|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$12,406.77
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$12,406.77 |
| Rate for Payer: Aetna Commercial |
$11,166.09
|
| Rate for Payer: Aetna Medicare |
$3,303.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: ASR ASR |
$12,034.57
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$10,229.38
|
| Rate for Payer: BCN Commercial |
$10,229.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cofinity Commercial |
$11,662.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,925.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$12,034.57
|
| Rate for Payer: Healthscope Whirlpool |
$12,406.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,303.54
|
| Rate for Payer: Mclaren Commercial |
$11,166.09
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$1,814.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,545.75
|
| Rate for Payer: Nomi Health Commercial |
$10,173.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,305.08
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$3,633.89
|
| Rate for Payer: PHP Medicaid |
$1,770.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,870.81
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Narrow Network |
$8,697.15
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,917.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$5,120.49
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP DNSP |
$3,303.54
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$12,406.77
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9,305.08 |
| Max. Negotiated Rate |
$12,406.77 |
| Rate for Payer: Aetna Commercial |
$11,166.09
|
| Rate for Payer: ASR ASR |
$12,034.57
|
| Rate for Payer: BCBS Trust/PPO |
$10,188.44
|
| Rate for Payer: BCN Commercial |
$10,188.44
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cofinity Commercial |
$11,662.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,925.42
|
| Rate for Payer: Healthscope Commercial |
$12,034.57
|
| Rate for Payer: Healthscope Whirlpool |
$12,406.77
|
| Rate for Payer: Mclaren Commercial |
$11,166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,545.75
|
| Rate for Payer: Nomi Health Commercial |
$10,173.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,305.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,917.96
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$32.77
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: ASR ASR |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$26.91
|
| Rate for Payer: BCN Commercial |
$26.91
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Healthscope Commercial |
$31.79
|
| Rate for Payer: Healthscope Whirlpool |
$32.77
|
| Rate for Payer: Mclaren Commercial |
$29.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Nomi Health Commercial |
$26.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$32.77
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Medicare |
$12.12
|
| Rate for Payer: ASR ASR |
$31.79
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.02
|
| Rate for Payer: BCN Commercial |
$27.02
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Healthscope Commercial |
$31.79
|
| Rate for Payer: Healthscope Whirlpool |
$32.77
|
| Rate for Payer: Mclaren Commercial |
$29.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Nomi Health Commercial |
$26.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.71
|
| Rate for Payer: Priority Health Narrow Network |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$45.26
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$45.26 |
| Rate for Payer: Aetna Commercial |
$40.73
|
| Rate for Payer: Aetna Medicare |
$16.75
|
| Rate for Payer: ASR ASR |
$43.90
|
| Rate for Payer: BCBS Complete |
$18.10
|
| Rate for Payer: BCBS Trust/PPO |
$37.32
|
| Rate for Payer: BCN Commercial |
$37.32
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.21
|
| Rate for Payer: Healthscope Commercial |
$43.90
|
| Rate for Payer: Healthscope Whirlpool |
$45.26
|
| Rate for Payer: Mclaren Commercial |
$40.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.47
|
| Rate for Payer: Nomi Health Commercial |
$37.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.66
|
| Rate for Payer: Priority Health Narrow Network |
$31.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.83
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$45.26
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.95 |
| Max. Negotiated Rate |
$45.26 |
| Rate for Payer: Aetna Commercial |
$40.73
|
| Rate for Payer: ASR ASR |
$43.90
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.21
|
| Rate for Payer: Healthscope Commercial |
$43.90
|
| Rate for Payer: Healthscope Whirlpool |
$45.26
|
| Rate for Payer: Mclaren Commercial |
$40.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.47
|
| Rate for Payer: Nomi Health Commercial |
$37.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.83
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
