|
HC STACLOT LA.
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$148.92 |
| Rate for Payer: Aetna Commercial |
$134.03
|
| Rate for Payer: ASR ASR |
$144.45
|
| Rate for Payer: ASR Commercial |
$144.45
|
| Rate for Payer: BCBS Trust/PPO |
$121.35
|
| Rate for Payer: BCN Commercial |
$115.46
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$139.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$148.92
|
| Rate for Payer: Healthscope Whirlpool |
$144.45
|
| Rate for Payer: Mclaren Commercial |
$134.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.05
|
|
|
HC STACLOT LA.
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$148.92 |
| Rate for Payer: Aetna Commercial |
$134.03
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: ASR ASR |
$144.45
|
| Rate for Payer: ASR Commercial |
$144.45
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$121.95
|
| Rate for Payer: BCN Commercial |
$115.46
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$139.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$148.92
|
| Rate for Payer: Healthscope Whirlpool |
$144.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.98
|
| Rate for Payer: Mclaren Commercial |
$134.03
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Medicaid |
$9.64
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.48
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$104.39
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$27.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP DNSP |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$9.64
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
IP
|
$2,417.64
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,571.47 |
| Max. Negotiated Rate |
$2,417.64 |
| Rate for Payer: Aetna Commercial |
$2,175.88
|
| Rate for Payer: ASR ASR |
$2,345.11
|
| Rate for Payer: ASR Commercial |
$2,345.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,970.13
|
| Rate for Payer: BCN Commercial |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,934.11
|
| Rate for Payer: Cofinity Commercial |
$2,272.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.11
|
| Rate for Payer: Healthscope Commercial |
$2,417.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,345.11
|
| Rate for Payer: Mclaren Commercial |
$2,175.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.99
|
| Rate for Payer: Nomi Health Commercial |
$1,982.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,127.52
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
OP
|
$2,417.64
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$967.06 |
| Max. Negotiated Rate |
$2,417.64 |
| Rate for Payer: Aetna Commercial |
$2,175.88
|
| Rate for Payer: Aetna Medicare |
$1,208.82
|
| Rate for Payer: ASR ASR |
$2,345.11
|
| Rate for Payer: ASR Commercial |
$2,345.11
|
| Rate for Payer: BCBS Complete |
$967.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.81
|
| Rate for Payer: BCN Commercial |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,934.11
|
| Rate for Payer: Cofinity Commercial |
$2,272.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.11
|
| Rate for Payer: Healthscope Commercial |
$2,417.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,345.11
|
| Rate for Payer: Mclaren Commercial |
$2,175.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.99
|
| Rate for Payer: Nomi Health Commercial |
$1,982.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,118.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,694.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,127.52
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: ASR Commercial |
$54.42
|
| Rate for Payer: BCBS Trust/PPO |
$45.72
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.69
|
| Rate for Payer: Nomi Health Commercial |
$46.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: ASR Commercial |
$54.42
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$45.94
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.69
|
| Rate for Payer: Nomi Health Commercial |
$46.00
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.15
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$39.33
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
IP
|
$61.69
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.10 |
| Max. Negotiated Rate |
$61.69 |
| Rate for Payer: Aetna Commercial |
$55.52
|
| Rate for Payer: ASR ASR |
$59.84
|
| Rate for Payer: ASR Commercial |
$59.84
|
| Rate for Payer: BCBS Trust/PPO |
$50.27
|
| Rate for Payer: BCN Commercial |
$47.83
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$57.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$61.69
|
| Rate for Payer: Healthscope Whirlpool |
$59.84
|
| Rate for Payer: Mclaren Commercial |
