ASR Commercial |
$20.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.29
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Mclaren Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.67
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$36.92
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$36.92 |
| Rate for Payer: Aetna Commercial |
$33.23
|
| 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 |
$35.81
|
| Rate for Payer: ASR Commercial |
$35.81
|
| Rate for Payer: BCBS Complete |
$2.66
|
| Rate for Payer: BCBS MAPPO |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$30.23
|
| Rate for Payer: BCN Commercial |
$28.62
|
| Rate for Payer: BCN Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$34.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$36.92
|
| Rate for Payer: Healthscope Whirlpool |
$35.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.73
|
| Rate for Payer: Mclaren Commercial |
$33.23
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| 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 |
$2.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$30.27
|
| 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 |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.84
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$25.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.73
|
| Rate for Payer: UHC Exchange |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$4.73
|
| Rate for Payer: UHCCP DNSP |
$4.73
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: VA VA |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$36.92
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$36.92 |
| Rate for Payer: Aetna Commercial |
$33.23
|
| Rate for Payer: ASR ASR |
$35.81
|
| Rate for Payer: ASR Commercial |
$35.81
|
| Rate for Payer: BCBS Trust/PPO |
$30.09
|
| Rate for Payer: BCN Commercial |
$28.62
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$34.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$36.92
|
| Rate for Payer: Healthscope Whirlpool |
$35.81
|
| Rate for Payer: Mclaren Commercial |
$33.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$30.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.49
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: ASR Commercial |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$8.31
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