IP
|
$43.70
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.89
|
| Rate for Payer: BCN Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$43.70
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: Aetna Medicare |
$16.17
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$36.03
|
| Rate for Payer: BCN Commercial |
$36.03
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.29
|
| Rate for Payer: Priority Health Narrow Network |
$30.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
IP
|
$160.24
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$160.24 |
| Rate for Payer: Aetna Commercial |
$144.22
|
| Rate for Payer: ASR ASR |
$155.43
|
| Rate for Payer: BCBS Trust/PPO |
$131.59
|
| Rate for Payer: BCN Commercial |
$131.59
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$155.43
|
| Rate for Payer: Healthscope Whirlpool |
$160.24
|
| Rate for Payer: Mclaren Commercial |
$144.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.01
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
OP
|
$160.24
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$160.24 |
| Rate for Payer: Aetna Commercial |
$144.22
|
| Rate for Payer: Aetna Medicare |
$59.29
|
| Rate for Payer: ASR ASR |
$155.43
|
| Rate for Payer: BCBS Complete |
$64.10
|
| Rate for Payer: BCBS Trust/PPO |
$132.12
|
| Rate for Payer: BCN Commercial |
$132.12
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$155.43
|
| Rate for Payer: Healthscope Whirlpool |
$160.24
|
| Rate for Payer: Mclaren Commercial |
$144.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.40
|
| Rate for Payer: Priority Health Narrow Network |
$112.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.01
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
OP
|
$88.43
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: ASR ASR |
$85.78
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$72.91
|
| Rate for Payer: BCN Commercial |
$72.91
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$83.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$24.11
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$13.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$72.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.32
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$26.52
|
| Rate for Payer: PHP Medicaid |
$12.92
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$171.90
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$137.52
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.11
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicaid |
$12.61
|
| Rate for Payer: UHCCP DNSP |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$12.61
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
IP
|
$88.43
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$88.43 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: ASR ASR |
$85.78
|
| Rate for Payer: BCBS Trust/PPO |
$72.62
|
| Rate for Payer: BCN Commercial |
$72.62
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$83.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.43
|
| Rate for Payer: Mclaren Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$72.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.82
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$121.35
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.01 |
| Max. Negotiated Rate |
$121.35 |
| Rate for Payer: Aetna Commercial |
$109.22
|
| Rate for Payer: ASR ASR |
$117.71
|
| Rate for Payer: BCBS Trust/PPO |
$99.65
|
| Rate for Payer: BCN Commercial |
$99.65
|
| Rate for Payer: Cash Price |
$97.08
|
| Rate for Payer: Cofinity Commercial |
$114.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.08
|
| Rate for Payer: Healthscope Commercial |
$117.71
|
| Rate for Payer: Healthscope Whirlpool |
$121.35
|
| Rate for Payer: Mclaren Commercial |
$109.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.15
|
| Rate for Payer: Nomi Health Commercial |
$99.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.79
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$121.35
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$121.35 |
| Rate for Payer: Aetna Commercial |
$109.22
|
| Rate for Payer: Aetna Medicare |
$44.90
|
| Rate for Payer: ASR ASR |
$117.71
|
| Rate for Payer: BCBS Complete |
$48.54
|
| Rate for Payer: BCBS Trust/PPO |
$100.05
|
| Rate for Payer: BCN Commercial |
$100.05
|
| Rate for Payer: Cash Price |
$97.08
|
| Rate for Payer: Cofinity Commercial |
$114.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.08
|
| Rate for Payer: Healthscope Commercial |
$117.71
|
| Rate for Payer: Healthscope Whirlpool |
$121.35
|
| Rate for Payer: Mclaren Commercial |
$109.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.15
|
| Rate for Payer: Nomi Health Commercial |
$99.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.33
|
| Rate for Payer: Priority Health Narrow Network |
$85.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.79
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