$55.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.29
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
OP
|
$61.69
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$61.69 |
| Rate for Payer: Aetna Commercial |
$55.52
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$59.84
|
| Rate for Payer: ASR Commercial |
$59.84
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$50.52
|
| Rate for Payer: BCN Commercial |
$47.83
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$57.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$61.69
|
| Rate for Payer: Healthscope Whirlpool |
$59.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$55.52
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.05
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$43.24
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$143.69
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$143.69 |
| Rate for Payer: Aetna Commercial |
$129.32
|
| Rate for Payer: Aetna Medicare |
$71.84
|
| Rate for Payer: ASR ASR |
$139.38
|
| Rate for Payer: ASR Commercial |
$139.38
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$117.67
|
| Rate for Payer: BCN Commercial |
$111.40
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$135.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Healthscope Commercial |
$143.69
|
| Rate for Payer: Healthscope Whirlpool |
$139.38
|
| Rate for Payer: Mclaren Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.14
|
| Rate for Payer: Nomi Health Commercial |
$117.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.90
|
| Rate for Payer: Priority Health Narrow Network |
$100.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.45
|
|
|
HC STATLOCK
|
Facility
|
IP
|
$143.69
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$143.69 |
| Rate for Payer: Aetna Commercial |
$129.32
|
| Rate for Payer: ASR ASR |
$139.38
|
| Rate for Payer: ASR Commercial |
$139.38
|
| Rate for Payer: BCBS Trust/PPO |
$117.09
|
| Rate for Payer: BCN Commercial |
$111.40
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$135.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Healthscope Commercial |
$143.69
|
| Rate for Payer: Healthscope Whirlpool |
$139.38
|
| Rate for Payer: Mclaren Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.14
|
| Rate for Payer: Nomi Health Commercial |
$117.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.45
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: ASR ASR |
$33.64
|
| Rate for Payer: ASR Commercial |
$33.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.26
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$32.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$34.68
|
| Rate for Payer: Healthscope Whirlpool |
$33.64
|
| Rate for Payer: Mclaren Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$33.64
|
| Rate for Payer: ASR Commercial |
$33.64
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$32.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$34.68
|
| Rate for Payer: Healthscope Whirlpool |
$33.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.39
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$24.31
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,449.42
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$1,449.42 |
| Rate for Payer: Aetna Commercial |
$1,304.48
|
| Rate for Payer: ASR ASR |
$1,405.94
|
| Rate for Payer: ASR Commercial |
$1,405.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.13
|
| Rate for Payer: BCN Commercial |
$1,123.74
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cofinity Commercial |
$1,362.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.54
|
| Rate for Payer: Healthscope Commercial |
$1,449.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,405.94
|
| Rate for Payer: Mclaren Commercial |
$1,304.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.01
|
| Rate for Payer: Nomi Health Commercial |
$1,188.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.49
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,449.42
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,449.42 |
| Rate for Payer: Aetna Commercial |
$1,304.48
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$1,405.94
|
| Rate for Payer: ASR Commercial |
$1,405.94
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.93
|
| Rate for Payer: BCN Commercial |
$1,123.74
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cofinity Commercial |
$1,362.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,449.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,405.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$1,304.48
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.01
|
| Rate for Payer: Nomi Health Commercial |
$1,188.52
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.98