OP
|
$76.19
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$68.57
|
| Rate for Payer: Aetna Medicare |
$28.19
|
| Rate for Payer: ASR ASR |
$73.90
|
| Rate for Payer: BCBS Complete |
$30.48
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCCCP Commercial |
$51.41
|
| Rate for Payer: BCN Commercial |
$62.82
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Commercial |
$71.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$73.90
|
| Rate for Payer: Healthscope Whirlpool |
$76.19
|
| Rate for Payer: Mclaren Commercial |
$68.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Nomi Health Commercial |
$62.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.76
|
| Rate for Payer: Priority Health Narrow Network |
$53.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.05
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$76.19
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.14 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$68.57
|
| Rate for Payer: ASR ASR |
$73.90
|
| Rate for Payer: BCBS Trust/PPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$62.57
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Commercial |
$71.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$73.90
|
| Rate for Payer: Healthscope Whirlpool |
$76.19
|
| Rate for Payer: Mclaren Commercial |
$68.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Nomi Health Commercial |
$62.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.05
|
|
|
HC SURGICAL HAND
|
Facility
|
OP
|
$718.51
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.85 |
| Max. Negotiated Rate |
$718.51 |
| Rate for Payer: Aetna Commercial |
$646.66
|
| Rate for Payer: Aetna Medicare |
$265.85
|
| Rate for Payer: ASR ASR |
$696.95
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS Trust/PPO |
$592.41
|
| Rate for Payer: BCN Commercial |
$592.41
|
| Rate for Payer: Cash Price |
$574.81
|
| Rate for Payer: Cofinity Commercial |
$675.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.81
|
| Rate for Payer: Healthscope Commercial |
$696.95
|
| Rate for Payer: Healthscope Whirlpool |
$718.51
|
| Rate for Payer: Mclaren Commercial |
$646.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$574.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.73
|
| Rate for Payer: Nomi Health Commercial |
$589.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$538.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$629.56
|
| Rate for Payer: Priority Health Narrow Network |
$503.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.29
|
|
|
HC SURGICAL HAND
|
Facility
|
IP
|
$718.51
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.88 |
| Max. Negotiated Rate |
$718.51 |
| Rate for Payer: Aetna Commercial |
$646.66
|
| Rate for Payer: ASR ASR |
$696.95
|
| Rate for Payer: BCBS Trust/PPO |
$590.04
|
| Rate for Payer: BCN Commercial |
$590.04
|
| Rate for Payer: Cash Price |
$574.81
|
| Rate for Payer: Cofinity Commercial |
$675.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.81
|
| Rate for Payer: Healthscope Commercial |
$696.95
|
| Rate for Payer: Healthscope Whirlpool |
$718.51
|
| Rate for Payer: Mclaren Commercial |
$646.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.73
|
| Rate for Payer: Nomi Health Commercial |
$589.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$538.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.29
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$32.62 |
| Max. Negotiated Rate |
$88.16 |
| Rate for Payer: Aetna Commercial |
$79.34
|
| Rate for Payer: Aetna Medicare |
$32.62
|
| Rate for Payer: ASR ASR |
$85.52
|
| Rate for Payer: BCBS Complete |
$35.26
|
| Rate for Payer: BCBS Trust/PPO |
$72.69
|
| Rate for Payer: BCN Commercial |
$72.69
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$82.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$85.52
|
| Rate for Payer: Healthscope Whirlpool |
$88.16
|
| Rate for Payer: Mclaren Commercial |
$79.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Nomi Health Commercial |
$72.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$61.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.58
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
IP
|
$88.16
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$88.16 |
| Rate for Payer: Aetna Commercial |
$79.34
|
| Rate for Payer: ASR ASR |
$85.52
|
| Rate for Payer: BCBS Trust/PPO |
$72.40
|
| Rate for Payer: BCN Commercial |
$72.40
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$82.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$85.52
|
| Rate for Payer: Healthscope Whirlpool |
$88.16
|
| Rate for Payer: Mclaren Commercial |
$79.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Nomi Health Commercial |
$72.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.58
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.87 |
| Max. Negotiated Rate |
$59.82 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: ASR ASR |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$49.12