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,016.04
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC STENT
|
Facility
|
OP
|
$953.16
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.26 |
| Max. Negotiated Rate |
$953.16 |
| Rate for Payer: Aetna Commercial |
$857.84
|
| Rate for Payer: Aetna Medicare |
$476.58
|
| Rate for Payer: ASR ASR |
$924.57
|
| Rate for Payer: ASR Commercial |
$924.57
|
| Rate for Payer: BCBS Complete |
$381.26
|
| Rate for Payer: BCBS Trust/PPO |
$780.54
|
| Rate for Payer: BCN Commercial |
$738.98
|
| Rate for Payer: Cash Price |
$762.53
|
| Rate for Payer: Cofinity Commercial |
$895.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.53
|
| Rate for Payer: Healthscope Commercial |
$953.16
|
| Rate for Payer: Healthscope Whirlpool |
$924.57
|
| Rate for Payer: Mclaren Commercial |
$857.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.19
|
| Rate for Payer: Nomi Health Commercial |
$781.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.16
|
| Rate for Payer: Priority Health Narrow Network |
$668.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.78
|
|
|
HC STENT
|
Facility
|
IP
|
$953.16
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.55 |
| Max. Negotiated Rate |
$953.16 |
| Rate for Payer: Aetna Commercial |
$857.84
|
| Rate for Payer: ASR ASR |
$924.57
|
| Rate for Payer: ASR Commercial |
$924.57
|
| Rate for Payer: BCBS Trust/PPO |
$776.73
|
| Rate for Payer: BCN Commercial |
$738.98
|
| Rate for Payer: Cash Price |
$762.53
|
| Rate for Payer: Cofinity Commercial |
$895.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.53
|
| Rate for Payer: Healthscope Commercial |
$953.16
|
| Rate for Payer: Healthscope Whirlpool |
$924.57
|
| Rate for Payer: Mclaren Commercial |
$857.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.19
|
| Rate for Payer: Nomi Health Commercial |
$781.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.78
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$17,010.57
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,056.87 |
| Max. Negotiated Rate |
$17,010.57 |
| Rate for Payer: Aetna Commercial |
$15,309.51
|
| Rate for Payer: ASR ASR |
$16,500.25
|
| Rate for Payer: ASR Commercial |
$16,500.25
|
| Rate for Payer: BCBS Trust/PPO |
$13,861.91
|
| Rate for Payer: BCN Commercial |
$13,188.29
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$15,989.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$17,010.57
|
| Rate for Payer: Healthscope Whirlpool |
$16,500.25
|
| Rate for Payer: Mclaren Commercial |
$15,309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,969.30
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$17,010.57
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,804.23 |
| Max. Negotiated Rate |
$17,010.57 |
| Rate for Payer: Aetna Commercial |
$15,309.51
|
| Rate for Payer: Aetna Medicare |
$8,505.28
|
| Rate for Payer: ASR ASR |
$16,500.25
|
| Rate for Payer: ASR Commercial |
$16,500.25
|
| Rate for Payer: BCBS Complete |
$6,804.23
|
| Rate for Payer: BCBS Trust/PPO |
$13,929.96
|
| Rate for Payer: BCN Commercial |
$13,188.29
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$15,989.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$17,010.57
|
| Rate for Payer: Healthscope Whirlpool |
$16,500.25
|
| Rate for Payer: Mclaren Commercial |
$15,309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,904.66
|
| Rate for Payer: Priority Health Narrow Network |
$11,924.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,969.30
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$11,875.31
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,718.95 |
| Max. Negotiated Rate |
$11,875.31 |
| Rate for Payer: Aetna Commercial |
$10,687.78
|
| Rate for Payer: ASR ASR |
$11,519.05
|
| Rate for Payer: ASR Commercial |
$11,519.05
|
| Rate for Payer: BCBS Trust/PPO |
$9,677.19
|
| Rate for Payer: BCN Commercial |
$9,206.93
|
| Rate for Payer: Cash Price |
$9,500.25
|
| Rate for Payer: Cofinity Commercial |
$11,162.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,500.25
|
| Rate for Payer: Healthscope Commercial |
$11,875.31
|
| Rate for Payer: Healthscope Whirlpool |
$11,519.05
|
| Rate for Payer: Mclaren Commercial |
$10,687.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,094.01
|
| Rate for Payer: Nomi Health Commercial |
$9,737.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,718.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,450.27
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$11,875.31
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,750.12 |
| Max. Negotiated Rate |
$11,875.31 |
| Rate for Payer: Aetna Commercial |
$10,687.78
|
| Rate for Payer: Aetna Medicare |
$5,937.65