|
| Rate for Payer: BCN Commercial |
$49.12
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$58.03
|
| Rate for Payer: Healthscope Whirlpool |
$59.82
|
| Rate for Payer: Mclaren Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.64
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$59.82 |
| Rate for Payer: Aetna Commercial |
$53.84
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.35
|
| Rate for Payer: ASR ASR |
$58.03
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$49.32
|
| Rate for Payer: BCN Commercial |
$49.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$58.03
|
| Rate for Payer: Healthscope Whirlpool |
$59.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.48
|
| Rate for Payer: Mclaren Commercial |
$53.84
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Mclaren Medicare |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.85
|
| Rate for Payer: Meridian Medicaid |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PACE Medicare |
$7.11
|
| Rate for Payer: PACE SWMI |
$7.48
|
| Rate for Payer: PHP Commercial |
$8.23
|
| Rate for Payer: PHP Medicaid |
$4.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.01
|
| Rate for Payer: Priority Health Medicare |
$7.48
|
| Rate for Payer: Priority Health Narrow Network |
$18.40
|
| Rate for Payer: Railroad Medicare Medicare |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.48
|
| Rate for Payer: UHC Exchange |
$11.59
|
| Rate for Payer: UHC Medicaid |
$3.91
|
| Rate for Payer: UHCCP DNSP |
$7.48
|
| Rate for Payer: UHCCP Medicaid |
$3.91
|
| Rate for Payer: VA VA |
$7.48
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
IP
|
$33.43
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$30.09
|
| Rate for Payer: ASR ASR |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.45
|
| Rate for Payer: BCN Commercial |
$27.45
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.74
|
| Rate for Payer: Healthscope Commercial |
$32.43
|
| Rate for Payer: Healthscope Whirlpool |
$33.43
|
| Rate for Payer: Mclaren Commercial |
$30.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.42
|
| Rate for Payer: Nomi Health Commercial |
$27.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.42
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
OP
|
$33.43
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$30.09
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: ASR ASR |
$32.43
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.56
|
| Rate for Payer: BCN Commercial |
$27.56
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$32.43
|
| Rate for Payer: Healthscope Whirlpool |
$33.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$30.09
|
| Rate for Payer: Mclaren Medicaid |
$4.75
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$2.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.42
|
| Rate for Payer: Nomi Health Commercial |
$27.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.07
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.22
|
| Rate for Payer: PHP Medicaid |
$2.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.29
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$23.43
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.36
|
| Rate for Payer: UHC Medicaid |
$2.48
|
| Rate for Payer: UHCCP DNSP |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.48
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC SUSCEPTIBILITY, MIC
|
Facility
|
OP
|
$82.19
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$82.19 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| Rate for Payer: Aetna Medicare |
$8.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.81
|
| Rate for Payer: ASR ASR |
$79.72
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$8.65
|
| Rate for Payer: BCBS Trust/PPO |
$67.77
|
| Rate for Payer: BCN Commercial |
$67.77
|
| Rate for Payer: BCN Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.65
|
| Rate for Payer: Healthscope Commercial |
$79.72
|
| Rate for Payer: Healthscope Whirlpool |
$82.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.65
|
| Rate for Payer: Mclaren Commercial |
$73.97
|
| Rate for Payer: Mclaren Medicaid |
$8.65
|
| Rate for Payer: Mclaren Medicare |
$8.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.08
|
| Rate for Payer: Meridian Medicaid |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$67.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.64
|
| Rate for Payer: PACE Medicare |
$8.22
|
| Rate for Payer: PACE SWMI |
$8.65
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Medicaid |
$4.64
|
| Rate for Payer: PHP Medicare Advantage |
$8.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$8.65
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.65
|
| Rate for Payer: UHC Exchange |
$13.41
|
| Rate for Payer: UHC Medicaid |
$4.52
|
| Rate for Payer: UHCCP DNSP |
$8.65
|
| Rate for Payer: UHCCP Medicaid |
$4.52
|
| Rate for Payer: VA VA |
$8.65
|
|