|
| Rate for Payer: ASR ASR |
$11,519.05
|
| Rate for Payer: ASR Commercial |
$11,519.05
|
| Rate for Payer: BCBS Complete |
$4,750.12
|
| Rate for Payer: BCBS Trust/PPO |
$9,724.69
|
| Rate for Payer: BCN Commercial |
$9,206.93
|
| Rate for Payer: Cash Price |
$9,500.25
|
| Rate for Payer: Cofinity Commercial |
$11,162.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,500.25
|
| Rate for Payer: Healthscope Commercial |
$11,875.31
|
| Rate for Payer: Healthscope Whirlpool |
$11,519.05
|
| Rate for Payer: Mclaren Commercial |
$10,687.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,094.01
|
| Rate for Payer: Nomi Health Commercial |
$9,737.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,718.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,405.15
|
| Rate for Payer: Priority Health Narrow Network |
$8,324.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,450.27
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.96 |
| Max. Negotiated Rate |
$5,572.41 |
| Rate for Payer: Aetna Commercial |
$5,015.17
|
| Rate for Payer: Aetna Medicare |
$2,786.20
|
| Rate for Payer: ASR ASR |
$5,405.24
|
| Rate for Payer: ASR Commercial |
$5,405.24
|
| Rate for Payer: BCBS Complete |
$2,228.96
|
| Rate for Payer: BCBS Trust/PPO |
$4,563.25
|
| Rate for Payer: BCN Commercial |
$4,320.29
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$5,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,572.41
|
| Rate for Payer: Healthscope Whirlpool |
$5,405.24
|
| Rate for Payer: Mclaren Commercial |
$5,015.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,622.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,882.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,906.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,903.72
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,622.07 |
| Max. Negotiated Rate |
$5,572.41 |
| Rate for Payer: Aetna Commercial |
$5,015.17
|
| Rate for Payer: ASR ASR |
$5,405.24
|
| Rate for Payer: ASR Commercial |
$5,405.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,540.96
|
| Rate for Payer: BCN Commercial |
$4,320.29
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$5,238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Healthscope Commercial |
$5,572.41
|
| Rate for Payer: Healthscope Whirlpool |
$5,405.24
|
| Rate for Payer: Mclaren Commercial |
$5,015.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,622.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,903.72
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.79 |
| Max. Negotiated Rate |
$6,476.98 |
| Rate for Payer: Aetna Commercial |
$5,829.28
|
| Rate for Payer: Aetna Medicare |
$3,238.49
|
| Rate for Payer: ASR ASR |
$6,282.67
|
| Rate for Payer: ASR Commercial |
$6,282.67
|
| Rate for Payer: BCBS Complete |
$2,590.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,304.00
|
| Rate for Payer: BCN Commercial |
$5,021.60
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$6,088.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$6,476.98
|
| Rate for Payer: Healthscope Whirlpool |
$6,282.67
|
| Rate for Payer: Mclaren Commercial |
$5,829.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,675.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,540.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,699.74
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,210.04 |
| Max. Negotiated Rate |
$6,476.98 |
| Rate for Payer: Aetna Commercial |
$5,829.28
|
| Rate for Payer: ASR ASR |
$6,282.67
|
| Rate for Payer: ASR Commercial |
$6,282.67
|
| Rate for Payer: BCBS Trust/PPO |
$5,278.09
|
| Rate for Payer: BCN Commercial |
$5,021.60
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$6,088.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$6,476.98
|
| Rate for Payer: Healthscope Whirlpool |
$6,282.67
|
| Rate for Payer: Mclaren Commercial |
$5,829.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,699.74
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,509.94 |
| Max. Negotiated Rate |
$8,774.84 |
| Rate for Payer: Aetna Commercial |
$7,897.36
|
| Rate for Payer: Aetna Medicare |
$4,387.42
|
| Rate for Payer: ASR ASR |
$8,511.59
|
| Rate for Payer: ASR Commercial |
$8,511.59
|
| Rate for Payer: BCBS Complete |
$3,509.94
|
| Rate for Payer: BCBS Trust/PPO |
$7,185.72
|
| Rate for Payer: BCN Commercial |
$6,803.13
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$8,248.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$8,774.84
|
| Rate for Payer: Healthscope Whirlpool |
$8,511.59
|
| Rate for Payer: Mclaren Commercial |
$7,897.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,688.51
|
| Rate for Payer: Priority Health Narrow Network |
$6,151.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,721.86
|
|
